Roland von Känel, MD, Professor of Psychosomatic and Psychosocial Medicine, Department of General Internal Medicine, Inselspital, Bern University Hospital, CH-3010 Bern, Switzerland, Tel.: +41 31 632 20 19, Fax: +41 31 382 11 84, E-mail:
Thromb Haemost. 2013 Nov;110(5):977-86. doi: 10.1160/TH13-05-0383. Epub 2013 Aug 22.
The risk of cardiovascular disease is dramatically increasing in Africans (black). The prothrombotic stress response contributes to atherothrombotic disease and is modulated by depressive symptoms. We examined coagulation reactivity to acute mental stress and its relation to psychological well-being in Africans relative to Caucasians (white). A total of 102 African and 165 Caucasian school teachers underwent the Stroop Color-Word Conflict test. Circulating levels of von Willebrand factor (VWF) antigen, fibrinogen, and D-dimer were measured before and after the Stroop. Cardiovascular reactivity measures were also obtained. All participants completed the Patient Health Questionnaire-9 and the General Health Questionnaire-28 for the assessment of depressive symptoms and total psychological distress, respectively. After controlling for covariates, resting levels of VWF, fibrinogen, and D-dimer were higher in Africans than in Caucasians (all p-values ≤0.006). Depressive symptoms and psychological distress were not significantly associated with resting coagulation measures. Stress reactivity in VWF (p<0.001) and fibrinogen (p=0.016), but not in D-dimer (p=0.27), were decreased in Africans relative to Caucasians with Africans showing greater reactivity of total peripheral resistance (p=0.017). Depressive symptoms, but not general psychological distress, were associated with greater VWF increase (p=0.029) and greater fibrinogen decrease (p=0.030) in Africans relative to Caucasians. In conclusion, Africans showed greater hypercoagulability at rest but diminished procoagulant reactivity to acute mental stress when compared with Caucasians. Ethnic differences in the vascular adrenergic stress response might partially explain this finding. Depressive symptoms were associated with exaggerated VWF reactivity in Africans relative to Caucasians. The clinical implications of these findings for Africans need further study.
非洲人（黑人）患心血管疾病的风险显著增加。促血栓形成应激反应导致动脉粥样硬化血栓形成疾病，并受抑郁症状的调节。我们研究了急性精神应激对凝血反应的影响及其与非洲人相对于白种人（白人）的心理健康的关系。共有 102 名非洲和 165 名白种人学校教师接受了 Stroop 颜色-词语冲突测试。在 Stroop 前后测量了 von Willebrand 因子（VWF）抗原、纤维蛋白原和 D-二聚体的循环水平。还获得了心血管反应测量值。所有参与者都完成了患者健康问卷-9 和一般健康问卷-28，分别用于评估抑郁症状和总心理困扰。在控制协变量后，非洲人的 VWF、纤维蛋白原和 D-二聚体的静息水平高于白种人（所有 p 值均≤0.006）。抑郁症状和心理困扰与静息凝血测量值无显著相关性。与白种人相比，非洲人的 VWF（p<0.001）和纤维蛋白原（p=0.016）的应激反应降低，但 D-二聚体（p=0.27）没有降低，非洲人表现出更大的总外周阻力反应性（p=0.017）。与白种人相比，抑郁症状而不是一般心理困扰与非洲人 VWF 增加（p=0.029）和纤维蛋白原减少（p=0.030）更大相关。总之，与白种人相比，非洲人在静息时表现出更大的高凝状态，但对急性精神应激的促凝反应降低。血管肾上腺素应激反应的种族差异可能部分解释了这一发现。与白种人相比，抑郁症状与非洲人 VWF 反应性增强相关。这些发现对非洲人的临床意义需要进一步研究。
