Booth Joanne, Connelly Lesley, Lawrence Maggie, Chalmers Campbell, Joice Sara, Becker Clarissa, Dougall Nadine
Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
NHS Lanarkshire, Coathill Hospital, Hospital Street, Coatbridge, ML5 4DN, UK.
BMC Neurol. 2015 Nov 12;15:233. doi: 10.1186/s12883-015-0456-4.
Several studies suggest that perceived psychosocial stress is associated with increased risk of stroke; however results are inconsistent with regard to definitions and measurement of perceived stress, features of individual study design, study conduct and conclusions drawn and no meta-analysis has yet been published. We performed a systematic review and meta-analysis of studies assessing association between perceived psychosocial stress and risk of stroke in adults.The results of the meta-analysis are presented.
Systematic searches of MEDLINE, EMBASE, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews were undertaken between 1980 and June 2014. Data extraction and quality appraisal was performed by two independent reviewers. Hazard ratios (HR) and odds ratios (OR) were pooled where appropriate.
14 studies were included in the meta-analysis, 10 prospective cohort, 4 case-control design. Overall pooled adjusted effect estimate for risk of total stroke in subjects exposed to general or work stress or to stressful life events was 1.33 (95 % confidence interval [CI], 1.17, 1.50; P < 0.00001). Sub-group analyses showed perceived psychosocial stress to be associated with increased risk of fatal stroke (HR 1.45 95 % CI, 1.19,1.78; P = 0.0002), total ischaemic stroke (HR 1.40 95 % CI, 1.00,1.97; P = 0.05) and total haemorrhagic stroke (HR 1.73 95 % CI, 1.33,2.25; P > 0.0001).A sex difference was noted with higher stroke risk identified for women (HR 1.90 95 % CI, 1.4, 2.56: P < 0.0001) compared to men (HR 1.24 95 % CI, 1.12, 1.36; P < 0.0001).
Current evidence indicates that perceived psychosocial stress is independently associated with increased risk of stroke.
多项研究表明，感知到的心理社会压力与中风风险增加有关；然而，在感知压力的定义和测量、个体研究设计的特点、研究实施以及得出的结论方面，结果并不一致，且尚未发表荟萃分析。我们对评估成年人感知心理社会压力与中风风险之间关联的研究进行了系统评价和荟萃分析。现将荟萃分析结果呈现如下。
于1980年至2014年6月期间，对MEDLINE、EMBASE、CINAHL、PsycInfo以及Cochrane系统评价数据库进行了系统检索。由两名独立的评审员进行数据提取和质量评估。在适当情况下汇总风险比（HR）和比值比（OR）。
荟萃分析纳入了14项研究，其中10项为前瞻性队列研究，4项为病例对照研究。暴露于一般或工作压力或生活应激事件的受试者发生全中风风险的总体合并调整效应估计值为1.33（95%置信区间[CI]，1.17, 1.50；P < 0.00001）。亚组分析显示，感知心理社会压力与致命性中风风险增加相关（HR 1.45，95% CI，1.19, 1.78；P = 0.0002）、全缺血性中风（HR 1.40，95% CI，1.00, 1.97；P = 0.05）和全出血性中风（HR 1.73，95% CI，1.33, 2.25；P > 0.0001）。发现存在性别差异，女性中风风险高于男性（HR 1.90，95% CI，1.4, 2.56：P < 0.0001）（HR 1.24，95% CI，1.12, 1.36；P < 0.0001）。
当前证据表明，感知心理社会压力与中风风险增加独立相关。
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