Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Br J Dermatol. 2018 May;178(5):1044-1055. doi: 10.1111/bjd.16116. Epub 2018 Mar 2.
Psychological stress has long been linked with the exacerbation/onset of psoriasis.
To determine if antecedent psychological stress is associated with the exacerbation/onset of psoriasis.
A search of the PubMed, PsycINFO, Cochrane library and ClinicalTrials.gov databases was performed. Surveys evaluating beliefs about stress reactivity were analysed separately. Suitable studies were meta-analysed.
Thirty-nine studies (32 537 patients) were included: 19 surveys, seven cross-sectional studies, 12 case-control studies and one cohort study. Forty-six per cent of patients believed their disease was stress reactive and 54% recalled preceding stressful events. Case-control studies evaluating stressful events rates prior to the exacerbation (n = 6) or onset (n = 6) of psoriasis varied in time lag to recollection (≤ 9 months to ≥ 5 years). Pooling five studies evaluating stressful events preceding onset of psoriasis gave an odds ratio (OR) of 3·4 [95% confidence interval (CI) 1·8-6·4; I = 87%]; the only study evaluating a documented stress disorder diagnosis reported similar rates between patients and controls (OR 1·2, 95% CI 0·8-1·8). Four studies evaluating stressful events prior to psoriasis exacerbation reported comparable rates with controls, whereas two found more frequent/severe preceding events among patients with psoriasis. A small prospective cohort study reported a modest association between stress levels and exacerbation of psoriasis (r = 0·28, P < 0·05).
The association between preceding stress and exacerbation/onset of psoriasis is based primarily on retrospective studies with many limitations. No convincing evidence exists that preceding stress is strongly associated with exacerbation/onset of psoriasis.
心理压力与银屑病的恶化/发作长期相关。
确定先前的心理压力是否与银屑病的恶化/发作有关。
对 PubMed、PsycINFO、Cochrane 图书馆和 ClinicalTrials.gov 数据库进行了检索。分别分析了评估应激反应信念的调查。合适的研究进行了荟萃分析。
共纳入 39 项研究（32537 例患者）：19 项调查、7 项横断面研究、12 项病例对照研究和 1 项队列研究。46%的患者认为自己的疾病与应激反应有关，54%的患者回忆起之前有过应激事件。评估银屑病恶化（n=6）或发作（n=6）前应激事件发生率的病例对照研究，回忆时间的时间差差异较大（≤9 个月至≥5 年）。汇总了 5 项评估银屑病发作前应激事件的研究，得出银屑病发作前发生应激事件的比值比（OR）为 3.4[95%置信区间（CI）1.8-6.4；I=87%]；唯一评估有记录的应激障碍诊断的研究报告了患者和对照组之间的相似发生率（OR 1.2，95%CI 0.8-1.8）。四项评估银屑病恶化前应激事件的研究报告了与对照组相似的发生率，而两项研究发现银屑病患者发生了更频繁/严重的先前事件。一项小型前瞻性队列研究报告了压力水平与银屑病恶化之间的适度相关性（r=0.28，P<0.05）。
先前的压力与银屑病恶化/发作之间的关联主要基于具有许多局限性的回顾性研究。没有令人信服的证据表明先前的压力与银屑病的恶化/发作密切相关。
