Department of Dermatovenerology, Karlovac General Hospital, Karlovac, Croatia.
University of Zagreb, School of Medicine, Andrija Stampar School of Public Health, Department for Environmental Health, Occupational and Sports Medicine, Zagreb, Croatia.
Clin Ther. 2020 May;42(5):783-799. doi: 10.1016/j.clinthera.2020.03.017. Epub 2020 Apr 25.
Because the results of studies investigating the relation between human papilloma virus (HPV) infection and the effects of psychological stress are inconsistent, this study was conducted to expand on previous research by analyzing patient stress levels, serum immune parameters, and cortisol levels in patients with clinical HPV manifestations. It also looked for differences in clinical manifestations of HPV depending on patient level of experienced stress.
This cross-sectional study included 213 subjects (94 women and 119 men aged ≥18 years; average age, 41 years) with clinical manifestations of HPV infection (165 subjects with extragenital manifestations and 48 with genital manifestations) who were treated at the Department of Dermatovenerology, Karlovac General Hospital, from January 1, 2012, to December 31, 2015. Psychological, neurohormonal and immune parameters (serum values of leukocytes, alpha-globulins, beta-globulins, albumins, and proteins), and serum cortisol levels were analyzed. Questionnaires were used to determine patients' perception of stress: the Recent Life Changes Questionnaire, the Perceived Stress Scale, and the Brief Cope Test. One group of subjects had confirmed stressful experiences, defined by the Recent Life Changes Questionnaire as a period of 1 year with at least 500 life change units; the control group included patients with no significant stressful experiences.
Patients with confirmed significant stress experience had a statistically significant higher degree of perception of stress. There were no statistically significant differences in terms of the impact of stress on clinical HPV manifestations (genital and extragenital), sex, lesional duration, or recurrence. In patients with significant stress experience, significantly higher values of leukocytes (6.68 × 10/L), alpha-globulins (6.85 g/L), and beta-globulins (7.33 g/L) were observed. Adaptive coping and a lower perception of stress significantly reduced the chances of having extragenital manifestations by 2.63 times. A higher perception of stress significantly increased the likelihood of genital manifestations.
Although this study found that stress increased the values of leukocytes, alpha-globulins, and beta-globulins, no evidence was found that it affected clinical manifestations of HPV infection. The redundancy of the immune system could account for this finding. This study is among the first to investigate the correlation between psychological, neurohormonal, and immune indicators of stress.
由于研究 HPV 感染与心理压力影响之间关系的结果不一致，因此进行本项研究以扩展先前的研究，分析有临床 HPV 表现的患者的应激水平、血清免疫参数和皮质醇水平，并寻找患者应激水平不同与 HPV 临床表现之间的差异。
本横断面研究纳入了 213 名（94 名女性和 119 名男性，年龄≥18 岁；平均年龄 41 岁）有 HPV 感染临床表现的患者（165 名有外阴表现，48 名有生殖器表现），他们于 2012 年 1 月 1 日至 2015 年 12 月 31 日在 Karlovac 总医院皮肤科接受治疗。分析了心理、神经激素和免疫参数（白细胞、α-球蛋白、β-球蛋白、白蛋白和蛋白质的血清值）以及血清皮质醇水平。采用问卷确定患者的应激感知：近期生活变化问卷、感知压力量表和简要应对测试。一组患者有确认的应激经历，近期生活变化问卷将 1 年内至少 500 个生活变化单位定义为应激经历；对照组为无明显应激经历的患者。
有确认的显著应激经历的患者在应激感知方面具有统计学意义上更高的程度。应激对临床 HPV 表现（生殖器和外阴）、性别、皮损持续时间或复发无统计学意义上的影响。在有显著应激经历的患者中，观察到白细胞（6.68×10/L）、α-球蛋白（6.85g/L）和β-球蛋白（7.33g/L）的数值显著更高。适应性应对和较低的应激感知使外阴表现的发生几率降低 2.63 倍。较高的应激感知显著增加了生殖器表现的可能性。
尽管本研究发现应激增加了白细胞、α-球蛋白和β-球蛋白的值，但没有证据表明它会影响 HPV 感染的临床表现。免疫系统的冗余可以解释这一发现。本研究是首次调查心理、神经激素和应激免疫指标之间相关性的研究之一。
