Lowry Chloe A, Jin Albert Y
Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
Department of Medicine, Queen's University, Kingston, ON, Canada.
Front Neurol. 2020 May 14;11:427. doi: 10.3389/fneur.2020.00427. eCollection 2020.
The outcome of ischemic stroke varies across socioeconomic strata, even among countries with universal health care. Emerging evidence suggests that psychosocial aspects of low socioeconomic status such as social isolation and social defeat stress interact with, and contribute to, stroke pathophysiology. However, experimental investigations of stroke rarely account for such socioeconomic influences. Social isolation in stroke survivors is associated with increased infarction volume, increased risk of post-stroke depression, and worse long-term functional outcome. Social defeat is thought to contribute significantly to chronic stress in low socioeconomic status groups and is associated with poor health outcomes. Chronic stress is also associated with worse post-stroke functional outcome and greater disability even after accounting for stroke severity, vascular risk factors, and access to acute stroke care. Experimental stroke studies which incorporate social isolation or social defeat stress have shown that both tissue and functional stroke outcome is affected by the increased expression of TNF-α and IL-6, increased glucocorticoid production, and suppression of the protooncogene . This review explores the consequences of social isolation and social defeat stress on stroke, preclinical stroke models that have been used to investigate these factors, and possible molecular mechanisms underlying the influence of socioeconomic disparities on stroke outcome.
缺血性中风的预后在不同社会经济阶层中存在差异，即使在实行全民医保的国家也是如此。新出现的证据表明，社会经济地位低下的心理社会因素，如社会隔离和社会挫败压力，与中风病理生理学相互作用并促成其发展。然而，中风的实验研究很少考虑到这种社会经济影响。中风幸存者的社会隔离与梗死体积增加、中风后抑郁风险增加以及长期功能预后较差有关。社会挫败被认为是社会经济地位低下群体慢性应激的重要因素，并且与不良健康结果相关。即使在考虑了中风严重程度、血管危险因素和急性中风护理可及性之后，慢性应激也与中风后功能预后较差和残疾程度加重有关。纳入社会隔离或社会挫败压力的实验性中风研究表明，组织和功能性中风预后均受到肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）表达增加、糖皮质激素产生增加以及原癌基因抑制的影响。本综述探讨了社会隔离和社会挫败压力对中风的影响、用于研究这些因素的临床前中风模型，以及社会经济差异对中风预后影响的潜在分子机制。
