Department of Psychiatry, Psychotherapy and Psychosomatics, Friedrich-Ebert-Krankenhaus, Friesenstraße 11, D-24534 Neumünster, Germany.
Institute for Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246 Hamburg; Charité Universitätsmedizin Berlin, Department of Psychiatry, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, D-12203 Berlin, Germany; Charité Universitätsmedizin Berlin, Medical Department, Section Psychosomatic Medicine, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, D-12203 Berlin, Germany.
Brain Behav Immun. 2024 Aug;120:620-629. doi: 10.1016/j.bbi.2024.06.004. Epub 2024 Jun 19.
This systematic review and meta-analysis address the evidence on the association of psychological stressors with onset of multiple sclerosis, inflammatory disease activity (relapses or new disease activity on magnetic resonance imaging, MRI) and disability progression.
PubMed was searched from 1946 to 15 July 2022. Studies and certain stressors were selected when they assessed stressors independent from stress elicited by the disease process itself. Risk of bias was assessed by the CASP Case Control Study Checklist and the CASP Cohort Study Checklist. Normal-Normal Hierarchical Model (NNHM) for random-effects meta-analysis was used in the Bayesian framework.
30 studies reporting data from 26 cohorts reporting on 24.781 cases could be identified. Ten studies addressed stressors and MS disease onset showing a weak to modest effect of psychological stressors. A meta-analysis of three studies investigating diagnosed stress disorders and MS risk showed a 1.87-fold (CI 1.061 to 3.429) increased MS risk. Stress and MS relapse risk were addressed in 19 heterogeneous studies. Meta-analyses from two independent cohorts investigating the same military threat of a population showed a threefold increased risk for relapses in association with war (relapse rate: 3.0, CI 1.56 to 5.81). In addition, two studies confirmed an association of stressful life events and MRI activity. Three studies of stressors and disease progression were included indicating some effect on disease progression.
Taken together studies indicate a minor to modest impact of psychological stressors on disease onset, inflammatory activity and progression of MS. Possible case-selection bias and lack of confounder analysis were present in many studies.
本系统评价和荟萃分析旨在探讨心理应激源与多发性硬化症发病、炎症性疾病活动（复发或磁共振成像上新的疾病活动，MRI）和残疾进展的相关性。
从 1946 年至 2022 年 7 月 15 日，在 PubMed 上进行了检索。当研究评估的应激源独立于疾病过程本身引起的应激时，选择了研究和某些应激源。使用 CASP 病例对照研究清单和 CASP 队列研究清单评估偏倚风险。在贝叶斯框架中，使用正常-正常分层模型（NNHM）进行随机效应荟萃分析。
确定了 30 项研究，这些研究报告了 26 个队列的数据，涉及 24781 例病例。10 项研究探讨了心理应激源与 MS 发病的关系，结果显示心理应激源的作用较弱至中等。三项研究调查诊断应激障碍与 MS 风险的荟萃分析显示，MS 风险增加 1.87 倍（CI 1.061 至 3.429）。19 项异质研究探讨了应激与 MS 复发风险的关系。两项独立队列研究调查同一人群的军事威胁与复发风险的关系，结果显示与战争相关的复发风险增加三倍（复发率：3.0，CI 1.56 至 5.81）。此外，两项研究证实了应激性生活事件与 MRI 活动之间的关联。三项研究探讨了应激源与疾病进展的关系，表明应激源对疾病进展有一定影响。
总的来说，这些研究表明心理应激源对 MS 的发病、炎症活动和进展有轻微至中等的影响。许多研究存在病例选择偏倚和缺乏混杂因素分析。
