Yaseen Sahar, Morgan Rawan, Yaseen Reem, Zohd Jihad, Salhab Ahmad, Amer Johnny, Hanani Ahmad A
Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
Department of Anesthesiology, An-Najah National University Hospital, Nablus, 44839, Palestine.
Sci Rep. 2025 Jul 19;15(1):26253. doi: 10.1038/s41598-025-01869-4.
Stress is a normal human physiological reaction that can unfavorably affect the body, such as cardiac and immunological disturbances. Several articles have shown how stress can affect the immune status. This study was designed to assess the impact of stress on the immune system using the WBC count as an indicator of immune status in the human body. In a tertiary care teaching hospital, a prospective observational study was carried out with a total of 309 samples collected; two complete blood counts were observed for each patient, one at the anesthesia clinic one week before the surgery and the other on the day of the surgery immediately following the beginning of the surgery; and each patient answered a Hospital Anxiety Depression Scale form just before presenting to the operating room for stress level assessment. Representative serum samples from patients with and without anxiety were assessed for proinflammatory and anti-inflammatory profiles via ELISA. In our study of 309 patients, 31.4% experienced stress, with the majority being females. Age did not significantly impact stress levels, but preoperative preparation and information gathering were significantly related to stress (P value.05), as the mean stress was highest among those using online searching as their primary source of information. The difference in immune mediators (WBCs, lymphocytes, and neutrophils) before and on the day of surgery was correlated with stress, with WBCs and lymphocytes showing a statistically significant decrease in P values (0.019, 0.016). In contrast, neutrophils increased acutely (P value.006). A total of 71.4% of patients suffering from postoperative complications were stressed before the procedures, with a strong association (P value of 0.003). In addition, the levels of the proinflammatory cytokines IL-1b, IL-6, TNF-a, and IL-2 were significantly increased by 4-, 10-, 2-, and 3-fold, respectively, in the sera of participants who were anxious compared with those who had no anxiety. Stress is associated with decreased WBCs and lymphocytes, and increased neutrophils. Therefore, stress should be considered a modifiable preoperative risk factor. Incorporating psychological assessments in anesthesia clinics may help identify and manage patients with high anxiety. The use of anxiolytics could be considered in selected cases, pending further evaluation of evidence.
压力是一种正常的人体生理反应，可能会对身体产生不利影响，如心脏和免疫紊乱。几篇文章已经表明压力如何影响免疫状态。本研究旨在以白细胞计数作为人体免疫状态指标，评估压力对免疫系统的影响。在一家三级护理教学医院进行了一项前瞻性观察研究，共收集了309份样本；对每位患者进行了两次全血细胞计数，一次在手术前一周的麻醉诊所，另一次在手术当天手术开始后立即进行；每位患者在进入手术室前填写一份医院焦虑抑郁量表以评估压力水平。通过酶联免疫吸附测定法对有焦虑和无焦虑患者的代表性血清样本进行促炎和抗炎特征评估。在我们对309名患者的研究中，31.4%的患者经历了压力，其中大多数为女性。年龄对压力水平没有显著影响，但术前准备和信息收集与压力显著相关（P值<0.05），因为以在线搜索作为主要信息来源的患者平均压力最高。手术前和手术当天免疫介质（白细胞、淋巴细胞和中性粒细胞）的差异与压力相关，白细胞和淋巴细胞的P值显示出统计学上的显著下降（0.019，0.016）。相比之下，中性粒细胞急剧增加（P值<0.006）。共有71.4%的术后并发症患者在手术前有压力，两者之间存在强烈关联（P值为0.003）。此外，与无焦虑的参与者相比，焦虑参与者血清中的促炎细胞因子白细胞介素-1β、白细胞介素-6、肿瘤坏死因子-α和白细胞介素-2水平分别显著升高了4倍、10倍、2倍和3倍。压力与白细胞和淋巴细胞减少以及中性粒细胞增加有关。因此，应将压力视为一种可改变的术前风险因素。在麻醉诊所纳入心理评估可能有助于识别和管理高焦虑患者。在进一步评估证据之前，可考虑在特定病例中使用抗焦虑药。
