Hodel L, Grob P J
Departement für Innere Medizin, Universitätsspital Zürich.
Schweiz Med Wochenschr. 1993 Dec 11;123(49):2323-41.
In the new field of psychoneuroimmunology essential ground has already been broken. Precisely in man, however, only hypotheses are possible in important areas: one that is commonly voiced is that stress weakens the immune system and would favour the onset of disease. A situation report is presented which summarizes, classifies and compares all 67 published studies relating psychic influences to immunologic factors in healthy human beings. A notable proportion turned out to be doubtful from the formal standpoint, e.g. no controls (40 publications) or with fewer than 30 probands (19). In 13 of these studies neuroendocrinologic parameters were taken into account and in 14 biological (health/disease) parameters. 42 studies were based on "externally defined" stress situations (partner loss, examinations, care of severely ill family members, space shuttle mission, etc.), 16 on specific personality traits and 9 on experimental stress situations or relaxation efforts. Since the studies varied widely in design, psychic starting position, psychic assessment (91 different methods) and immunity (68 varying parameters) and also in regard to the biological result (various "endpoints" of health/disease), only a few general conclusions can be drawn. Subjective or objective stress can be associated with diminished lymphocyte functions such as reduced mitogen stimulation and natural killer cell activity, elevated antibody titers against some latent and/or ubiquitous viruses, and reduced immunoglobulin A in saliva. This is confirmed to varying degrees, usually on a shortterm basis and not in all studies. Others contain evidence that the immunologic changes mentioned may be associated with particular personality traits (anxiety, depression, loneliness, good coping, power motive syndrome, social support, etc.). What the immunologic changes had in common was that they moved within a relatively narrow range and overstepped the norm little or only marginally. Whether the immunologic "anomalies" observed reflect a weakened immune system or an adequate "homeostatic" immune modulation by psychic signals, or point to adequate immune defence in an altered "antigen situation" arising from a changed lifestyle in stress situations, cannot be said. There is little evidence of a relationship to disease onset. While the present review shows certain relationships between psychic and immunologic factors, their biological relevance remains unclear. The often voiced hypothesis that stress weakens the immune system and a larger number of diseases therefore ensue cannot be confirmed or denied by the available data. The results permit other, contradictory hypotheses.
在心理神经免疫学这一新领域，已经取得了重要的突破。然而，恰恰在人类身上，在一些重要领域只能提出假说：一种常见的说法是，压力会削弱免疫系统，从而助长疾病的发生。本文给出了一份情况报告，总结、分类并比较了所有67项已发表的研究，这些研究探讨了健康人群中心理影响与免疫因素之间的关系。从形式角度来看，相当一部分研究结果令人怀疑，例如没有对照组（40篇出版物）或样本量少于30名受试者（19篇）。在其中13项研究中考虑了神经内分泌参数，14项研究考虑了生物学（健康/疾病）参数。42项研究基于“外部定义”的压力情境（伴侣离世、考试、照顾重症家庭成员、航天飞机任务等），16项基于特定人格特质，9项基于实验性压力情境或放松措施。由于这些研究在设计、心理起始点、心理评估（91种不同方法）和免疫指标（68个不同参数）方面差异很大，在生物学结果（健康/疾病的各种“终点”）方面也各不相同，因此只能得出一些一般性结论。主观或客观压力可能与淋巴细胞功能减退有关，如丝裂原刺激反应降低和自然杀伤细胞活性降低、针对某些潜伏和/或普遍存在病毒的抗体滴度升高以及唾液中免疫球蛋白A降低。这在不同程度上得到了证实，通常是短期的，并非所有研究都如此。其他研究则表明，上述免疫变化可能与特定人格特质（焦虑、抑郁、孤独、良好应对方式、权力动机综合征、社会支持等）有关。这些免疫变化的共同之处在于，它们都在相对较窄的范围内波动，很少或只是略微超出正常范围。观察到的免疫“异常”是反映免疫系统减弱、心理信号对免疫进行适当的“稳态”调节，还是表明在压力情境下生活方式改变导致的“抗原情境”改变中免疫防御充分，目前尚无法确定。几乎没有证据表明其与疾病发生有关。虽然本综述显示了心理因素与免疫因素之间的某些关系，但其生物学相关性仍不明确。压力会削弱免疫系统，进而引发更多疾病这一常被提及的假说，现有数据既无法证实也无法否认。这些结果也支持其他相互矛盾的假说。
