Sonino N, Girelli M E, Boscaro M, Fallo F, Busnardo B, Fava G A
Institute of Semeiotica Medica, University of Padova, Italy.
Acta Endocrinol (Copenh). 1993 Apr;128(4):293-6. doi: 10.1530/acta.0.1280293.
Contradictory findings have been reported about a possible causal relationship of life stress to Graves' disease. We evaluated this issue by investigating the occurrence of stressful life events in the year before the first signs of disease onset, using methods that have been found to be valid and reliable in psychosomatic research. Seventy consecutive patients with Graves' disease and a control group of 70 healthy subjects, matched for sociodemographic variables, were studied. Paykel's Interview for Recent Life Events (a semistructured research interview covering 64 life events) was administered to patients, not during the acute phase of illness but while on remission, by antithyroid drug treatment. Patients with Graves' disease reported significantly more life events compared to controls (p < 0.001). They also had more independent events (p < 0.001) and events that had an objective negative impact (p < 0.001) according to an independent rater, unaware whether the events had occurred in patients or controls. All categories of events were found to be significantly more frequent in patients suffering from Graves' disease than in controls. By rigorous methods (inclusion of patients with Graves' disease only, careful dating of the onset of symptoms, accurate event definition, delay of the interview upon disease remission, use of a blind rater for judging independence and objective negative impact), our results support the concept of an excess of life events in Graves' disease. Stressful life events may affect the regulatory mechanisms of immune function in a number of ways. Within the extreme complexity of the phenomena implicated in the pathogenesis of autoimmune thyroid hyperfunction, our findings emphasize the role of emotional stress.
关于生活压力与格雷夫斯病之间可能的因果关系，已有相互矛盾的研究结果报道。我们通过调查疾病首次出现症状前一年中应激性生活事件的发生情况来评估这一问题，采用的方法在身心医学研究中已被证明是有效且可靠的。我们研究了连续70例格雷夫斯病患者以及70名健康对照者，后者在社会人口统计学变量方面与患者相匹配。对患者进行了佩克尔近期生活事件访谈（一种涵盖64项生活事件的半结构化研究访谈），访谈并非在疾病急性期进行，而是在通过抗甲状腺药物治疗病情缓解期间进行。与对照组相比，格雷夫斯病患者报告的生活事件显著更多（p < 0.001）。根据一名不知情事件发生在患者还是对照者身上的独立评估者判断，他们还有更多独立事件（p < 0.001）以及具有客观负面影响的事件（p < 0.001）。发现格雷夫斯病患者各类事件的发生频率均显著高于对照组。通过严格的方法（仅纳入格雷夫斯病患者、仔细确定症状出现的日期、准确界定事件、在疾病缓解后延迟访谈、使用盲法评估者判断独立性和客观负面影响），我们的结果支持格雷夫斯病中生活事件过多这一概念。应激性生活事件可能通过多种方式影响免疫功能的调节机制。在自身免疫性甲状腺功能亢进发病机制所涉及的极其复杂的现象中，我们的发现强调了情绪应激的作用。
