Fricchione G, Bilfinger T V, Jandorf L, Smith E M, Stefano G B
Division of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Int J Cardiol. 1996 Apr 26;53 Suppl:S65-73. doi: 10.1016/0167-5273(96)02570-3.
The immunocyte behavior (conformational changes and locomotion in response to signal molecule challenge) in patients about to undergo elective cardiac surgery was studied to elucidate the effect of psychological anticipatory stress on the immune system. Granulocytes and monocytes from 10 patients and 35 non-surgical controls were examined. Computer-assisted microscopic image analysis, capable of measuring cellular conformational and velocity changes, was used to measure the responsiveness of these immunocytes to peptidergic and cytokine stimulation. Immunocyte desensitization would appear to account for the reduction in their abilities to respond to chemotaxic challenge associated with the pre-cardiac surgery state. Their abilities to respond to D-Ala2-Met-enkephalinamide (DAMA) were observed only at much higher concentrations than previously reported (10-11 M vs. 10-9 M prior to surgery). This finding, together with the observed decrease in adrenocorticotropin levels compared to non-surgical controls, suggests that neutral endopeptidase activity was elevated just prior to surgery. Indeed, neutral endopeptidase activity is statistically elevated in the pre-cardiac surgery state. Furthermore, glucocorticoid levels remained constant, within normal resting limits, in both groups. Thus, surgical anticipatory stress may manifest itself, in part, as a desensitization of various immunocytes. Thus, a psychological anticipatory stress response may be a precipitant of the desensitization. Although this desensitization seemed not to involve the entire hypothalamic-pituitary-adrenal axis, the data suggest that psychological anticipatory stress may initially involve and influence autoimmunoregulation.
为了阐明心理预期应激对免疫系统的影响，对即将接受择期心脏手术的患者的免疫细胞行为（对信号分子刺激的构象变化和运动）进行了研究。对10例患者和35例非手术对照者的粒细胞和单核细胞进行了检查。采用能够测量细胞构象和速度变化的计算机辅助显微图像分析技术，来检测这些免疫细胞对肽能和细胞因子刺激的反应性。免疫细胞脱敏似乎可以解释与心脏手术前状态相关的免疫细胞对趋化性刺激反应能力的降低。仅在比先前报道的浓度高得多的情况下（手术前为10-11M，而之前为10-9M），才观察到它们对D-丙氨酸2-甲硫氨酸脑啡肽酰胺（DAMA）的反应能力。这一发现，连同与非手术对照相比观察到的促肾上腺皮质激素水平降低，表明在手术前中性内肽酶活性升高。事实上，在心脏手术前状态下，中性内肽酶活性在统计学上升高。此外，两组的糖皮质激素水平均保持恒定，在正常静息范围内。因此，手术预期应激可能部分表现为各种免疫细胞的脱敏。因此，心理预期应激反应可能是脱敏的一个诱因。虽然这种脱敏似乎不涉及整个下丘脑-垂体-肾上腺轴，但数据表明心理预期应激可能最初涉及并影响自身免疫调节。
