Kario K, Matsuo T, Kobayashi H, Yamamoto K, Shimada K
Department of Cardiology, Jichi Medical School, Kawachi, Tochigi, Japan.
J Am Coll Cardiol. 1997 Apr;29(5):926-33. doi: 10.1016/s0735-1097(97)00002-8.
We sought to investigate the potentiation of acute risk factors after the Hanshin-Awaji earthquake (7.2 on the Richter scale).
The frequency of cardiovascular events increases just after a major earthquake, but the causative factors have not been fully investigated.
We studied the changes in cardiovascular risk factors in 42 elderly outpatients with well-controlled hypertension living near the epicenter (Awaji-Hokudan districts) 7 to 14 days after the earthquake when the major felt-aftershocks persisted. They all experienced the highest stress grading of 6 (catastrophic stress) according to the DSM-III-R. To study the hemostatic profile and endothelial cell state, we measured the blood pressure (BP), hematocrit and lipid profiles as well as fibrinogen, a marker of fibrin turnover (D-dimer), fibrinolytic factors (plasmin-alpha2-plasmin inhibitor complex [PIC], tissue-type plasminogen activator [t-PA] antigen and t-PA inhibitor [PAI] activity) and an endothelial cell-derived marker (von Willebrand factor [vWF]).
Systolic and diastolic blood pressures and other variables increased after the earthquake. Before and after the earthquake, the median (25th to 75th percentiles) systolic BP was 152 (range 142 to 164) and 170 mm Hg (range 161 to 178), respectively (p < 0.0001), and the diastolic BP was 83 (range 79 to 88) and 91 mm Hg (range 84 to 96), respectively (p < 0.0001). Of blood viscosity determinants, hematocrit was 38.1% (range 40.7% to 35.9%) and 39.7% (range 42.9% to 38.3%), respectively (p < 0.001), and fibrinogen 316 (range 272 to 360) and 335 mg/dl (range 307 to 391), respectively (p < 0.05). Von Willebrand factor was 128% (range 74% to 148%) and 148% (range 100% to 178%), respectively (p < 0.01); D-dimer was 410 (range 285 to 633) and 560 ng/ml (range 391 to 888), respectively (p < 0.0001); and PIC was 0.74 (range 0.58 to 0.91) and 0.75 microg/ml (range 0.58 to 1.1), respectively (p < 0.05). In contrast, lipid profiles did not change after the quake. When the patients were classified into the high stress and moderate stress groups according to the degrees of damage to their house and injury to family members, the levels of fibrinogen, vWF, PIC and t-PA antigen were increased only in the former group, whereas BP, hematocrit and D-dimer levels were increased in both groups. These abnormalities of acute risk factors, except for vWF, were transient and decreased to prequake levels by 4 to 6 months after the quake.
Earthquake-induced stress seems to induce transient increases in BP, blood viscosity determinants and fibrin turnover and to prolong endothelial cell stimulation. The potentiation of these acute risk factors might contribute to the occurrence of cardiovascular events just after a major earthquake in elderly subjects with hypertension.
我们试图调查阪神-淡路大地震（里氏7.2级）后急性风险因素的增强情况。
大地震后心血管事件的发生率会立即增加，但致病因素尚未得到充分研究。
我们研究了42名居住在震中附近（淡路北丹地区）、高血压得到良好控制的老年门诊患者在地震7至14天后（此时仍有强烈余震）心血管危险因素的变化。根据《精神疾病诊断与统计手册第三版修订本》，他们都经历了最高的6级压力分级（灾难性压力）。为了研究止血情况和内皮细胞状态，我们测量了血压（BP）、血细胞比容、血脂谱以及纤维蛋白原（纤维蛋白周转的标志物D-二聚体）、纤溶因子（纤溶酶-α2-纤溶酶抑制剂复合物[PIC]、组织型纤溶酶原激活剂[t-PA]抗原和t-PA抑制剂[PAI]活性）以及一种内皮细胞衍生标志物（血管性血友病因子[vWF]）。
地震后收缩压和舒张压以及其他变量均升高。地震前后，收缩压的中位数（第25至75百分位数）分别为152（范围142至164）和170 mmHg（范围161至178）（p<0.0001），舒张压分别为83（范围79至88）和91 mmHg（范围84至96）（p<0.0001）。在血液粘度决定因素中，血细胞比容分别为38.1%（范围40.7%至35.9%）和39.7%（范围42.9%至38.3%）（p<0.001），纤维蛋白原分别为316（范围272至360）和335 mg/dl（范围307至391）（p<0.05）。血管性血友病因子分别为128%（范围74%至148%）和148%（范围100%至178%）（p<0.01）；D-二聚体分别为410（范围285至633）和560 ng/ml（范围391至888）（p<0.0001）；PIC分别为0.74（范围0.58至0.91）和0.75 μg/ml（范围0.58至1.1）（p<0.05）。相比之下，地震后血脂谱没有变化。当根据房屋受损程度和家庭成员受伤情况将患者分为高压力组和中度压力组时，纤维蛋白原、vWF、PIC和t-PA抗原水平仅在前一组中升高，而两组的血压、血细胞比容和D-二聚体水平均升高。除vWF外，这些急性风险因素的异常是短暂的，在地震后4至6个月降至震前水平。
地震诱发的压力似乎会导致血压、血液粘度决定因素和纤维蛋白周转的短暂增加，并延长内皮细胞刺激。这些急性风险因素的增强可能导致高血压老年患者在大地震后立即发生心血管事件。
