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压力相关疾病可能会增加随后威胁生命的感染风险
作者:小柯机器人 发布时间:2019/10/25 10:28:23

冰岛大学医学院/瑞典卡罗林斯卡医学院博士后宋欢等的最新研究,揭示了压力相关疾病和随后威胁生命的感染风险的关系。相关论文在线发表于10月23日的《英国医学杂志》。

研究组选择了1987-2013年间瑞典人口健康数据库中144919名压力相关疾病的患者,包括创伤后应激障碍(PTSD)、急性应激反应、调节障碍和其他应激反应,与184612名没有压力相关疾病的兄弟姐妹进行配对,并选择1449190名健康普通人作为对照组。

压力相关疾病的平均诊断年龄为37岁。平均随访8年后,压力相关疾病患者中威胁生命的感染发生率为每1000人年2.9例,没有压力相关疾病的兄弟姐妹为1.7例,健康对照组为1.3例。与没有压力相关疾病的兄弟姐妹相比,有压力相关疾病的患者更容易受到威胁生命的感染,风险比为1.47,其中PTSD的风险比为1.92。

压力相关疾病与所有危及生命的感染均显著相关,其中脑膜炎和心内膜炎的相对风险最高。患病年龄越小,存在精神共病尤其是药物使用障碍,遭受威胁生命感染的风险越高。但确诊后第一年使用选择性5-羟色胺再摄取抑制剂进行治疗可降低感染的风险。

总之,在控制家族背景和身体精神共病之后,压力相关疾病可能会增加随后威胁生命的感染风险。

宋欢,冰岛大学医学院和瑞典卡罗林斯卡医学院博士后。(来源:瑞典卡罗林斯卡医学院

附:英文原文

Title: Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study

Author: Huan Song, Katja Fall, Fang Fang, Helga Erlendsdóttir, Donghao Lu, David Mataix-Cols, Lorena Fernández de la Cruz, Brian M. D’Onofrio, Paul Lichtenstein, Magnús Gottfreesson, Catarina Almqvist, Unnur A Valdimarsdóttir

Issue&Volume: 2019/10/23

Abstract: 

Objective To assess whether severe psychiatric reactions to trauma and other adversities are associated with subsequent risk of life threatening infections.

Design Population and sibling matched cohort study.

Setting Swedish population.

Participants 144 919 individuals with stress related disorders (post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions) identified from 1987 to 2013 compared with 184 612 full siblings of individuals with a diagnosed stress related disorder and 1 449 190 matched individuals without such a diagnosis from the general population.

Main outcome measures A first inpatient or outpatient visit with a primary diagnosis of severe infections with high mortality rates (ie, sepsis, endocarditis, and meningitis or other central nervous system infections) from the Swedish National Patient Register, and deaths from these infections or infections of any origin from the Cause of Death Register. After controlling for multiple confounders, Cox models were used to estimate hazard ratios of these life threatening infections.

Results The average age at diagnosis of a stress related disorder was 37 years (55 541, 38.3% men). During a mean follow-up of eight years, the incidence of life threatening infections per 1000 person years was 2.9 in individuals with a stress related disorder, 1.7 in siblings without a diagnosis, and 1.3 in matched individuals without a diagnosis. Compared with full siblings without a diagnosis of a stress related disorder, individuals with such a diagnosis were at increased risk of life threatening infections (hazard ratio for any stress related disorder was 1.47 (95% confidence intervals1.37 to 1.58) and for PTSD was 1.92 (1.46 to 2.52)). Corresponding estimates in the population based analysis were similar (1.58 (1.51 to 1.65) for any stress related disorder, P=0.09 for difference between sibling and population based comparison, and 1.95 (1.66 to 2.28) for PTSD, P=0.92 for difference). Stress related disorders were associated with all studied life threatening infections, with the highest relative risk observed for meningitis (sibling based analysis 1.63 (1.23 to 2.16)) and endocarditis (1.57 (1.08 to 2.30)). Younger age at diagnosis of a stress related disorder and the presence of psychiatric comorbidity, especially substance use disorders, were associated with higher hazard ratios, whereas use of selective serotonin reuptake inhibitors in the first year after diagnosis of a stress related disorder was associated with attenuated hazard ratios.

Conclusion In the Swedish population, stress related disorders were associated with a subsequent risk of life threatening infections, after controlling for familial background and physical or psychiatric comorbidities.

DOI: 10.1136/bmj.l5784

Source: https://www.bmj.com/content/367/bmj.l5784

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj