【作者】 李军杰；

【导师】 叶平；

【作者基本信息】 中国人民解放军军医进修学院 ， 老年医学， 2010， 博士

【摘要】 目的：1.探讨慢性应激与血压、血糖和血脂的关系。2.研究慢性应激与血清皮质醇、肾上腺素和去甲肾上腺素的关系。3.评价慢性应激与5-HTTLPR基因多态性的关系。方法：选择驻守戈壁的某部军人847人作为研究对象,使用特质应对方式问卷、领悟社会支持量表和90项症状清单评测其应激状态,测量收缩压和舒张压,测定空腹血糖、口服葡萄糖耐量实验2h血糖和血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇,检测血清皮质醇、肾上腺素和去甲肾上腺素浓度,使用聚合酶链式反应技术和琼脂糖凝胶电泳技术分析5-HTTLPR的基因多态性,将数据进行统计学处理。结果：1.研究对象SCL-90高于SCL-90中国成人常模(P<0.01)；NC与FPG、OGTT2hPG、TC、1gTG和LDL-C存在线性关系(P<0.05),PC与FPG存在线性关系(P<0.05),SCL-90与SBP、FPG,OGTT2hPG、TC、lgTG和LDL-C存在线性关系(P<0.05)；NC是TC和LDL-C的影响因素(b=0.013,0.008),PC是FPG的影响因素(b=-0.006),SCL-90是SBP、OGTT2hPG、TC、1gTG和LDL-C的影响因素(b=0.014,0.002,0.002,0.001,0.001)。2.研究对象COR, E和NE与正常人测量值未见显著差异(P>0.05),SCL-90与COR、E和NE存在线性关系(P<0.05),NC与COR和E存在线性关系(P<0.05)；NC和SCL-90是E的影响因素(b=0.385,0.054)。3.5-HTTLPR多态性的等位基因与研究对象的应激状态相关,即不同等位基因的NC和SCL-90评分差异有统计学意义(χ2=21.232、30.359,P均小于0.05),携带S等位基因的个体应激水平较高；NC和SCL-90评分组Ⅰ高于组Ⅱ(P<0.05),S／S基因型个体的应激水平高于S／L和L／L基因型个体。结论：1.长期驻守戈壁的军人应激水平高于正常人,慢性应激可能与高血压、高血糖和高血脂的发病相关。2.慢性应激可能导致血清肾上腺素浓度升高。3.S等位基因相对L等位基因对应激易感,S／S基因型个体相对S／L和L／L基因型个体,可能产生较高应激水平。更多还原

【Abstract】 Objective:1. To assess the effect of the chronic stress on blood pressure, blood glucose and blood lipids.2. To explore the relationship between the chronic stress and cortisol, epinephrine and norepinephrine in serum.3. To investigate the association between the chronic stress and the polymorphism of 5-hydroxytryptamine transporter-linked promoter region.Methods:We used cross-sectional study with the 847 soldiers stationed in the gobi. Trait Coping Style Questionnaire, Perceived Social Support Scale and Symptom Checklist-90 were adopted to evaluate the stress state of the participants. Systolic pressure, diastolic pressure, fasting plasma glucose, oral glucose tolerance test 2h plasma glucose and the concentrations of TC, TG, LDL-C, HDL-C in serum were measured. The concentrations of cortisol, epinephrine and norepinephrine in serum were also measured. The genotypes of the polymorphism in 5-HTTLPR were determined by using polymerase chain reaction and agarose gel electrophoresis. The data were statistically treated.Results:1. The scores of SCL-90 of the participants were significantly higher than the norms of SCL-90 of Chinese (P<0.01). NC was correlated with FPG, OGTT2hPG, TC, lgTG and LDL-C (P<0.05), PC was correlated with FPG (P<0.05), and SCL-90 was correlated with SBP, FPG, OGTT2hPG, TC, lgTG and LDL-C (P<0.05). Multiple stepwise regression analysis showed that NC was an influencing factor on TC and LDL-C (b= 0.013,0.008), that PC was an influencing factor on FPG (b=-0.006), and that SCL-90 was an influencing factor on SBP, OGTT2hPG, TC, lgTG and LDL-C (b=0.014,0.002, 0.002,0.001,0.001).2. As to COR, E and NE, there was no significant difference between the participants and the normal people. SCL-90 was correlated with COR, E and NE (P< 0.05), and NC was correlated with COR and E (P<0.05). Multiple stepwise regression confirmed that SCL-90 and NC was influencing factors on E (b=0.054,0.385).3. The allele of 5-HTTLPR had strong genetic relationship with the scores of NC and SCL-90 (X2=21.232,30.359, P<0.05). There were significant differences in NC and SCL-90 between the two groups (P<0.05), the stress state in the participants with S/S genotype was statistically higher than that in those with S/L or L/L genotype.Conclusions:1. The stress state in the participants is significantly higher than that in normal people. The chronic stress may be a risk factor of hypertension, hyperglycemia and hyperlipemia.2. The chronic stress may be related to the increase of E in serum.3. The allele S is more sensitive to stress than the alleve L, and the individuals with S/S genotype may suffer more intense stress reaction than those with S/L or L/L genotype.更多还原