日常心理应激与中青年心肌梗死/脑梗死风险：基于生物学机制的循证综述

Daily Psychological Stress and the Risk of Acute Myocardial Infarction/Cerebral Infarction in Young and Middle-Aged Adults: An Evidence-Based Review Based on Biological Mechanisms

摘要: 日常心理应激与中青年急性心脑血管事件的关系日益受到关注。现有流行病学、临床观察和机制研究提示，心理应激与急性心肌梗死、脑梗死风险升高相关，并可能作为急性事件的触发或放大因素。急性应激可通过交感–肾上腺髓质系统激活，引起儿茶酚胺释放增加、血压骤升、心率增快、血管痉挛、心肌耗氧增加及心律失常；慢性应激则可通过下丘脑–垂体–肾上腺轴持续激活、自主神经失衡、内皮功能障碍、炎症反应增强、血小板活化及凝血纤溶异常，促进动脉粥样硬化进展、斑块不稳定和血栓形成。中青年人群常处于职业压力、睡眠不足、吸烟饮酒、血压或血脂异常等因素叠加状态，心理应激可能与传统危险因素协同作用。因此，急诊及心脑血管疾病防控中应重视心理应激筛查与干预，构建传统危险因素管理、生活方式改善和心理干预并重的综合防治模式。

Abstract: The relationship between daily psychological stress and acute cardiovascular and cerebrovascular events in middle-aged and young adults has received increasing attention. Existing epidemiological, clinical observational, and mechanistic studies suggest that psychological stress is associated with an increased risk of acute myocardial infarction and cerebral infarction, and may serve as a trigger or amplifying factor for acute events. Acute stress can activate the sympathetic-adrenal medullary system, leading to increased catecholamine release, sudden blood pressure elevation, increased heart rate, vasospasm, increased myocardial oxygen consumption, and arrhythmias; chronic stress, through sustained activation of the hypothalamic-pituitary-adrenal axis, autonomic imbalance, endothelial dysfunction, enhanced inflammatory responses, platelet activation, and abnormalities in coagulation and fibrinolysis, promotes the progression of atherosclerosis, plaque instability, and thrombosis. Middle-aged and young adults are often exposed to a combination of factors such as occupational stress, sleep deprivation, smoking and alcohol consumption, abnormal blood pressure or blood lipids, and psychological stress, which may act synergistically with traditional risk factors. Therefore, in the prevention and control of emergency and cardiovascular and cerebrovascular diseases, attention should be paid to psychological stress screening and intervention, and a comprehensive prevention and treatment model that integrates traditional risk factor management, lifestyle improvement, and psychological intervention should be established.