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Chapter 8 Stress

Zhao Mingyao
BMC.ZZU
2006-3-20
• I cannot and should not be cured of
by stress, but merely taught to enjoy
it.
-- Hans Selye
Hans Selye 1909~1982

Stress
General Adaptation Syndrome

• Experiment found :
• ?
• ?
• ?
STRESS MODEL

BLACK
BOX RESPONSE CONSEQUENCES

WELLNESS

?
FLIGHT
STRESSOR FIGHT
ADAPT ILLNESS
stress in medicine ?

Disease Specific response


cause
Non-specific response
Body

protect effect
Non-specific response
harmful effect
Stress
over low —— suitable ——
over high
Pathologica
l status
Physiological
status
New Pathological status
when against pathological process
Stress
wide meaning in medicine
physiological & pathological
somatical & schycological
eustress & distress
narrow meaning here
somatical & pathological & distress
Stress around us
Exam now

Tour now

Healthy person Traffic accident injury patient


without any disease with gastric ulcer
Section 1 Terminology of stress
1.stress ---- Non-specific response
2.stressor ---- stimuli that induces stress
3.General Adaptation Syndrome, GAS
Mechanism of stress
⑴   LC/NE ( locus ceruleus-norepinephrine
/sympathetic-adrenal meddula axis ) ----- Cannon
⑵   HPA ( Hypothalamus-pituitary-adrenal cortex
system ) ----- Selye

⑶   Other hormones
⑷   AP ( Acute phase protein )
⑸   HSP( Heat shock protein, stress protein )

‘ Flight or Fight Response’


Section 2 Neuroendocrine
response
1.locus ceruleus-norepinephrine
/sympathetic-adrenal meddula
axis, LC/NE

(1)central site of LC/NE


Limbic system: emotion/cognition/action
Lateral horn of spinal cord: sympathetic-adrenal
meddula
(2)Effects of catecholamine
during stress
Central: exiting , alert , tension, anxiety
Peripheral:

Locus Ceruleus arouses the Brain


Sympathetics activate entire body
1)Peripheral beneficial effects :

①Cardiovascular function
②hypermetabolism: glycogenolysis
③respiration
④promoting secretion of other hormone
2)Peripheral detrimental effects :

①hypertension & ischemia


②thrombosis
③O2 overconsumption: HR
④lipid peroxidation
SAM-Route

“Rest and Digest” Stress “Fight or Flight”


2.Hypothalamus-pituitary-
adrenal cortex system, HPA

(1) HPA axis constitution


(2) Effects of HPA

Central: CRH ↑, endophin ↑


adaptation, euphoria;
anxiety, depression
(2) Effects of Glucocorticoids (GC)

Central: ?
Peripheral: interact with adrenaline to affect, blood flow, cardiac output,
respiration
① blood glucose↑
② promote catecholamine and glucagon to activate fat
③ maintain response of circulatory system to CA
④ stabolize lysosomal membrane: inhibits PLA 2

⑤ anti-inflammation anti-allergy action


The HPA-Axis

Cortisol

• Energy Mobilization
• Immune System Regulation
3. effects of Other hormones
during stress

Thyroid hormone system↓


Sex gland hormone system ↓
insulin ↓
other hormone ↑

Central
Peripheral
Section 3 Cellular and humoral
response
1. Acute phase protein
positive
negative
AP origin : comes from

• liver cell (C-reactive protein)


• monocyte (complement components)
• endothelium cell
• fibroblast
AP roles
Leukocytosis
fever
certain hormones↑
serum iron↓ and zinc↓
activation of the proteolytic enzyme cascade
(clotting, complement, kinin-forming and
fibrinolytic pathways)
negative nitrogen balance
transfer of amino acids from muscles to the
liver
Inhibiting proteinase
Coagulation and fibronolysis
Cleaving foreign body and necrotic tissue
Cleaving OFR: ceruloplasmin
Other:
2. Heat shock
protein (HSP)

7 subfamilies
Conserved
Little quantity

Drosophila

HSPs20, 40, 60, 70, 90, 110, ubiquitin


• a group of proteins that are present in all
cells in all life forms. They are induced
when a cell undergoes various types of
environmental stresses like heat, cold and
oxygen deprivation.
Molecule structure of
HSP
ATPase activity Matrix
N-terminal recognition C-terminal
450aa
domain
200aa

HSP70

molecular chaperone
• Heat shock proteins
(HSPs) play essential
roles in protein folding
and membrane
translocation.
Section 4 functional an d
metabolic response
Total tendency

sympathetic nerve system +++


vagal nerve system - - -
metabolism: synthesize↓
decompose↑ , but katolysis
directive stressor stimulation &
cytokines:
immune: eustress or distress
Positive & negative effect
1.CNS
2.Immune system
3.Cardiovascular ~
4.Digestive ~
5.Gnitourinary ~
6.Metabolism
section 5 stress-related disease
common stress-related disease
* Essential Hypertension
* Stress Heart Disease
* Stress Peptic Ulcer
* Tumor
* Depression
* Psychosocial dwarf
1. Stress Peptic Ulcer
mechanism:
(1)ischemia
(2)counter-diffusion of gastric H+ to
mucosa
Multiple stress ulcers of the stomach, highlighted by the
dark digested blood in their bases.
2. Cardiovascular diseases
(1)Essential Hypertension
(2)Stress Heart Disease:
coronary artery disease
arrhythmia
3. endocrine disorder
(1)Disturbance in growth-thyroid
function
pschycosocial dworf
(2)Disturbance in gonadal axis
4.pschycosocial
disturbance
• Post-traumatic stress disorder (PTSD)
a whole family with 8 persons made a tour,
faced Tsunami, only one return.
How does person response?
Research indicates that
–70 % ~ 80% of health-related problems
may be precipitated or aggravated by
stress
Section 6 Prevention and
treatment
1.remove serious stressor
2.decrease stress degree
3.supply GC
4.supply nutrients
5.psychosocial comforting
end