Последствия аллостатической нагрузки при хроническом боевом стрессе

Хронический боевой стресс (ХБС) представляют собой особую форму длительного стрессового воздействия, ассоциированную с развитием у ветеранов войн  в начале пограничных функциональных состояний, в последующем — отдаленных психических и соматических нарушений. Современные данные указывают на системный характер этих нарушений в виде формирования донозологических проявлений, выходящих за рамки изолированной психической патологии.

Цель работы: систематический анализ и метааналитическая оценка лонгитюдных исследований, посвященных отдаленным психическим и соматическим последствиям ХБС с позиций концепции аллостатической нагрузки.

Материал и методы. Выполнен систематический обзор и метаанализ лонгитюдных когортных исследований, опубликованных в 2010–2025 гг. Поиск проводился в базах PubMed/MEDLINE и Scopus в соответствии с международными рекомендациями по структуре и отчетности систематических обзоров и метаанализов (PRISMA). В анализ включены исследования с количественной оценкой боевой экспозиции и психических либо соматических исходов. Метааналитический синтез выполнен с использованием модели случайных эффектов; гетерогенность оценивалась по статистикам I² и τ².

Результаты. В итоговый анализ включено 42 исследования. ХБС ассоциирован с повышенным риском развития посттравматического стрессового расстройства, депрессивных и тревожных расстройств, а также заболеваний сердечно-сосудистой системы, метаболических и эндокринных нарушений. Выявлены признаки устойчивой автономной, нейроэндокринной и иммунной дисрегуляции. Генетически информированные исследования подтверждают частичную общность биологических детерминант психических и сердечно-сосудистых нарушений.

Выводы. ХБС следует рассматривать как многоуровневый патогенетический фактор формирования отдаленных психических и соматических последствий, что обосновывает необходимость междисциплинарного подхода к ведению данной категории пациентов.

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