本文關(guān)鍵詞：D型人格對住院冠心病患者焦慮抑郁及生活質(zhì)量的影響，由筆耕文化傳播整理發(fā)布。

        背景冠心病(Coronary heart disease,CHD)是一種由生物學(xué)因素和心理社會因素綜合作用的心身疾病。人們已經(jīng)認(rèn)識到,D型人格(Type D Personality)寸冠心病患者的病因和預(yù)后有潛在的不利影響,具有D型人格的冠心病患者死亡率、再次心梗率,甚至藥物洗脫支架治療后的危險性增加。然而,有幾個問題仍懸而未決。盡管有研究表明,冠心病患者焦慮(Anxiety).抑郁(Depression)的發(fā)病率明顯增高,但D型人格是否對冠心病患者伴發(fā)焦慮、抑郁的有預(yù)測價值未見報道。D型人格、焦慮、抑郁對冠心病患者生活質(zhì)量均有影響,但它們之間交互作用對冠心病患者生活質(zhì)量的影響未見報道。目的探討D型人格與冠心病的相關(guān)性；分析D型人格對冠心病患者焦慮、抑郁發(fā)病的影響；探討D型人格、焦慮、抑郁及它們交互作用對冠心病患者生活質(zhì)量的影響,為冠心病的心理行為干預(yù)治療提供理論依據(jù)。研究對象和方法1.首先根據(jù)入選標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),選擇2011年10月至2012年3月在濟(jì)寧醫(yī)學(xué)院附屬醫(yī)院心血管內(nèi)科病房住院并經(jīng)冠脈造影確診的冠心病患者和冠脈造影正常者中隨機(jī)選擇370例為研究對象，其中冠心病組296例,包括穩(wěn)定型心絞痛(Stable Angina Pectoris,SAP)患者103例,不穩(wěn)定型心絞痛(Unstable Angina Pectoris,UAP)患者122例,急性心肌梗(?)(Acute Myocardial Infarction,AMI)患者71例,健康對照組(冠脈造影正常)74例。然后根據(jù)D型人格量表的評分再將冠心病患者分為D型人格組和非D型人格組。2.所有研究對象均進(jìn)行一般資料調(diào)查,包括：性別、年齡、文化程度、職業(yè),以及高血壓史、糖尿病史、冠心病家族史、吸煙史、飲酒史、身體活動不足,應(yīng)用D型人格量表(DS14)進(jìn)行D型人格測定。除上述調(diào)查外,所有冠心病患者均于冠脈造影后第二天,進(jìn)行焦慮自評量表(SAS)、抑郁自評量表(SDS)和簡明36項健康問卷(SF-36)的調(diào)查。3.冠脈病變程度的Gensini評分：狹窄《25%計1分,25%-49%計2分,50%-74%計4分,75%-90%計8分,91%-99%計16分,100%計32分。不同節(jié)段冠脈病變乘以相應(yīng)系數(shù)：LM病變×5；LAD近段、中段、遠(yuǎn)段分別×2.5、1.5、1;D1×1, D2×0.5;LCX近段、遠(yuǎn)段分別×2.5、1, OM×1;RCA近、中、遠(yuǎn)段均×I, PDA×1,PLB×0.5.冠脈病變程度最終積分為各分支積分之和。4.應(yīng)用SPSS13.0統(tǒng)計軟件進(jìn)行數(shù)據(jù)分析。計量資料以均數(shù)±標(biāo)準(zhǔn)差表示,兩組間比較采用t檢驗,計數(shù)資料以頻數(shù)和百分比表示,組間幣比采用x2檢驗。單因素和多因素Logistic回歸分析D型人格對冠心病患者合并焦慮、抑郁的預(yù)測價值(OR值及95%可信區(qū)間)。D型人格與冠心病患者生活質(zhì)量的相關(guān)性采用Spearman相關(guān)分析；D型人格及各種冠心病危險因素共同對住院冠心病患者的生活質(zhì)量的影響應(yīng)用多元逐步回歸分析,P<0.05差異具有統(tǒng)計學(xué)意義。結(jié)果1.共入組370例,其中男207例,女163例,年齡29～85歲,平均年齡(59.40±9.38)歲。冠心病組和對照組間在年齡、性別、吸煙史、飲酒史、高血壓史、糖尿病史、心血管家族史、經(jīng)常運(yùn)動等方面,差異均無統(tǒng)計學(xué)意義(P>0.05)；在文化程度及職業(yè)方面,差異具有統(tǒng)計學(xué)意義(P<0.05)。2.D型人格在兩組間的檢出和分布兩組中,D型人格在冠心病組檢出110例(37.2%)高于正常對照組的12例(16.2%),差異具有統(tǒng)計學(xué)意義,P值=0.001。3.冠心病組中,D型人格冠心病患者的Gensini評分高于非D型人格冠心病患者(46.36±40.54VS31.56±28.27),差異具有統(tǒng)計學(xué)意義(t=16.65,P<0.01)。4.D型人格對冠心病患者合并焦慮、抑郁的預(yù)測價值單因素Logistic回歸分析顯示,各變量對冠心病患者伴發(fā)焦慮的預(yù)測價值：性別(OR為0.248,95%CI：0.136-0.452)、文化程度(OR為0.521,95%CI：0.360-0.756)、吸煙史(OR為0.286,95%CI：0.147-0.554)、飲酒史(OR為0.248,95%CI：0.086-0.716)、高血壓史(OR為1.785,95%CI：1.001-3.183)和D型人格(OR為3.119,95%CI：1.759-5.531)；各變量對冠心病患者伴發(fā)抑郁的預(yù)測價值：性別(OR為0.546,95%CI：0.334-0.892)、文化程度(OR為0.609,95%CI:0.445-0.832)和D型人格(OR為3.207,95%CI：1.934-5.318)。多因素條件logistic回歸分析顯示,控制上述傳統(tǒng)生物學(xué)危險因素后,D型人格是冠心病患者伴發(fā)焦慮、抑郁的危險因素,OR值分別為2.900(95%CI：1.570-5.359)、2.894(95%CI：1.724～4.856),P<0.01。5.D型人格對冠心病患者生活質(zhì)量的影響以296例冠心病患者為研究對象,D型人格組的RP、BP、GH、VT、SF、 RE、MH、PCS、MCS、SF-36的總分均低于非D型人格組,差異具有統(tǒng)計學(xué)意義(P<0.01或0.05)。D型人格、Gensini評分、焦慮、抑郁與冠心病患者的生活質(zhì)量呈負(fù)相關(guān)(r分別為-0.322、-0.236、-0.373、-0.498,p<0.01),文化程度、性別(女=0,男=1)呈正相關(guān)(r=0.240、0.162,p<0.01)。以生活質(zhì)量為因變量,將單因素分析中與冠心病患者生活質(zhì)量相關(guān)的因素代入回歸方程,進(jìn)行多元線性逐步回歸分析顯示,抑郁、焦慮、D型人格、文化程度和Gensini評分進(jìn)入回歸方程(B值分別為-16.30、-8.00、-5.73、2.96、-0.08,p<0.05或0.01)。6.D型人格與焦慮、抑郁交互作用對冠心病患者生活質(zhì)量的影響D型人格與焦慮、抑郁無交互作用(F=0.35,p=0.79)。在無焦慮無抑郁組,D型人格冠心病患者生活質(zhì)量低于非D型人格(t=3.618,D=0.001)；在單純焦慮、單純抑郁和焦慮合并抑郁組,D型人格冠心病患者生活質(zhì)量與非D型人格無統(tǒng)計學(xué)差異(t值分別為1.22、1.74和1.39,P>0.05)。四組內(nèi)多重比較,冠心病患者合并單純焦慮和單純抑郁組的生活質(zhì)量得分低于無焦慮無抑郁組,高于焦慮、抑郁共患組,但兩組內(nèi)得分無統(tǒng)計學(xué)差異。結(jié)論1.D型人格與冠心病具有相關(guān)性,D型人格對冠脈病變嚴(yán)重程度有影響。2.D型人格是冠心病患者并發(fā)焦慮、抑郁的危險因素，D型人格冠心病患者中發(fā)生焦慮和抑郁的風(fēng)險是非D型人格的2.90倍和2.89倍。3.D型人格與冠心病患者的生活質(zhì)量呈負(fù)相關(guān),但其對生活質(zhì)量的影響較焦慮、抑郁弱,焦慮、抑郁可能中介了D型人格冠心病患者的不良預(yù)后。4.應(yīng)對已確診冠心病患者進(jìn)行D型人格篩查,并進(jìn)行相應(yīng)心理行為干預(yù)。

    BackgroundCoronary heart disease (CHD) is a kind of psychosomatic disease,which is a result of the integrated effects of biological, psychological and social factors. The potentially deleterious effects of type d Personality on the etiology and prognosis of CHD are well recognized. Type D patients are at increased risk for mortality and repeat MI, even after invasive treatment with a drug-eluting stent. Several issues need to be solved, however. Although research shows that the incidence of anxiety and depression is significantly increased in patients with CHD, it is unclear whether type d Personality has any prognostic value in CHD patients on anxiety and depression. CHD patients with anxiety, depression and type d personality have a poor quality of life, but little is known about its interactions of anxiety, depression and type d personality.PurposeTo explore the relationship among type d personality and coronary heart disease; to explore the effect of the type d personality on CHD patients with anxiety and depression.To evaluate the impact of type d personality, anxiety and depression on quality of life in CHD patients and its interaction of anxiety, depression and type d personality on quality of life in CHD patients.Which would provide theoretical basis of psychological behavior intervention for CHD patients.Materials and Methods1. According to the inclusion and exclusion criteria, a total of370inpatients with CHD and normal coronary angiogram that had undergone coronary angiography from October2010to March2012in our hospital were enrolled in this study. There were296subjects in CHD group (including103subjects of stable angina pectoris,122subjects of unstable angina pectoris and71subjects of acute myocardial infarction) and74subjects without CHD as the control group. The296CHD patients were divided into two groups according to the results of DS14:type d personality group and non type d personality group.2. All subjects were administered a standardized questionnaire that provided information about their sex, age, occupation, educational level, smoking and drinking history, history of hypertension and diabetes, et al. And type d personality scale were used to assess the type of personality of all the participants. In addition to the above survey, all the CHD patients were administered Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and the Short Form36Questionnaire (SF-36) to text the anxiety, depression and quality of life.3. Gensini scores of coronary artery lesionsThe severity of coronary stenosis was evaluated on coronary angiography findings by Gensini score.4. All data were analyzed by SPSS (version13.0) using chi-square for categorical variables and independent t text for continuous variables. Continuous variables were expressed as mean±standard deviation. Categorial variables were presented as ratio or constituent ratio. Logistic regression was conducted to assess the predicted values of type d personality to anxiety and depression (OR and95%CI).Spearman correlation was used to determine the correlative relationship between type d personality and quality of life of patients with CHD. Multiple stepwise regression analysis was performed to investigate the impact of personality factors, risk factors of quality of life of CHD patients. A P value of＜0.05was used for all tests to indicate statistical significance.Results1. We eventually selected valid questionnaires370subjects, the mean age (59.40±9.38)year, and207/370subjects were male. The subjects were divided into two groups:CHD patients groups and the control groups. There were significant differences between two groups in educational level and occupation. And other demographic and clinical characteristics were no significant difference.2. Prevalence of type d personality in different groupsOf370subjects,110/296(37.2%) were classified as type d personality, which was higher than the control group(12/74). The proportion of type D personality among four groups:stable angina pectoris(38/103), unstable angina pectoris(46/122), acute myocardial infarction(26/71) and control group(12/74), has a statistically significant difference (P=0.008)3. The scores of Gensini between296CHD patients with and without type D personality had statistically significant differences (46.36±40.54VS31.56±28.27, t=16.65,P＜0.01)(P＜0.002)4. The role of type d personality in the prediction of anxiety and depressionUnivariate logistic regression analysis of each variable for prediction of the CHD patients with anxiety showed:OR=0.248(95%CI:0.136-0.452) for sex; OR=0.521(95%CI:0.360-0.756) for educational level; OR=0.286(95%CI:0.147-0.554) for smoking history; OR=0.248(95%CI:0.086-0.716) for drinking history; OR=1.785(95%CI:1.001-3.183) for hypertension history; OR=3.119(95%CI:1.759-5.531) for type d personality. And univariate logistic regression analysis of each variable for prediction of the CHD patients with depression showed:OR=0.546(95%CI:0.334-0.892) for sex; OR=0.609(95%CI:0.445-0.832) for educational level; OR=3.207(95%CI:1.934-5.318) for type d personality. Multivariate logistic regression analysis showed only type d personality had the role in the prediction of the CHD patients with anxiety and depression[OR:2.900(95%CI:1.570～5.359),OR:2.894(95%CI:1.724～4.856), P＜0.01, separately].5. The influence of type d personality on the quality of life in patients with CHDThe scores of role-physical(RP), bodily pain(BP), general health(GH), vitality(VT). social functioning(SF), role-emotional(RE), mental health(MH), Physical Component Summary(MCS), Mental Component Summary(MCS) and SF-36in patients with type D personality [(32.73±42.52),(57.68±26.93), (42.14±18.23),(47.15±22.60),(59.43±26.67),(45.91±46.22),(49.25±22.21),(53.14±19.59),(50.43±23.74),(51.78±19.85),separately] were lower than the patients with non-type D personality [(56.00±46.61),(64.62±22.27),(48.27±19.19),(61.56±20.17),(69.70±24.35),(70.79±44.53),(70.52±18.91),(63.03±18.73),(68.14±21.17),(65.59±19.00), separately](p＜0.05or0.01). Type d personality, Gensini score, anxiety and depression had negative correlation with the quality of life of patients with coronary heart disease(r=-0.322,-0.236,-0.373,-0.498, separately, p＜0.01), but educational level and sex had positive correlation with the quality of life of patients with coronary heart disease(r=0.240,0.162, separately, p＜0.01). Multiple stepwise regression analysis showed that depression, anxiety, type D personality, education level and Gensini score were entered QOL regression equation (B=-16.30,-8.00,-5.73,2.96,-0.08,p＜0.05or0.01)6. The interaction of anxiety, depression and type d personality on quality of life in CHD patients.There were no interactions among type d personality, anxiety and depression (F=0.35, p=0.79). In the group without anxiety and depression, CHD patients with type d personality had poorer quality of life than that without type d personality, but there were no significant differences in only anxiety group, only depression group and comorbidity anxiety-depression group(t=1.22,1.74,1.39, separately, p＞0.05).The total points of SF-36in only anxiety group and only depression group were significantly lower than that in the group without anxiety and depression, were significantly higher than that in comorbidity anxiety-depression group, but there were no significant differences between two groups.Conclusion1. Type D personality is associated with coronary heart disease (stable angina pectoris, unstable angina pectoris and acute myocardial infarction).2. Type D personality had impact on the extent of coronary lesion in coronary heart disease.3. Type D personality is a risk factor for patients with coronary heart disease accompanied with anxiety and depression. Type D personality increased risk of anxiety and depression in patients with coronary heart disease-2.90times and2.89times than Non-type D personality.4. Type D personality had negative correlation with the quality of life of patients with coronary heart disease, but higher levels of quality of life compared with anxiety and depression patients. Anxiety and depression may mediate the association between type D personality and poor prognosis in patients with coronary heart disease.5. Identifying type D personality and corresponding psychological behavior intervention is important in clinical practice, especially cardiovascular disease, in Chinese.

D型人格對住院冠心病患者焦慮抑郁及生活質(zhì)量的影響

中文摘要6-10ABSTRACT10-14符號說明15-16前言16-18研究對象與方法18-21結(jié)果21-28討論28-35結(jié)論35-36參考文獻(xiàn)36-41附錄41-47致謝47-48攻讀碩士期間發(fā)表的論文48-49學(xué)位論文評閱及答辯情況表49

  本文關(guān)鍵詞：D型人格對住院冠心病患者焦慮抑郁及生活質(zhì)量的影響，，由筆耕文化傳播整理發(fā)布。