D型人格对住院冠心病患者焦虑抑郁及生活质量的影响

  本文关键词：D型人格对住院冠心病患者焦虑抑郁及生活质量的影响，由笔耕文化传播整理发布。

        背景冠心病(Coronary heart disease,CHD)是一种由生物学因素和心理社会因素综合作用的心身疾病。人们已经认识到,D型人格(Type D Personality)寸冠心病患者的病因和预后有潜在的不利影响,具有D型人格的冠心病患者死亡率、再次心梗率,甚至药物洗脱支架治疗后的危险性增加。然而,有几个问题仍悬而未决。尽管有研究表明,冠心病患者焦虑(Anxiety).抑郁(Depression)的发病率明显增高,但D型人格是否对冠心病患者伴发焦虑、抑郁的有预测价值未见报道。D型人格、焦虑、抑郁对冠心病患者生活质量均有影响,但它们之间交互作用对冠心病患者生活质量的影响未见报道。目的探讨D型人格与冠心病的相关性；分析D型人格对冠心病患者焦虑、抑郁发病的影响；探讨D型人格、焦虑、抑郁及它们交互作用对冠心病患者生活质量的影响,为冠心病的心理行为干预治疗提供理论依据。研究对象和方法1.首先根据入选标准和排除标准,选择2011年10月至2012年3月在济宁医学院附属医院心血管内科病房住院并经冠脉造影确诊的冠心病患者和冠脉造影正常者中随机选择370例为研究对象，其中冠心病组296例,包括稳定型心绞痛(Stable Angina Pectoris,SAP)患者103例,不稳定型心绞痛(Unstable Angina Pectoris,UAP)患者122例,急性心肌梗(?)(Acute Myocardial Infarction,AMI)患者71例,健康对照组(冠脉造影正常)74例。然后根据D型人格量表的评分再将冠心病患者分为D型人格组和非D型人格组。2.所有研究对象均进行一般资料调查,包括：性别、年龄、文化程度、职业,以及高血压史、糖尿病史、冠心病家族史、吸烟史、饮酒史、身体活动不足,应用D型人格量表(DS14)进行D型人格测定。除上述调查外,所有冠心病患者均于冠脉造影后第二天,进行焦虑自评量表(SAS)、抑郁自评量表(SDS)和简明36项健康问卷(SF-36)的调查。3.冠脉病变程度的Gensini评分：狭窄《25%计1分,25%-49%计2分,50%-74%计4分,75%-90%计8分,91%-99%计16分,100%计32分。不同节段冠脉病变乘以相应系数：LM病变×5；LAD近段、中段、远段分别×2.5、1.5、1;D1×1, D2×0.5;LCX近段、远段分别×2.5、1, OM×1;RCA近、中、远段均×I, PDA×1,PLB×0.5.冠脉病变程度最终积分为各分支积分之和。4.应用SPSS13.0统计软件进行数据分析。计量资料以均数±标准差表示,两组间比较采用t检验,计数资料以频数和百分比表示,组间币比采用x2检验。单因素和多因素Logistic回归分析D型人格对冠心病患者合并焦虑、抑郁的预测价值(OR值及95%可信区间)。D型人格与冠心病患者生活质量的相关性采用Spearman相关分析；D型人格及各种冠心病危险因素共同对住院冠心病患者的生活质量的影响应用多元逐步回归分析,P<0.05差异具有统计学意义。结果1.共入组370例,其中男207例,女163例,年龄29～85岁,平均年龄(59.40±9.38)岁。冠心病组和对照组间在年龄、性别、吸烟史、饮酒史、高血压史、糖尿病史、心血管家族史、经常运动等方面,差异均无统计学意义(P>0.05)；在文化程度及职业方面,差异具有统计学意义(P<0.05)。2.D型人格在两组间的检出和分布两组中,D型人格在冠心病组检出110例(37.2%)高于正常对照组的12例(16.2%),差异具有统计学意义,P值=0.001。3.冠心病组中,D型人格冠心病患者的Gensini评分高于非D型人格冠心病患者(46.36±40.54VS31.56±28.27),差异具有统计学意义(t=16.65,P<0.01)。4.D型人格对冠心病患者合并焦虑、抑郁的预测价值单因素Logistic回归分析显示,各变量对冠心病患者伴发焦虑的预测价值：性别(OR为0.248,95%CI：0.136-0.452)、文化程度(OR为0.521,95%CI：0.360-0.756)、吸烟史(OR为0.286,95%CI：0.147-0.554)、饮酒史(OR为0.248,95%CI：0.086-0.716)、高血压史(OR为1.785,95%CI：1.001-3.183)和D型人格(OR为3.119,95%CI：1.759-5.531)；各变量对冠心病患者伴发抑郁的预测价值：性别(OR为0.546,95%CI：0.334-0.892)、文化程度(OR为0.609,95%CI:0.445-0.832)和D型人格(OR为3.207,95%CI：1.934-5.318)。多因素条件logistic回归分析显示,控制上述传统生物学危险因素后,D型人格是冠心病患者伴发焦虑、抑郁的危险因素,OR值分别为2.900(95%CI：1.570-5.359)、2.894(95%CI：1.724～4.856),P<0.01。5.D型人格对冠心病患者生活质量的影响以296例冠心病患者为研究对象,D型人格组的RP、BP、GH、VT、SF、 RE、MH、PCS、MCS、SF-36的总分均低于非D型人格组,差异具有统计学意义(P<0.01或0.05)。D型人格、Gensini评分、焦虑、抑郁与冠心病患者的生活质量呈负相关(r分别为-0.322、-0.236、-0.373、-0.498,p<0.01),文化程度、性别(女=0,男=1)呈正相关(r=0.240、0.162,p<0.01)。以生活质量为因变量,将单因素分析中与冠心病患者生活质量相关的因素代入回归方程,进行多元线性逐步回归分析显示,抑郁、焦虑、D型人格、文化程度和Gensini评分进入回归方程(B值分别为-16.30、-8.00、-5.73、2.96、-0.08,p<0.05或0.01)。6.D型人格与焦虑、抑郁交互作用对冠心病患者生活质量的影响D型人格与焦虑、抑郁无交互作用(F=0.35,p=0.79)。在无焦虑无抑郁组,D型人格冠心病患者生活质量低于非D型人格(t=3.618,D=0.001)；在单纯焦虑、单纯抑郁和焦虑合并抑郁组,D型人格冠心病患者生活质量与非D型人格无统计学差异(t值分别为1.22、1.74和1.39,P>0.05)。四组内多重比较,冠心病患者合并单纯焦虑和单纯抑郁组的生活质量得分低于无焦虑无抑郁组,高于焦虑、抑郁共患组,但两组内得分无统计学差异。结论1.D型人格与冠心病具有相关性,D型人格对冠脉病变严重程度有影响。2.D型人格是冠心病患者并发焦虑、抑郁的危险因素，D型人格冠心病患者中发生焦虑和抑郁的风险是非D型人格的2.90倍和2.89倍。3.D型人格与冠心病患者的生活质量呈负相关,但其对生活质量的影响较焦虑、抑郁弱,焦虑、抑郁可能中介了D型人格冠心病患者的不良预后。4.应对已确诊冠心病患者进行D型人格筛查,并进行相应心理行为干预。

    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型人格对住院冠心病患者焦虑抑郁及生活质量的影响

中文摘要6-10ABSTRACT10-14符号说明15-16前言16-18研究对象与方法18-21结果21-28讨论28-35结论35-36参考文献36-41附录41-47致谢47-48攻读硕士期间发表的论文48-49学位论文评阅及答辩情况表49

  本文关键词：D型人格对住院冠心病患者焦虑抑郁及生活质量的影响，，由笔耕文化传播整理发布。