摘要
目的基于交互作用的应激中介模型,明确D型人格对冠心病患者斑块易损性的影响及作用机制。方法采用方便抽样法,选取2020年12月—2021年5月哈尔滨医科大学附属第二医院心内科收治的386例冠心病患者为研究对象。采用D型人格问卷、焦虑自评量表、抑郁自评量表、应激评价量表和特质应对方式问卷对患者进行调查。同时采用光学相干断层成像技术评估患者冠状动脉病变处的斑块特征。运用结构方程模型进行D型人格冠心病患者斑块易损性影响因素模型的构建。结果本研究冠心病患者中,D型人格者138例,易损斑块组200例。易损斑块组的D型人格得分、焦虑、抑郁、消极应对和认知评价得分均高于非易损斑块组,差异均有统计学意义(P<0.01)。易损斑块组的积极应对得分低于非易损斑块组,差异有统计学意义(P<0.01)。结构方程模型结果显示,D型人格可通过认知评价(β=0.588,P<0.01)及消极应对(β=0.189,P<0.05)对斑块易损性产生直接或间接影响。其中,认知评价(β=-0.061、0.121;P<0.01)及消极应对(β=-0.124、0.031;P<0.01)对斑块易损性有间接效应;消极应对(β=0.215,P<0.01)、心理反应(β=0.241、-0.150;P<0.01)和生理反应(β=-0.321,P<0.01)对斑块易损性有直接效应。结论D型人格冠心病患者的认知评价、应对方式、心理反应和生理反应等可通过多种路径影响斑块易损性。因此,临床上加强对D型人格的筛查可早期识别斑块易损性发生的高危人群,同时应对此类人群进行个性化、系统化心理行为干预,从而将冠心病的防治关口前移。
Objective To clarify the mechanism of type D personality on plaque vulnerability in patients with coronary heart disease based on the stress-mediator model.Methods Using the convenient sampling method,a total of 386 patients with coronary heart disease who were admitted to Department of Cardiology of the Second Affiliated Hospital of Harbin Medical University from December 2020 to May 2021 were selected as the research objects.The patients were investigated using Type D Personality Scale-14(DS-14),Self-rating Anxiety Scale,Self-rating Depression Scale,The Stress Appraisal Measure(SAM)and Trait Coping Style Questionnaire(TCSQ).At the same time,optical coherence tomography was used to evaluate the plaque characteristics of patients with coronary lesions.A structural equation model was used to construct a model of influencing factors of plaque vulnerability in patients with type D personality coronary heart disease.Results Among the patients with coronary heart disease in this study,there were 138 patients with type D personality and 200 patients in the vulnerable plaque group.The D-type personality score,anxiety,depression,negative coping and cognitive evaluation scores in the vulnerable plaque group were higher than those in the non-vulnerable plaque group,and the differences were statistically significant(P<0.01).The active coping score of the vulnerable plaque group was lower than that of the non-vulnerable plaque group,and the difference was statistically significant(P<0.01).The results of structural equation modeling showed that type D personality could directly or indirectly affect plaque vulnerability through cognitive assessment(β=0.588,P<0.01)and negative coping(β=0.189,P<0.05).Among them,cognitive assessment(β=-0.061,0.121;P<0.01)and negative coping(β=-0.124,0.031;P<0.01)had indirect effects on plaque vulnerability.Negative coping(β=0.215,P<0.01),psychological responses(β=0.241,-0.150,P<0.01)and physiological responses(β=-0.321,P<0.01)had direct effects on plaque vulnerability.Conclusions Cognitive
作者
马心蕊
高学琴
林平
赵振娟
王旖旎
Ma Xinrui;Gao Xueqin;Lin Ping;Zhao Zhenjuan;Wang Yini(Department of Cardiology,the Second Affiliated Hospital of Harbin Medical University,Harbin 150086,China)
出处
《中华现代护理杂志》
2022年第16期2137-2143,共7页
Chinese Journal of Modern Nursing
基金
国家自然科学基金委员会面上项目(31771241,31971015)
2019教育部人文社会科学研究一般项目(19YJC190034)。
关键词
冠心病
D型人格
斑块易损性
光学相干断层成像技术
结构方程模型
Coronary atherosclerotic heart disease
Type D personality
Plaque vulnerability
Optical coherence tomography
Structural equation model
