D型人格与冠心病生物学危险因素的相关性研究

Correlations Between Type D Personality and Biological Risk Factors

目的:在冠心病人和中老年正常人群中应用D型人格量表(DS14)中文版,检验其信、效度及其在这两个样本中的适用性。探讨冠心病人D型人格的临床特点以及与生物学危险因素的交互作用对冠心病的影响。方法:187名冠心病病人和453名中老年正常人完成了一般情况调查问卷和DS14。对冠心病病人进行有关临床情况的测查,包括冠心病家族史、体重指数、心率、血压、血糖、血清总胆固醇和C-反应蛋白以及冠状动脉造影术。结果:在正常组和冠心病组,DS14及其分量表消极情感(NA)和社交抑制(SI)的Cronbachα系数的范围在0.68～0.89,条目间平均相关系数的范围在0.28～0.52,NA和SI的重测信度系数分别为0.79和0.82。验证性因素分析显示,DS14的两因素结构在两个样本中其χ2/df<5;CFI、IFI、GFI均大于0.90;RMSEA均小于等于0.08。D型人格中有冠心病家族史者显著高于非D型人格(χ2=6.86,P<0.05),吸烟量、空腹血糖和C反应蛋白均显著高于非D型人格(P<0.05)。D型人格的SI与血清总胆固醇的交互作用可增加对危险因素聚集性的预测(β=1.81,P<0.05),而SI与吸烟的交互作用可减少对危险因素聚集性的预测(β=-1.03,P<0.05)。结论:DS14显示了满意的信、效度,可用来评价我国中老年正常人群和冠心病人的D型人格。D型人格和冠心病的生物学危险因素密切相关,可能是通过生物学机制影响冠心病的预后。

Objective： To examine the validity and reliability of the Type D personality Scale（DS14） in both a coronary heart disease （CHD） sample and a normative sample. To explore the clinical characteristics of Type D personality in patients with CHD,and the interactions between Type D and classical risk factors for predicting the rate of clustering of CHD risk factors. Methods： The study included 187 patients with CHD and 453 normative subjects, and they all filled out the following scales： Demographics questionnaire and DS14. CHD patients were administered clinical examination. Results： The Cronbach’s alpha coefficients of the two subscales of DS14 ranged from 0.68～0.89, the mean inter-item correlations ranged from 0.28～0.52, the test-retest coefficients was 0.79 for NA and 0.82 for SI in the normative sample. A confirmatory factor analysis provided a good fit for a two-factor model in two samples （with χ^2/df〈5;CFI、IFI、GFI≥0.90;RMSEA≤ 0.08）. The percentage of the family history of CHD, smoking, fasting glucose, and CRP in patients with Type D personality was higher than the ones in patients without Type D （P〈0.05 ）. The interactions between SI and TC predicted increased the rate of clustering of CHD risk factors （β=1.81,P〈0.05）; while the interactions between SI and smoking exhibited decreased predictive power（β=-1.03,P〈0.05）. Conclusion： The Chinese version of the DS14 demonstrated satisfactory reliability and validity in both CHD sample and normative sample. Type D may exert influences on CHD via biological factors.