颞下颌关节紊乱病不同症状患者心理因素调查

Investigation of psychological factors in patients with different symptoms of temporomandibular disorders

目的研究颞下颌关节紊乱病(TMD)不同症状患者心理社会因素,尤其是焦虑的差别,为心理治疗对策提供试验依据。方法 206例就诊于天津医科大学口腔医院的TMD患者和201名无症状志愿者,填写症状自评量表(SCL-90)和状态-特质焦虑问卷(STAI),根据患者主诉分组。采用SPSS 17.0统计软件,采用独立样本t检验和单因素方差分析对所有数据进行统计学分析。结果(1)TMD患者SCL-90量表中的躯体化、抑郁、焦虑、敌对、精神病性因子得分及总分高于无症状志愿者,差异有统计学意义(t躯体化=3.79,P躯体化=0.000;t抑郁=2.14,P抑郁=0.033;t焦虑=2.91,P焦虑=0.004;t敌对=3.93,P敌对=0.000;t精神病性=2.48,P精神病性=0.013;t总分=2.80,P总分=0.005);女性TMD患者的状态焦虑及特质焦虑得分均高于女性无症状志愿者(t状态焦虑=3.52,P状态焦虑=0.001;t特质焦虑=4.26,P特质焦虑=0.000),两组男性之间差异无统计学意义(t状态焦虑=0.36,P状态焦虑=0.718;t特质焦虑=0.76,P特质焦虑=0.453);(2)不同症状TMD患者在躯体化和状态焦虑方面差异有统计学意义(F躯体化=2.714,P躯体化=0.046;F特质焦虑=3.007,P特质焦虑=0.031),具有单纯疼痛症状者躯体化得分高于单纯弹响患者(P=0.005),单纯弹响及疼痛伴弹响患者的特质焦虑得分高于疼痛伴开口受限者(P=0.016)。结论 TMD患者心理健康水平比无症状人群低,主要表现在躯体化、抑郁、焦虑、敌对和精神病性方面。女性TMD患者有明显焦虑特征。单纯疼痛TMD患者躯体化比单纯弹响者更为明显。

Objective To compare the psychosocial factors especially anxiety in patients with different symptoms of temporomandibular disorders（TMD）and provide evidence for psychotherapy strategies of patients with TMD. Methods Totally 206 patients visited TMD clinic of stomatological hospital of Tianjin Medical University and 201 asymptomatic volunteers were included in this study. Symptom Checklist 90（SCL-90）and State-Trait Anxiety Inventory（STAI）were used to assess the psychological status. The patients were classified according to the chief complaints. The datas were analyzed by SPSS 17.0. Results There was a statistically significant difference（tsomatization=3.79,Psomatization=0.000;tdepres ion=2.14,Pdepres ion=0.033;tanxiety=2.91,Panxiety=0.004;thostility=3.93,Phostility=0.000;tpsychoticism=2.48,Ppsychoticism=0.013;ttotal=2.80,Ptotal=0.005）in the scores of SCL？90 between the patients and the volunteers,the patients got higher scores on the somatization,depression,anxiety,hostility,psychoticism and the total score of SCL？90. Both scores of state anxiety inventory and trait anxiety inventory in female patients were significantly higher than the female volunteers（tS？AI=3.52,PS？AI=0.001;tT？AI=4.26,PT？AI=0.000）,but＆nbsp;there was no difference between male patients and volunteers（tS？AI=0.36,PS？AI=0.718;tT？AI=0.76,PT？AI=0.453）. The scores of somatization and trait？anxiety were different among patients with different TMD symptoms（Fsomatization=2.714,Psomatization=0.046;FT？AI=3.007,PT？AI=0.031）. Patients with pain symptom had a higher somatization score than those with clicking symptom （P=0.005）. The trait？anxiety score of patients who had clicking with or without pain were higher than those had pain with limited opening（P=0.016）. Conclusions The level of psychological health of TMD patients were lower than the controls, focusing on somatization,depression,anxiety,hostility and psychoticism. The female TMD paients had the more obvious anxiety. Somatization in patients with pain were more obvious than patients with clicking.