D型人格与自发性心绞痛关联性的回顾性队列研究

A retrospective cohort study of the relationship between type D personality and spontaneous angina pectoris

目的探究D型人格对冠状动脉粥样硬化性心脏病(冠心病)患者自发性心绞痛发作的影响。方法收集2016年1月至2019年1月收治的首次确诊冠心病患者建立回顾性队列研究,记录随访期间自发性心绞痛发作情况,将患者分为发作组与对照组。采用t检验或卡方检验分析两组患者基线特征及人格特征差异,并采用Logistic回归模型分析D型人格与自发性心绞痛的关系。结果共448例冠心病患者进入队列,其中D型人格94例(20.98%)。随访至2020年1月31日,共176例(39.29%)患者发生自发性心绞痛。与对照组患者相比,发作组合并原发性高血压(高血压)、吸烟患者比例明显较高,Gemini积分、左心室舒张末期容积(EDV)、收缩末期容积(ESV)及全血黏度(高切/低切)、血浆黏度明显高,左心室射血分数(LVEF)明显低,且有D型人格者所占比例明显高,差异均有统计学意义(P<0.05)。与非D型人格患者相比,D型人格患者中自发性心绞痛发作次数与发作时主观疼痛评分明显更高,单次发作持续时间明显更长,均差异有统计学意义(P<0.05),且相关性分析显示D型人格患者消极情感(negative affectivity,NA)评分与社会抑制(social interference,SI)评分与自发性心绞痛发作次数、单次发作持续时间、发作时主观疼痛评分均呈正相关(P<0.05)。非条件Logistic回归分析显示Gemini积分、左心室射血分数、D型人格为冠心病患者发生自发性心绞痛的独立危险因素(P<0.05)。结论冠心病患者中D型人格占比较高,其是冠心病患者自发性心绞痛发作的独立危险因素,且与自发性心绞痛程度密切相关,临床应从人格特征方面着手给予适当干预。

Objectives To investigate the effect of type D personality on spontaneous angina pectoris in patients with coronary heart disease.Methods A retrospective cohort study was conducted in the first confirmed patients with coronary heart disease between January 2016 and January 2019.The incidence of spontaneous angina pectoris during follow-up was recorded.The patients were divided into attack group and control group.The t-test or chi-square test was used to analyze the differences in baseline characteristics and personality characteristics between the two groups,and the relationship between type D personality and spontaneous angina pectoris was analyzed using Logistic regression model.Results A total of 448 patients with coronary heart disease were enrolled in the study,including 94 cases(20.98%)with type D personality.The subjects were followed up till January 31,2020,and a total of 176 cases(39.29%)had spontaneous angina pectoris.Compared with control group,the proportions of patients with hypertension and smokers,the Gemini score,left ventricular end-diastolic volume(EDV),end-systolic volume(ESV),whole blood viscosity(high-shear/low-shear),plasma viscosity and the proportion of patients with type D personality were significantly high⁃er;the left ventricular ejection fraction(LVEF)was significantly lower in attack group(P<0.05).The average number of episodes and subjective pain scores during attack of patients with spontaneous angina pectoris and type D personali⁃ty were significantly higher,and the duration of a single episode was significantly longer than those without type D per⁃sonality(P<0.05).The correlation analysis showed that the negative affectivity(Na)score and social interference(Si)score of patients with type D personality were positively correlated with the average attack times,single attack duration and subjective pain score(P<0.05).Unconditional Logistic regression analysis showed that Gemini score,LVEF and type D personality were independent risk factors for spontaneous angina pectoris in patients with coronary heart disease(P<0.05).Conclusions The proportion of patients with type D personality in patients with coronary heart disease is high.It is an independent risk factor for spontaneous angina pectoris in patients with coronary heart disease,and it is closely related to the degree of spontaneous angina pectoris.Clinically,appropriate intervention should be car⁃ried out from the perspective of personality characteristics.