心理因素与颞下颌关节紊乱病的关系研究

Study on the relationship between psychological factors and temporomandibular joint disorders

目的 探讨颞下颌关节紊乱病(TMD)与焦虑、抑郁以及人格特征(外倾性、神经质、精神质)的关系。方法 选取2021年4月—2022年7月就诊于南京大学医学院附属口腔医院颞下颌关节科和正畸科门诊的235名TMD患者,进行信息收集和问卷调查,以Zung氏焦虑自评量表(SAS)、抑郁自评量表(SDS)和艾森克人格问卷(EPQ)评估其心理状态和人格特征,以Helkimo临床功能障碍指数(Di)评估TMD症状水平,应用单样本t检验、Pearson相关性分析、多元逐步回归分析TMD与心理因素之间的相关性。结果 问卷有效应答率92.3%,研究组男女患者焦虑、抑郁评分高于健康人群、外倾性低于全国常模,女性患者精神质评分高于全国常模,其余与常模相比无显著统计学差异,Pearson相关性分析显示Di与神经质、精神质、焦虑、抑郁程度、病程成正相关,与外倾程度负相关。多元逐步回归分析显示焦虑、抑郁、精神质、病程都对Di产生正向影响,外倾性对Di产生反向影响;另外,女性性别、伴磨牙症、偏侧咀嚼或者喜食硬物也对Di有正向影响。结论 焦虑、抑郁、精神质可被视为TMD加重的风险因素。

Objective To explore the relationship between temporomandibular disorders(TMD)and anxiety,depression,personality traits(extroversion,neuroticism,psychoticism).Methods From April 2021 to July 2022,235 TMD patients who visited the Department of Temporomandibular Joint and Orthodontics of Affiliated Stomatology Hospital of Medical School,Nanjing University were selected for information collection and questionnaire survey.Zung’s Anxiety Self-Rating Scale(SAS),Self-Rating Depression Scale(SDS)and Eysenck Personality Questionnaire(EPQ)were used to evaluate their mental state and personality traits,Helkimo clinical symptom index(Di)was used to evaluate the level of TMD symptoms,and the One Sample t test,Pearson correlation analysis and multiple linear regression analysis were used to analyze the correlation between TMD and psychological factors.Results The effective response rate of the questionnaire was 92.3%.The Anxiety and Depression scores of the research group were higher than those of the healthy group;the Extraversion was lower than the national norm,and the Neuroticism and Psychotic scores of females were higher than the national norm.There were no statistical differences in the rest.Pearson correlation Sexual analysis showed that Di was positively correlated with the degree of nervousness,psychosis,anxiety,depression,and disease duration and negatively correlated with the degree of extraversion.Multiple stepwise regression analysis showed that Di increased with the increase of anxiety,depression,psychosis,and course of disease scores,and the decrease of extraversion scores.The Di score of female patients was significantly higher than that of male patients.Bruxism and lateralization also had positive effects on Di score.The Di score of TMD patients who chewed or liked to eat hard objects was significantly higher than that of those without accompanying symptoms.Conclusion Anxiety,depression and psychoticism can be regarded as risk factors for TMD aggravation.