膳食炎症指数与全身免疫炎症指数在D型人格与冠心病患者轻度认知功能障碍间的多重中介效应

Multiple mediating effects of dietary inflammation index and systemic immune inflammation index between type D personality and mild cognitive impairment in patients with coronary heart disease

目的探讨D型人格对冠心病患者轻度认知功能障碍(MCI)的影响及膳食炎症指数(DII)与全身免疫炎症指数(SII)在D型人格与MCI之间的多重中介作用。方法采用横断面研究方法, 便利抽样法选取2022年5月至2023年3月在哈尔滨医科大学附属第二医院经冠状动脉造影确诊为冠心病的321例患者为研究对象, 采用一般资料调查表、D型人格量表、蒙特利尔认知评估量表、半定量食物频率问卷进行资料收集, 使用DII、SII分别评价膳食炎症潜能及机体炎症状态, 采用结构方程模型对D型人格、DII、SII、MCI之间的关系进行中介效应分析。结果回收有效问卷306份。306例患者中男215例(70.3%), 女91例(29.7%);年龄27 ~ 70(59.24 ± 9.16)岁。结构方程模型显示D型人格可直接影响MCI(效应值= - 1.098, 95%CI - 1.869 ~ - 0.327), 也可通过DII(效应值= - 0.374, 95%CI - 0.644 ~ - 0.128)和SII(效应值= - 0.450, 95%CI - 0.806 ~ - 0.132)的单中介及DII与SII的链式中介(效应值= - 0.146, 95%CI - 0.293 ~ - 0.027)介导冠心病患者MCI的发生。结论 D型人格、DII和SII均能影响冠心病患者MCI的发生, 且DII和SII在D型人格与冠心病患者MCI之间起到多重中介作用。临床及社区护士可通过早期筛查冠心病患者中的D型人格个体, 改善其不健康的膳食行为, 降低机体炎症反应水平, 延缓MCI的发生发展。

Objective To explore the effects of type D personality on mild cognitive dysfunction(MCI)in patients with coronary heart disease and the multiple mediating roles of dietary inflammation index(DII)and systemic immune inflammation index(SII)between type D personality and MCI.Methods A cross-sectional study was used.A total of 321 patients diagnosed with coronary heart disease by coronary angiography in the Second Affiliated Hospital of Harbin Medical University from May 2022 to March 2023 were selected as the study objects by convenient sampling method.General Information Questionnaire,Type-D Personality Scale-14,Montreal Cognitive Assessment,and Semi-Quantitative Food Frequency Questionnaire were employed for data collection.DII and SII were used to evaluate dietary inflammatory potential and systemic inflammatory status,respectively.Structural equation modeling was utilized to analyze the mediating effectsamong type D personality,DI,SII and MCI.Results A total of 306 valid questionnaires were collected.Among the 306 patients,there were 215 males(70.3%)and 91 females(29.7%),aged 27-70(59.24±9.16)years old.The structural equation model showed that type D personality could directly influence MCI(effect size=-1.098,95%CI-1.869-0.327),and could also mediate the occurrence of MCI in coronary heart disease patients through the single mediation of DII(effect size=-0.374,95%CI-0.644-0.128)and SII(effect size=-0.450,95%CI-0.806-0.132),as well as the chain mediation of DII and SII(effect size=-0.146,95%CI-0.293-0.027).Conclusions Type D personality,DII and SII can affect the occurrence of MCI in CHD patients,and DII and SII play multiple mediating roles between type D personality and MCI in patients with coronary heart disease.Clinical and community nurses can improve the unhealthy dietary behavior,reduce the level of inflammation and delay the occurrence and development of MCI by early screening of type D personality in patients with coronary heart disease.