D型人格对成人先天性心脏病患者死亡率影响的队列研究

doi:10.3969/j.issn.1004-583X.2022.05.005

摘要/Abstract

摘要：

目的研究成人先天性心脏病患者中D型人格对死亡率的影响。方法纳入中国科学技术大学附属第一医院2016年4月-2020年4月心血管内科门诊及病房就诊的成人先天性心脏病患者287例,采用D型人格量表评估是否具有D型人格,随访至2021年4月结束。进一步比较D型人格与非D型人格先天性心脏病患者的一般资料及死亡率有无差异。结果最终入组263例患者,其中124例为男性,平均(49.4±7.1)岁。D型人格者62例。D型人格患者更容易出现NYHA分级II级以上的心功能,罹患慢性肾脏病(12.9% vs 4.5%,P=0.039),无业(32.3% vs 20.0%,P=0.043)及单身(35.5% vs 20.1%,P=0.019)的比例均更高。随访结束发现,D型人格的先天性心脏病患者较无D型人格者的生存率明显变差(82% vs 87%,P=0.014),在Cox比例风险回归模型分析中,D型人格是死亡的明显预测因子(风险比1.85,95%置信区间1.12-3.04,P=0.015)。结论成人先天性心脏病患者中D型人格可以预测死亡率,护理工作中需注意评估。

关键词: D型人格, 先天性心脏病, 死亡率

Abstract:

Objective To study the effects of type D personality on mortality of adults with congenital heart disease (CHD).Methods Two hundred and eighty seven adult patients with CHD admitted to the Department of Cardiovascular Medicine, the First Affiliated Hospital of University of Science and Technology of China from April 2016 to April 2020 were included in the study. Type D personality scale was applied to evaluate if the patients had Type D personality, the follow-up was ended in April 2021. The differences in general data and mortality of patients with type D personality and those without type D personality were further compared. Results A total of 263 patients were enrolled, 124 were male with average age of (49.4±7.1) years, 62 patients were found to have type D personality. Patients with type D personality were more likely to have NYHA II or higher cardiac function, and were more likely to have higher percentage for chronic kidney disease (12.9% vs 4.5%, P=0.039), unemployed status (32.3% vs 20.0%, P=0.043), and single (35.5% vs 20.1%, P=0.019). The patients with type D personality were found to have significantly worse survival than those without type D personality (82% vs 87%, P=0.014) at the end of the follow-up. Type D personality was noted to be significant predictor of death (hazard ratio of 1.85, 95% confidence interval 1.12-3.04, P=0.015) in Cox proportional hazard regression model analysis. Conclusion Type D personality is eligible to predict the mortality rate in adults with CHD, and need to pay attention to assessment in nursing work.

Key words: type D personality, congenital heart disease, mortality

中图分类号:

R541

李莉, 白璐, 孙明裕, 张世阳. D型人格对成人先天性心脏病患者死亡率影响的队列研究[J]. 临床荟萃, 2022, 37(5): 418-421.

Li Li, Bai Lu, Sun Mingyu, Zhang Shiyang. Cohort study on effects of type D personality on mortality of adults with congenital heart disease[J]. Clinical Focus, 2022, 37(5): 418-421.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.05.005

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I5/418

图/表 2

参考文献 17

[1]	Stefanie D, Annemiek K, Johan D, et al. Situation selection and modification in social inhibition: A person-centered approach[J]. Anxiety Stress Coping, 2021, 34(6):658-671. doi: 10.1080/10615806.2021.1908541 URL
[2]	Wei Lü, Ziyan Yao. Type D personality and blunted cardiovascular stress reactivity: Role of task engagement[J]. Br J Health Psychol, 2021, 26(2):385-400. doi: 10.1111/bjhp.12488 pmid: 33159832
[3]	Sung RK, Sunho K, Bang HC, et al. Influence of type D personality on health promoting behaviours and quality of life in stroke patients: A cross-sectional study in south Korea[J]. J Stroke Cerebrovasc Dis, 2021, 30(5):105721. doi: 10.1016/j.jstrokecerebrovasdis.2021.105721 URL
[4]	Sebastian BUJ, Federica B, Brian ML, et al. Type D personality is associated with depressive symptoms and clinical activity in inflammatory bowel disease[J]. Aliment Pharmacol Ther, 2021, 54(1):53-67. doi: 10.1111/apt.16365 URL
[5]	Nefs G, Speight J, Pouwer F, et al. Type D personality, suboptimal health behaviors and emotional distress in adults with diabetes: Results from Diabetes MILES-The Netherlands[J]. Diabetes Res Clin Pract, 2015, 108(1):94-105. doi: 10.1016/j.diabres.2015.01.015 URL
[6]	Raykh OI, Sumin AN, Korok EV, et al. The influence of personality type D on cardiovascular prognosis in patients after coronary artery bypass grafting: Data from a 5-year-follow-up study[J]. Int J Behav Med, 2022, 29(1):46-56. doi: 10.1007/s12529-021-09992-y URL
[7]	Schoormans D, Mulder BJ, vanMelle JP, et al. Patients with a congenital heart defect and type D personality feel functionally more impaired, report a poorer health status and quality of life, but use less healthcare[J]. Eur J Cardiovasc Nurs, 2012, 11(3):349-355. doi: 10.1177/1474515112437828 URL
[8]	于肖楠, 张建新. D型人格量表(DS14)在中国两所大学生样本中的试用[J]. 中国心理卫生杂志, 2006, 20(5):313-316.
[9]	刘赢, 林平, 赵振娟. D型人格调控认知评价在急性心肌梗死患者ASD演变为PTSD的中介机制研究[J]. 中华现代护理杂志, 2021, 27(18):2430-2436.
[10]	Verhey FRJ, Pouwer F, et al. Association of type D personality with increased vulnerability to depression: Is there a role for inflammation or endothelial dysfunction?- the Maastricht study[J]. J Affect Disord, 2016, 189:118-125. doi: 10.1016/j.jad.2015.09.028 URL
[11]	Jandackova VK, Koenig J, Jarczok MN, et al. Potential biological pathways linking type-D personality and poor health: A cross-sectional investigation[J]. PLoS One, 2017, 12(4):e0176014. doi: 10.1371/journal.pone.0176014 URL
[12]	Rassart J, Apers S, Kovacs AH, et al. Illness perceptions in adult congenital heart disease: A multi-center international study[J]. Int J Cardiol, 2017, 244:130-138. doi: 10.1016/j.ijcard.2017.06.072 URL
[13]	Benderly M, Kalter LO, Weitzman D, et al. Depression and anxiety are associated with high health care utilization and mortality among adults with congenital heart disease[J]. Int J Cardiol, 2019, 276:81-86. doi: S0167-5273(18)33988-3 pmid: 30224258
[14]	Cao X, Wong EML, Chow CK, et al. Interventions for cardiovascular patients with type D personality: A systematic review[J]. Worldviews Evid Based Nurs, 2016, 13(4): 314-323. doi: 10.1111/wvn.12153 URL
[15]	Herrmann-Lingen C, Beutel ME, Bosbach A, et al. A stepwise psychotherapy intervention for reducing risk in coronary artery disease (SPIRR-CAD): Results of an observer-blinded, multicenter, randomized trial in depressed patients with coronary artery disease[J]. Psychosom Med, 2016, 78(6):704-715. doi: 10.1097/PSY.0000000000000332 pmid: 27187851
[16]	邢程, 仲青, 李冬灵. 微信群干预对房颤术后出院患者华法林用药依从性及自我护理能力的影响[J]. 齐齐哈尔医学院学报, 2020, 41(10):1305-1307.
[17]	Bundgaard JS, Østergaard L, Gislason G, et al. Association between type D personality and outcomes in patients with non-ischemic heart failure[J]. Qual Life Res, 2019, 28(11):2901-2908. doi: 10.1007/s11136-019-02241-6 pmid: 31292822

项目	D型人格组 (n=62)	非D型人格组 (n=201)	t/Z/ χ²值	P值
年龄(岁)	48.3±6.2	49.8±7.4	0.720	0.472
男[例(%)]	29(46.8)	95(47.3)	0.005	0.946
心功能分级(NYHA 分级)[例(%)]
Ⅰ	36(58.1)	155(77.1)
Ⅱ	17(27.4)	34(16.9)	9.398	0.024
Ⅲ	6(9.7)	8(4.0)
Ⅳ	3(4.8)	4(2.0)
先天性心脏病严重性 [例(%)]
轻微型中重度型	37(59.7) 25(40.3)	117(58.2) 84(41.8)	0.042	0.837
左室射血分数(%)	41.37±18.62	40.15±17.90	0.646^*	0.518
收缩压(mmHg)	104.15±15.08	105.41±16.23	0.472	0.637
心室率(次/min)	77.19±12.43	76.53±12.08	0.225	0.822
糖尿病史[例(%)]	5(8.1)	8(4.0)	0.925	0.336
慢性肾脏病史[例(%)]	8(12.9)	9(4.5)	4.257	0.039
抑郁症状[例(%)]	14(22.6)	4(2.0)	28.363	<0.01
无业状态[例(%)]	20(32.3)	40(20.0)	4.109	0.043
单身状态[例(%)]	22(35.5)	42(20.9)	5.477	0.019

项目	D型人格组 (n=62)	非D型人格组 (n=201)	t/Z/ χ²值	P值
年龄(岁)	48.3±6.2	49.8±7.4	0.720	0.472
男[例(%)]	29(46.8)	95(47.3)	0.005	0.946
心功能分级(NYHA 分级)[例(%)]
Ⅰ	36(58.1)	155(77.1)
Ⅱ	17(27.4)	34(16.9)	9.398	0.024
Ⅲ	6(9.7)	8(4.0)
Ⅳ	3(4.8)	4(2.0)
先天性心脏病严重性 [例(%)]
轻微型中重度型	37(59.7) 25(40.3)	117(58.2) 84(41.8)	0.042	0.837
左室射血分数(%)	41.37±18.62	40.15±17.90	0.646^*	0.518
收缩压(mmHg)	104.15±15.08	105.41±16.23	0.472	0.637
心室率(次/min)	77.19±12.43	76.53±12.08	0.225	0.822
糖尿病史[例(%)]	5(8.1)	8(4.0)	0.925	0.336
慢性肾脏病史[例(%)]	8(12.9)	9(4.5)	4.257	0.039
抑郁症状[例(%)]	14(22.6)	4(2.0)	28.363	<0.01
无业状态[例(%)]	20(32.3)	40(20.0)	4.109	0.043
单身状态[例(%)]	22(35.5)	42(20.9)	5.477	0.019