A型、D型人格影响冠心病预后的心理生理机制

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	A型、D型人格影响冠心病预后的心理生理机制
其他题名	Study on the Psychobiological Mechanism of Type－A and Type－D Personality Influencing the Prognosis of CHD
	祝卓宏
	2008-06-05
摘要	冠心病是中老年人常见的心血管疾病，也是一种典型的心身疾病。在影响冠心病患者预后的诸多心理因素中，人格因素起着重要作用。与冠心病相关人格因素主要是A型人格和D型人格。研究表明，虽然A型人格是冠心病发生的危险因素，但是冠心病确诊后，A型人格却不能很好预测冠心病的病情发展和预后。而大量研究表明，D型人格能够独立预测CHD的预后。为什么A型人格不能很好预测冠心病的预后，而D型人格却能够有效预测冠心病的预后？这一临床问题和理论问题目前一直没有得到系统回答。本课题通过一项对正常对照和冠心病患者的相关分析研究和四项应激实验研究对上述问题作出了比较系统的研究。从心理机制和自主神经反应机制两个角度基本上回答了“为什么A型人格不能很好预测冠心病的预后，而D型人格却能够有效预测冠心病的预后？”这一重要问题。本研究的主要发现和基本结论可以概括为一下几个方面： A型人格和D型人格影响冠心病预后的不同心理机制主要表现为：D型人格的两个维度均对社会支持有直接效应，而A型人格的两个维度对社会支持则没有直接或间接效应。D型人格的负性情感对于焦虑和抑郁的直接效应很显著，社会抑制对于焦虑的直接效应显著，对于抑郁的直接效应不显著。A型人格两个维度对于焦虑的直接效应显著，对于抑郁的直接效应不显著。无论是休息状态下还是腹式呼吸状态下，A型人格对健康青年男性自主神经反应均无显著影响。 A型人格和D型人格对休息状态下老年冠心病患者的自主神经反应均无显著影响。休息状态下D型人格能降低健康青年男性交感神经兴奋性，在腹式呼吸状态下D型人格因素降低青年男性的迷走神经张力。休息状态下接受主动应激时（进行心算），A型人格能增加青年男性被试的交感神经兴奋性，腹式呼吸状态下接受主动应激时（进行心算），A型人格能增加被试的迷走神经张力。无论休息还是腹式呼吸后接受主动应激时（进行心算），D型人格因素对青年男性的自主神经反应无显著影响。无论休息还是腹式呼吸后接受被动应激时（观看录像），A型人格因素对青年男性的自主神经反应无显著影响。在休息后接受被动应激时（观看录像），D型人格因素增高青年男性被试交感神经兴奋，降低迷走神经张力。腹式呼吸后接受被动应激时（观看录像），D型人格因素对青年男性被试自主神经反应无明显影响。以上这些结果表明，A型人格与D型人格对冠心病预后产生不同影响的心理机制主要表现在A型人格两个维度对社会支持没有直接和简介效应，D型人格的两个维度对社会支持均有直接和间接效应。A型人格两个维度对抑郁的直接效应不显著，而只对焦虑有直接效应。D型人格的负性情感对于焦虑和抑郁的直接效应很显著，社会抑制对于焦虑的直接效应显著，对于抑郁的直接效应不显著。而社会支持和焦虑、抑郁对冠心病的预后有比较肯定的影响。A型人格与D型人格对冠心病预后产生不同影响的生理机制主要表现在A型人格在休息状态下接受主动应激时（进行心算）能增加青年男性被试的交感神经兴奋性，而接受被动应激时（观看录像），A型人格因素对青年男性的自主神经反应无显著影响。在休息后接受被动应激时（观看录像），D型人格因素增高青年男性被试交感神经兴奋，降低迷走神经张力，而接受主动应激时（进行心算），D型人格因素对青年男性的自主神经反应无显著影响。关键词：A型人格 D型人格冠心病预后心理生理机制; Coronary heart disease （CHD）is a common cardiovascular disease in the elderly, is also a typical psychosomatic disease. Personality factors are very important in many psychological factors impacting on the prognosis of patients with CHD. The most influential personality factors to CHD are Type A and Type D personality. The previous research has shown that although Type A personality increased the prevalence of CHD, it cannot predict the development and prognosis after diagnosis. In contradict, Type D personality can predict prognosis. There is still no clinic-based or theory-based answer to the question: Why Type A personality cannot predict the outcome while Type D personality could predict the prognosis independently. The current research conducted a systematic investigation to the above question, which included one comparison study between CHD patients and control group, and four studies on reaction experiment and answered the question: why Type A personality cannot predict whereas Type D personality could effectively predict prognosis of CHD. The findings of the current research were: Type A and Type D personality influence CHD prognosis through different psychological mechanisms: both dimensions of Type D personality have direct influence on social support, whereas neither dimensions of Type A personality related to social support, directly of indirectly. Negative affection component of Type D personality significantly related to anxiety and depression, Social repression significantly related to anxiety but not depression. Both dimensions of Type A personality significantly related to anxiety but not depression. Neither under rest or diaphragmatic breathing conditions, Type A personality had no significant influence on vestibular autonomic reaction among healthy young males. Neither Type A nor Type D personality had significant influence on vestibular autonomic reaction among old CHD patients under rest condition. Type D personality predicted lower sympathetic excitation under rest condition, and lower cardiac vagal tone under diaphragmatic breathing condition among healthy young males. When actively reacted to stimuli (math calculation) under rest condition, Type A personality increased sympathetic excitation among healthy young males. When actively reacted to stimuli (math calculation) under diaphragmatic breathing condition, Type A personality increased cardiac vagal tone among the same group of subjects. When actively reacted to stimuli under neither condition, Type D personality showed no significant influence on vestibular autonomic reaction among young males. When passively reacted to stimuli under neither condition, Type A personality showed no significant influence on vestibular autonomic reaction among young males. When passively stimulated followed rest, Type D personality increased sympathetic excitation and decreased cardiac vagal tone among young males. When passively stimulated followed diaphragmatic breathing, Typed showed no significant influence on vestibular autonomic reaction among young males. The above results indicated that Type A and Type D personalities had different psychological mechanisms to the outcome of CHD treatment: neither dimensions of Type A personality had direct or indirect effects on social support; both dimensions of Type D personality had direct and indirect effects on social support. Negative affection component of Type D personality significantly related to anxiety and depression, Social repression significantly related to anxiety but not depression. Both dimensions of Type A personality significantly related to anxiety but not depression. Social support positively related to the outcome after CHD treatment. The biological mechanisms of Type A and Type B personality to CHD prognosis differed in the following ways: Type A personality increased sympathetic excitation when actively stimulated, but had no influence when passively stimulated among young male subjects. When passively stimulated after rest, Type D personality predicted high sympathetic excitation and low cardiac vagal tone among young males, but not vestibular autonomic reaction among young males. Key words: Type A personality, Type D personality, Coronary Heart Disease (CHD), Prognosis, Psychobiological Mechanisms
关键词	A型人格 D型人格冠心病预后心理生理机制
学位类型	博士
语种	中文
学位授予单位	中国科学院心理研究所
学位授予地点	心理研究所
文献类型	学位论文
条目标识符	http://ir.psych.ac.cn/handle/311026/4582
专题	中国科学院心理研究所回溯数据库(1956-2010)
推荐引用方式 GB/T 7714	祝卓宏. A型、D型人格影响冠心病预后的心理生理机制[D]. 心理研究所. 中国科学院心理研究所,2008.

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