D型人格与冠心病患者身心健康的关系

D型人格（指经历消极情感和社交压抑的综合行为模式）作为冠心病的心理危险因素，得到了广泛的关注。本研究在中国人群中首次探索D型人格与冠心病的关系。作者建构了心理、行为、生理、医学相结合的综合研究框架，采用问卷调查法、临床实验法以及访谈法，考察D型人格对冠心病患者身心健康的影响，以及可能的行为和生理机制。结果表明： 1．D型人格量表中文版具有良好的信度和效度。根据消极情感≧10且社交压抑≧10的划分标准，D型人格在我国冠心病人群和健康人群中的分布比例均为31％。 2．A型人格与D型人格的共同点在于消极情感，区别在于D型人格具有特殊的社交压抑结构。我国冠心病患者中A型人格比例（58％）高于健康人群（43％）。 3．A型人格与冠心病的病情（即冠状动脉狭窄程度）、患者的自评身心健康均无关。D型人格与冠心病的病情无关，但D型人格能够独立地预测自评身心健康的下降，并且不依赖于疾病状况（患病或健康）。 4．D型人格患者在应对疾病的过程中，更多地采用屈服，更少地采用面对。疾病应对方式对D型人格与患者自评身心健康的关系起中介作用。 5．在冠状动脉造影的应激条件下，冠心病患者的D型人格总分与应激下心血管反应无关，但男性患者的消极情感、社交压抑能够预测应激下舒张压反应。 此外，本研究的结果具有重要的临床价值，比如采用D型人格量表中文版鉴别高危人群以提高他们的身心健康水平，在进行D型人格干预时要关注行为方式，在对冠心病进行预防和治疗时要注意心理生理反应的性别差异等。

A型、D型人格影响冠心病预后的心理生理机制

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