D型人格與血壓及心臟自主神經活動之關聯性：以高血壓患者為例

Association of Type D personality with the blood pressure and autonomic response among hypertensive patients

涂逸儒(YI-RU TU)

指導教授 ： 翁嘉英

國立中正大學/社會科學院/臨床心理學研究所/碩士(2016年)

摘要

摘要
目的：本研究旨在檢驗D型人格特質(包含「負向情緒」及「社交抑制」兩項構成要件)於高血壓族群，在生氣情緒誘發下，與血壓及心臟自主神經反應之關聯性，以了解D型人格對於高血壓疾病預後之可能影響。
方法：本研究資料取自民國102年翁嘉英教授主持的科技部專題研究計畫(NSC 102-2410-H-194-022)，作者為本研究計畫之兼任助理，經翁嘉英教授之指導，負責部分為計畫撰寫以及問卷施測。本研究採用實驗室研究，於南部某綜合醫院家醫科及心臟科門診邀請高血壓族群參與，排除精神疾病、心臟疾病、癌症病史、腎臟疾病、神經系統疾病等，最終納入69人進行資料分析，平均年齡55歲(SD=8.33)，女性比例為49.3%。以雙盲設計進行實驗，並使用生氣回憶作業誘發研究參與者情緒及生理反應。生氣回憶作業以下四個五分鐘的階段：基準期、生氣回憶期、生氣陳述期、恢復期。Ｄ型人格評估使用台灣Ｄ型人格量表。結果：研究結果發現，D型人格作為類別變項時，男性Ｄ型人格者相較於非Ｄ型人格者，在整個實驗階段有較高的收縮壓及舒張壓水準(收縮壓：F(1,17)= 6.571, p< .05，舒張壓：F(1,17)= 6.920, p< .05)；而Ｄ型人格連續變項「負向情感」*「社交抑制」在恢復期與更高收縮壓反應有關("β" = 2.411, p<.05)。進一步分析，「社交抑制」特質在男性樣本，與恢復期較高的交感神經優勢(sympathetic dominance)有關("β" = .511, p<.05)有關；「負向情感」特質在女性樣本，與生氣回憶期及生氣陳述期較高的副交感神經活性有關("β" = .838, p<.01)。
結論：本研究結果支持在高血壓患者中，D型人格與生氣情境下血壓反應之關聯性；同時，D型人格與心臟自主神經反應亦有關聯性，本研究推論心臟自主神經系統失衡，可能為連結D型人格與高血壓疾病心理生理病理路徑之一。

關鍵字：D型人格、心血管疾病、自主神經失衡、心跳變異率、血壓、交感神經、副交感神經

關鍵字

副交感神經 ； 交感神經 ； 血壓 ； 心跳變異率 ； 自主神經失衡 ； 心血管疾病 ； D型人格

並列摘要

Abstract
Objective:The association between Type D personality and the higher prevalence of hypertensive disease has been proved by empirical research. But the psychopathological mechanisms linking the disease course and Type D personality are largely unknown with autonomic imbalance is one of the candidates. Therefore, the purpose of this study is to examine the association between Type D personality and autonomic nervous system (ANS) reactivity during anger recall task among patients with hypertension disease.Method: The database collected by the projects supported by the grants from Ministry of Science and Technology(NSC 102-2410-H-194-022) to Chia-Ying Weng. The author served as a part-time research assistant in the project, and participated in parts of drafting the projects proposals, and collecting through survey administraction.Under the supervision and assistance of Chia-Ying Weng. Seventy- one (mean age = 55, SD 8.33 years; female=49.29% ) patients with hypertension were recruited from a general hospital in Taiwan. Type D personality was assessed by Type D Scale-14-Taiwanese version which includes two subscales, Negative affectivity (NA) and Social inhibition (SI).Participants underwent the anger recall task and their heart rate variety (HRV) was recorded during the following stages: baseline (B), anger recall (AR), anger description (AD), and recovery (R). Result:In male, the systolic and diastolic blood pressure (SBP: F(1,17)= 6.571, p< .05; DBP: F(1,17)= 6.920, p< .05) of participants with Type D personality was higher than that of the non-TD counterpart.In male, Social Inhibition was positively correlated with LF/HF ("β" = .511, p<.05) during recovery stage. In female, Negative affectivity was positively correlated with ln(HF) ("β" = .838, p<.01) during anger recall stage.Conclusion: The results of this study demonstrated that male hypertension patients with Type D personality perform higher blood pressure.The male hypertension patients with higher Social Inhibition trait showed the pattern of the sympathetic dominance during a 5-min period after anger elicited state, which might link Type D personality to the higher risk of poor prognosis of hypertensive disease.

Key word:Type D personality, cardiovascular disease, autonomic imbalance, heart rate variability, blood pressure, sympathetic nervous system, parasympathetic nervous system

並列關鍵字

blood pressure ； sympathetic nervous system ； parasympathetic nervous system ； heart rate variability ； autonomic imbalance ； cardiovascular disease ； Type D personality

參考文獻

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