在誘發生氣情境下血管收縮與擴張兩組之D型人格與自主神經系統反應之關聯性比較：以高血壓患者為例

The relationship between Type D personality and autonomic nervous responses in the peripheral vasoconstriction or vasodilation group during the anger recall task among hypertensive patients

紀慧菁(HUI-JING JI)

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

目的：本研究探討高血壓患者在生氣情境下，典型末梢血管收縮組與非典型末梢血管擴張兩者，在是否合併D型人格特質下，其自主神經活動之變化情形。方法：本研究資料取自於民國102年翁嘉英教授所主持之科技部研究計畫(NSC102-2410-H194-022)，研究參與者共納入南部某綜合醫院家醫科及心臟內科之72位高血壓患者(平均55.37 ± 8.69歲，男性佔45.80%)，排除心血管疾病、中風、神經系統疾病、腎臟疾病、肝臟疾病，以及精神疾病之患者。D型人格評估，使用臺灣版D型人格量表，分為負向情感與社交抑制兩個分向度；所有參與者皆經歷實驗室生氣回憶作業，包含適應期、基準期、生氣回憶期、生氣陳述期與恢復期，共五個實驗階段之血流脈波振幅(blood volume amplitude, BVA)與自主神經指標訊號收集。並使用生氣陳述期/基準期之BVA反應量，並乘以100，定義為反應量百分比，作為分組的依據：(1)典型血管收縮組(n = 48, 年齡54.15 ± 12.24歲，男性43.75%)：BVA ≤ 100%；(1)非典型血管擴張組(n = 24, 年齡55.45 ± 7.45歲，男性50.00%)：BVA > 100%。兩組間之性別、年齡皆無顯著差異(t = -0.46, p = .646; χ2 = 0.08, p = .773)。結果：有67%的參與者在生氣情境下會出現典型血管收縮反應，而有33%的參與者在休息狀態下血管較為緊縮，而在生氣情境下出現非典型血管擴張反應。非典型血管擴張組在基準期與生氣回憶期之BVA皆顯著小於典型血管收縮組(F = 11.34, p < .001, ηp2 = .048; F = 4.95, p = .027, ηp2 = .022)。在非D型人格特質者，非典型血管擴張組之整體心跳變異(F = 7.29, p = .009, ηp2 = .098 )與副交感神經活動(F = 5.42, p = .023, ηp2 = .075)皆顯著低於典型血管收縮組；而在非典型血管擴張組中，D型人格特質者之整體心跳變異(F = 5.43, p = .023, ηp2 = .075)與副交感神經活動皆顯著高於非D型人格特質者(F = 6.21, p = .015, ηp2 = .085)。結論：(1)在休息狀態下，擴張組之BVA顯著低於收縮組；然而，整體心跳變異、副交感神經、交感與副交感神經平衡，與收縮組並無顯著差異，顯示擴張組在基準期之血管緊縮狀態與自主神經活動無明顯關聯性。(2)在生氣情境下，擴張組與收縮組同樣出現副交感神經明顯退縮，且整體心跳變異與交感與副交感平衡明顯增加，再次支持血管收縮與擴張之不同反應型態與自主神經變化無關。(3)本研究進而合併不同血管反應分組與是否具有D型人格特質者，探討其自主神經反應型態，結果發現，(A)在收縮組中，是否合併D型人格特質兩組，其自主神經反應並無明顯差異。(B)在擴張組中，D型人格特質者之整體心跳變異與副交感神經活動顯著高於一般非D型人格者，不僅整體ANS活化程度較高，副交感神經在生氣描述時，亦出現明顯撤除反應。由於其副交感神經活動雖明顯撤除，然整體ANS活性仍相當高，故本研究推論其交感神經活動並無撤除現象。在交感神經依然活躍的情況下，血管並未進一步緊縮，反而出現擴張反應，推論個體可能欲維護血管運作功能，而啟動其他血管調節機制，而引發血管擴張反應。相對的，在一般非D型人格特質的血管擴張組，雖同樣出現血管在基準期已開始緊縮，生氣描述時反而擴張之反應。然而，其ANS整體調節活性相較於其他各組明顯低下，相關機制有待進一步探討。

關鍵字

心跳變異率 ； 非典型血管擴張反應 ； D型人格特質

並列摘要

Objective: The purpose of this study is to examine the relationships between peripheral vascular responses with type D personality traits and heart rate variability (HRV) during the anger-induced task. Methods: 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. Seventy-two adults with elevated blood pressure were recruited (age: 55.37 ± 8.69, male: 45.80%). The excluded criteria were coronary artery disease, stroke, neurologic diseases, liver diseases, kidney diseases and mental disorders. Type D personality was assessed by Type D Scale-14-Taiwanese version which includes two subscales, negative affectivity (NA) and social inhibition (SI). Blood volume amplitude (BVA) and HRV indices were collected during the following five stages of the anger recall task: adaptation, baseline, anger recall, anger description, and recovery. The participants were then divided into the following two groups by anger description reactivity in BVA (%): (1) typical vasoconstriction group (n = 48, age: 54.15 ± 12.24, male: 43.75%) with BVA (%) less than zero; (2) atypical vasodilation group (n = 24, age: 55.45 ± 7.45, male: 50.00%) with BVA (%) greater than zero. There were no significant differences in age and gender between the two groups (t = -0.46, p = .646; χ2 = 0.08, p = .773). Results: 67% of the participants demonstrated a typical vasoconstriction reaction during the anger description stage. The remaining 33% of the participants showed peripheral blood vessel constriction than the typical vasoconstriction group during the baseline resting stage, and demonstrated an atypical vasodilation reaction during the anger description stage. During baseline and anger recall task, the BVA of atypical vasodilation group were significantly lower than that of the typical vasoconstriction group (F = 11.34, p < .001, ηp2 = .048; F = 4.95, p = .027, ηp2 = .022). In normal non-type D personality, the total HRV reactivity indexed by SDNN(F = 7.29, p = .009, ηp2 = .098 ) and parasympathetic activity indexed by HF(F = 5.42, p = .023, ηp2 = .075) of vasodilation group were significantly lower than that of the typical vasoconstriction group. In atypical vasodilation group, the total HRV reactivity indexed by SDNN(F = 5.43, p = .023, ηp2 = .075) and parasympathetic activity indexed by HF(F = 6.21, p = .015, ηp2 = .085) of type D personality were significantly greater than that of the non-type D personality. Conclusion: (1)The BVA of atypical vasodilation group was lower than typical vasoconstriction group during the baseline resting stage. But, there were no significant differences of autonomic nervous system between two groups. (2)Both of typical vasoconstriction group and atypical vasodilation group demonstrated a parasympathetic nervous withdrawal, enhanced total heart rate variability and sympathetic-parasympathetic balance. Also, there were no relationship in the different blood vessel reactivity and autonomic nervous system activity. (3)In typical vasoconstriction group with/without Type D personality, the autonomic nervous system activity were no significant differences. The parasympathetic nervous activity, total heart rate variability in atypical vasodilation group with Type D personality were higher than atypical vasodilation group without Type D personality. The results of this study demonstrated that atypical vasodilation group with Type D personality may evoke more autonomic nervous system activity to dilating. Atypical vasodilation group without Type D personality may not evoke autonomic nervous system activity to dilating. However, autonomic nervous system activity in atypical vasodilation group without Type D personality were lower than else group, the mechanism was unclear.

並列關鍵字

heart rate variability ； atypical vasodilation reaction ； Type D personality

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