Modica Maddalena, Carabalona Roberta, Spezzaferri Rosa, Tavanelli Monica, Torri A, Ripamonti Vittorino, Castiglioni Paolo, De Maria Renata, Ferratini Maurizio
Fondazione Don Carlo Gnocchi, UO Cardiologia Riabilitativa, Milan, Italy.
Monaldi Arch Chest Dis. 2012 Mar;78(1):29-33. doi: 10.4081/monaldi.2012.141.
To evaluate the psychological characteristics of coronary heart disease (CHD) patients after coronary artery bypass grafting (CABG) by cluster analysis of Minnesota Multiphasic Personality Inventory (MMPI-2) questionnaires and to assess the impact of the profiles obtained on long-term outcome.
229 CHD patients admitted to cardiac rehabilitation filled in self-administered MMPI-2 questionnaires early after CABG. We assessed the relation between MMPI-2 profiles derived by cluster analysis, clinical characteristics and outcome at 3-year follow-up.
Among the 215 patients (76% men, median age 66 years) with valid criteria in control scales, we identified 3 clusters (G) with homogenous psychological characteristics: G1 patients (N = 75) presented somatoform complaints but overall minimal psychological distress. G2 patients (N=72) presented type D personality traits. G3 subjects (N=68) showed a trend to cynicism, mild increases in anger, social introversion and hostility. Clusters overlapped for clinical characteristics such as smoking (G1 21%, G2 24%, G3 24%, p ns), previous myocardial infarction (G1 43%, G2 47%, G3 49% p ns), LV ejection fraction (G1 60 [51-60]; G2 58 [49-60]; G3 60 [55-60], p ns), 3-vessel-disease prevalence (G1 69%, G2 65%, G3 71%, p ns). Three-year event rates were comparable (G1 15%; G2 18%; G3 15%) and Kaplan-Meier curves overlapped among clusters (p ns).
After CABG, the interpretation of MMPI-2 by cluster analysis is useful for the psychological and personological diagnosis to direct psychological assistance. Conversely, results from cluster analysis of MMPI-2 do not seem helpful to the clinician to predict long term outcome.
通过明尼苏达多相人格调查表（MMPI-2）问卷的聚类分析来评估冠状动脉旁路移植术（CABG）后冠心病（CHD）患者的心理特征，并评估所得剖面类型对长期预后的影响。
229例接受心脏康复治疗的冠心病患者在CABG术后早期自行填写MMPI-2问卷。我们评估了聚类分析得出的MMPI-2剖面类型、临床特征与3年随访结果之间的关系。
在215例（76%为男性，中位年龄66岁）对照量表符合有效标准的患者中，我们识别出3个具有同质心理特征的聚类（G）：G1组患者（N = 75）表现出躯体形式主诉，但总体心理困扰最小。G2组患者（N = 72）表现出D型人格特质。G3组受试者（N = 68）表现出愤世嫉俗的倾向、愤怒轻度增加、社交内向和敌意。各聚类在吸烟（G1组21%，G2组24%，G3组24%，p无显著性差异）、既往心肌梗死（G1组43%，G2组47%，G3组49%，p无显著性差异）、左心室射血分数（G1组60[51 - 60]；G2组58[49 - 60]；G3组60[55 - 60]，p无显著性差异）、三支血管病变患病率（G1组69%，G2组65%，G3组71%，p无显著性差异）等临床特征方面存在重叠。3年事件发生率相当（G1组15%；G2组18%；G3组15%），各聚类间的Kaplan-Meier曲线重叠（p无显著性差异）。
CABG术后，通过聚类分析对MMPI-2进行解读，有助于心理和人格诊断，以指导心理援助。相反，MMPI-2聚类分析的结果似乎对临床医生预测长期预后并无帮助。
