D 型人格是心血管疾病患者不良结局的危险因素：一项个体患者数据荟萃分析。
Type D Personality as a Risk Factor for Adverse Outcome in Patients With Cardiovascular Disease: An Individual Patient-Data Meta-analysis.
机构信息
From the Department of Methodology and Statistics (Lodder, Wicherts), and Center of Research on Psychology in Somatic diseases (CoRPS) (Lodder, Antens, Kupper), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands;Department of Psychosomatics and Psychotherapy (Albus), University of Cologne, Medical Faculty and University Hospital, Cologne, Germany; Tyumen Cardiology Research Center (Bessonov, Pushkarev), Tomsk National Research Medical Center, Russian Academy of Science, Tyumen, Russia; Uppsala University, Centre for Clinical Research (Condén), Hospital of Västmanland, Västmanland, Sweden; Intensive Care Unit, Department of Pediatrics and Pediatric Surgery (Dulfer), Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Psychology (Gostoli, Rafanelli), University of Bologna, Bologna, Italy; Brandenburgische Technische Universität Cottbus-Senftenberg (Grande), Cottbus, Germany; Department of Clinical Physiology and Centre for Clinical Research (Hedberg), Uppsala University, Västmanland County Hospital, Västerås, Sweden; Department of Psychosomatic Medicine and Psychotherapy (Herrmann-Lingen, Meyer), University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Germany; Department of Health, Medicine and Caring Sciences (Jaarsma), Linköping University, Linköping, Sweden; Graduate Institute of Long-term Care (Koo), Tzu Chi University of Science and Technology, Hualien City, Hualien, Taiwan;Dalla Lana School of Public Health (Koo), University of Toronto, Toronto, Ontario, Canada;College of Nursing of Harbin Medical University (P. Lin), The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Division of Cardiology, Department of Internal Medicine (T.-K. Lin), Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi; School of Medicine, Tzu Chi University (T.-K. Lin), Hualien City, Hualien, Taiwan; Laboratory of Comorbidity in Cardiovascular Diseases (Raykh, Sumin), Federal State Budgetary Scientific Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Moscow, Russian Federation; Institute of Cardiology (Schaan de Quadros, Schmidt), University Foundation of Cardiology, Porto Alegre, Rio Grande do Sul, Brazil; Research Institute of Child Development and Education (Utens), Amsterdam UMC/ Level, Amsterdam; Department of Cardiology, University of Groningen (van Veldhuisen), University Medical Center Groningen, Groningen, the Netherlands; and Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University (Wang), Harbin, China.
出版信息
Psychosom Med. 2023;85(2):188-202. doi: 10.1097/PSY.0000000000001164. Epub 2023 Jan 9.
OBJECTIVE
Type D personality, a joint tendency toward negative affectivity and social inhibition, has been linked to adverse events in patients with heart disease, although with inconsistent findings. Here, we apply an individual patient-data meta-analysis to data from 19 prospective cohort studies ( N = 11,151) to investigate the prediction of adverse outcomes by type D personality in patients with acquired cardiovascular disease.
METHOD
For each outcome (all-cause mortality, cardiac mortality, myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, major adverse cardiac event, any adverse event), we estimated type D's prognostic influence and the moderation by age, sex, and disease type.
RESULTS
In patients with cardiovascular disease, evidence for a type D effect in terms of the Bayes factor (BF) was strong for major adverse cardiac event (BF = 42.5; odds ratio [OR] = 1.14) and any adverse event (BF = 129.4; OR = 1.15). Evidence for the null hypothesis was found for all-cause mortality (BF = 45.9; OR = 1.03), cardiac mortality (BF = 23.7; OR = 0.99), and myocardial infarction (BF = 16.9; OR = 1.12), suggesting that type D had no effect on these outcomes. This evidence was similar in the subset of patients with coronary artery disease (CAD), but inconclusive for patients with heart failure (HF). Positive effects were found for negative affectivity on cardiac and all-cause mortality, with the latter being more pronounced in male than female patients.
CONCLUSION
Across 19 prospective cohort studies, type D predicts adverse events in patients with CAD, whereas evidence in patients with HF was inconclusive. In both patients with CAD and HF, we found evidence for a null effect of type D on cardiac and all-cause mortality.
目的
D 型人格是一种消极情绪和社交抑制倾向的综合表现，与心脏病患者的不良事件有关，尽管研究结果不一致。在这里，我们应用个体患者数据荟萃分析，对 19 项前瞻性队列研究（N=11151）的数据进行分析，以研究 D 型人格在后天性心血管疾病患者不良结局中的预测作用。
方法
对于每个结局（全因死亡率、心脏死亡率、心肌梗死、冠状动脉旁路移植术、经皮冠状动脉介入治疗、主要不良心脏事件、任何不良事件），我们估计了 D 型人格对预后的影响，并评估了年龄、性别和疾病类型的调节作用。
结果
在患有心血管疾病的患者中，D 型人格对主要不良心脏事件（贝叶斯因子[BF]=42.5；优势比[OR]=1.14）和任何不良事件（BF=129.4；OR=1.15）的影响有强有力的证据。对于全因死亡率（BF=45.9；OR=1.03）、心脏死亡率（BF=23.7；OR=0.99）和心肌梗死（BF=16.9；OR=1.12），则发现了对零假设的证据，这表明 D 型人格对这些结局没有影响。这种证据在冠心病（CAD）患者亚组中是相似的，但在心力衰竭（HF）患者中则不确定。负性情感对心脏和全因死亡率有积极影响，而后者在男性患者中比女性患者更为明显。
结论
在 19 项前瞻性队列研究中，D 型人格预测 CAD 患者的不良事件，而在 HF 患者中证据不确定。在 CAD 和 HF 患者中，我们都发现 D 型人格对心脏和全因死亡率的影响为零。
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