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| 題 名 | 憂鬱、焦慮、及D型人格與心衰竭疾病預後之關聯性的可能直接與間接路徑=The Possible Direct and Indirect Pathways Underlying the Associations between Depression, Anxiety, and Type D Personality with the Prognosis of Heart Failure |
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| 作 者 | 潘鈺凱; 潘念宜; 張育禎; 蕭伊祐; 蘇珈徵; 李易達; 翁嘉英; 林庭光; | 書刊名 | 臨床心理學刊 |
| 卷 期 | 18:2 2024.12[民113.12] |
| 頁 次 | 頁63-81 |
| 分類號 | 415.319 |
| 關鍵詞 | 心衰竭; 憂鬱; 焦慮; 自我照護行為; 生理病理機制; Heart failure; Depression; Anxiety; Self-care behavior; Physio-pathological mechanism; |
| 語 文 | 中文(Chinese) |
| DOI | 10.6550/ACP.202412_18(2).0001 |
| 中文摘要 | 目的:較高的憂鬱、焦慮程度、以及D型人格傾向,與心衰竭不良的疾病預後有關。方法:本文針對心衰竭上述心理危險因子之橫斷性實徵研究進行文獻回顧,闡述心理危險因子:(1)與心衰竭生理病理機制之關聯性的可能直接路徑、(2)透過其與心衰竭自我照護行為之間,以及自我照護行為與生理病理機制間之關聯性的可能間接路徑。結果:(1)心衰竭生理機制之可能直接路徑:心衰竭患者的憂鬱、焦慮症狀、及D型人格,與自主神經功能異常及發炎反應呈正向關聯性;焦慮症狀及D型人格,與內皮細胞功能障礙呈正向關聯性;憂鬱症狀,與腎素-血管收縮素-醛固酮系統(renin-angiotension-aldosterone system, RAAS)系統過度活化呈正向關聯性。(2)行為機制之可能間接路徑:心衰竭患者的憂鬱症狀、焦慮症狀、D型人格,與自我照護行為呈顯著負相關;而心衰竭自我照護行為與較低的自主神經與RAAS系統的神經激素活化、及較低的發炎反應呈顯著關聯性。結論:心衰竭患者的負向心理危險因子,可能透過(1)自主神經功能異常、發炎反應、RAAS系統過度活化、內皮細胞功能異常之生理機制直接路徑、以及(2)較低的自我照護行為之間接路徑,與其疾病發展與預後產生關聯性。 |
| 英文摘要 | Purpose: Depression, anxiety, and type D personality tendencies are related to poor prognosis of heart failure. Methods: This study reviewed the empirical evidence of cross-sectional studies on correlations between heart failure disease and psychological risk factors mentioned above to illustrate the associations between psychological risk factors and (1) physio-pathological mechanisms of heart failure, the possible direct pathways, (2) self-care behaviors which are negatively correlated with physio-pathological mechanisms of the disease, the possible indirect pathways affecting disease prognoses. Results: We searched Pubmed and PsycINFO. The results of the review showed possible (1) direct pathways of physio-pathological mechanism: depression symptoms in heart failure patients are related to autonomic nervous system (ANS) dysfunction indicating a hyperactivity of sympathetic nervous function, higher levels of pro-inflammatory markers including interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF- α) and C-reactive protein (CRP), and overactivation of the renin-angiotensin-aldosterone system (RAAS); anxiety symptoms are related to ANS dysfunction, higher levels of pro-inflammatory markers including IL-6, TNF-α, CRP, homocysteine, and fibrinogen, and lower brachial artery flow-mediated dilation (FMD); type D personality is related to blunt ANS regulations, higher levels of pro-inflammatory markers including TNF-α, soluble tumor necrosis factor receptors 1 (sTNFR1), sTNFR2, and lower levels of FMD and endothelial progenitor cell (EPC). (2) indirect pathways of self-care behavioral mechanism: The depression, anxiety symptoms, and type D personality in heart failure patients are negatively correlated with self-care behaviors. Self-care behaviors are negatively correlated with neurohormone hyperactivations of both ANS and RAAS, and pro-inflammatory state. Conclusion: The empirical research we searched showed that psychological risk factors, including depression, anxiety, and type D personality, in heart failure patients might be through (1) direct physio-pathological mechanisms, including ANS dysfunction, elevation of pro-inflammatory state, RAAS overactivation, and vasodilation dysfunction, and (2) indirect pathway of lower self-care behaviors which are associated with physio-pathological mechanisms, and correlated with disease prognosis. |
本系統中英文摘要資訊取自各篇刊載內容。