D型人格冠心病患者斑块易损性的作用机制研究及风险预警模型的建立

Coronary artery plaque vulnerability is closely related to the severity of coronary heart disease (CHD). Identification of plaque vulnerability and its risk factors in early stage will be beneficial to prevent the major adverse cardiac events. Currently, physiological indexes have been known to impact plaque vulnerability, which can only illustrate the etiology and pathogenesis of CHD partly. We, for the first time, identified type D personality as a risk factor of plaque vulnerability after controlling confounding factors based on the relationship we had previously discussed between type D personality and plaque vulnerability in the field of psychology. Furthermore, it was confirmed that type D patients tended to have negative emotions and unhealthy behaviors. Compared with non-type D patients, the expression of serum lipids, C reactive protein and inflammatory cytokines is higher in type D patients. Therefore, we presume that type D personality might impact plaque vulnerability in a direct or indirect way. However, the exact mechanism is unclear. Based on “personality and health” theory-health behavior model, the aim of this project is to identify the risk factors of plaque vulnerability and establish a model, in order to clarify the mechanism between type D personality and plaque vulnerability. Moreover, BP artificial neural net is used as a tool for establishing risk prediction models of plaque vulnerability and evaluating the risk levels in CHA patients with type D personality, aiming at identifying and intervening high risk patients in early stage for advanced prevention and treatment.

冠心病的严重程度与冠状动脉斑块易损性密切相关，早期识别斑块易损性及危险因素有助于防止心脏不良事件的发生。目前已知影响斑块易损性的生理指标，只能部分解释冠心病发病原因。项目组前期从心理学角度，探讨D型人格与斑块易损性的关系，首次确认控制混杂因素后，D型人格是斑块易损性的影响因素，且证实D型人格冠心病患者更趋于存在消极情感及不健康行为，血脂、CRP和促炎性因子的表达均显著高于非D型人格患者。因此，推测D型人格直接或间接影响斑块易损程度，但是，具体机制不明确。本项目基于“人格与健康”理论—健康行为模型，确定斑块易损性的多维影响因素，构建D型人格与斑块易损性结构方程模型，明确二者之间作用途径，为解释D型人格对斑块易损性的作用机制及后续研究提供依据；运用BP人工神经网络模型，构建针对D型人格冠心病患者斑块易损性的风险预警模型及风险等级评价工具，以早期识别和干预高风险人群，将斑块易损性的防治关口前移。

冠心病因其高发病率及致死率，已成为全球重大公共卫生问题。近期心血管腔内影像学研究证实，冠状动脉粥样硬化斑块易损性是冠心病发生发展的重要病理学机制。因此，早期识别易损斑块及其影响因素已是当前心血管领域研究的焦点。目前，在临床及基础研究中较多的关注生理指标对冠心病发生发展的影响，但其只能部分解释冠心病的发病原因。冠心病作为典型的心身疾病，研究证实，心理因素在冠心病发病中占有重要作用，特别是占冠心病患者中30%-40%的D型人格，已成为预测冠心病发病的重要因子。项目组前期从心理学角度，探讨D型人格与斑块易损性的关系，首次确认控制混杂因素后，D型人格是斑块易损性的影响因素，且证实D型人格冠心病患者更趋于存在消极情感及不健康行为，其血脂、C反应蛋白和促炎因子的表达均显著高于非D型人格患者。因此，推测D型人格直接或间接影响斑块易损程度，这对认识易损斑块的形成机制提供了全新视角。基于此，本项目提出创新性科学问题：即D型人格与斑块易损性间可能存在特定作用机制，但是，二者之间具体作用关系如何？存在哪些中介变量？多因素间是孤立存在？还是交互作用？是平行关系？还是存在网络多形性？尚需进一步探索。因此，本项目基于“人格与健康”理论—健康行为模型，运用先进的腔内影像学技术，从斑块易损性的防控角度出发，以D型人格为研究的切入点，从生物、心理及行为学等层面，确定斑块易损性的多维影响因素，构建了D型人格作用于斑块易损性的结构方程模型，深入剖析了多变量之间的潜在关联和具体作用路径，研究结果将是对斑块易损性形成机制的重要补充，亦为临床促进斑块的稳定提供新的干预靶点。同时，本项目基于BP神经网络算法，首次开发了针对D型人格冠心病患者斑块易损性的风险预警模型及风险等级评价工具，为临床早期筛查冠心病预后不良的高危人群提供关键证据，具有重要的临床实践价值和社会效益。

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