冠心病合并2型糖尿病患者A型行为以及抑郁 情绪研究

Type A Behavior Pattern and Depression in Patients with Coronary Heart Disease and Type 2 Diabetes Mellitus

摘要: 目的：观察冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease, CHD)合并2型糖尿病(type 2 diabetes mellitus, T2DM)患者A型行为以及抑郁情绪情况。方法：横断面选取2023年10月~2025年10月于青岛大学附属医院住院患者及健康查体人员，其中冠心病合并2型糖尿病患者(共病组) 76例、冠心病患者(冠心病组) 57例、2型糖尿病患者(糖尿病组) 73例、健康查体人群(对照组) 89例。对上述患者进行A型行为、焦虑抑郁情绪、压力大小等问卷调查，以及生活方式、病史资料、生化指标采集。采用R语言进行统计分析。组间比较采用方差分析或秩和检验，多重比较采用Bonferroni校正。采用多因素Logistic回归分析共病的相关因素。通过中介效应分析探讨HbA1c在抑郁与共病之间的作用机制，并采用ROC曲线及DeLong检验评价模型判别能力。结果：四组在性别、有吸烟饮酒史占比、BMI、压力大小、RBC、Hb、PLT、WBC、LYM差异无统计学意义(P > 0.05)。四组在年龄、有高血压病史占比、A型行为、焦虑情绪、抑郁情绪、FPG、HbA1c、NE、MONO、TG、TC、HDL-C、LDL-C有统计学意义。多因素Logistic回归分析显示，A型行为、抑郁情绪、HbA1c、年龄及高血压病为共病的独立相关因素。在未纳入HbA1c时，抑郁情绪为显著因素；加入HbA1c后，抑郁情绪的效应明显减弱。中介分析结果显示，HbA1c在抑郁与共病之间发挥显著中介作用(间接效应β = 0.00272，95%CI：0.00076~0.00503)。ROC曲线分析显示，加入HbA1c后模型AUC由0.831提高至0.869，差异具有统计学意义(P < 0.005)。结论：冠心病合并2型糖尿病共病患者存在明显的心理行为特征改变。HbA1c可能在抑郁情绪与共病之间发挥中介作用，并显著增强模型的区分能力。上述结果提示心理因素可能通过血糖控制水平参与共病形成，仍需前瞻性研究进一步验证。

Abstract: Objective: To observe Type A behavior and depression in patients with coronary atherosclerotic heart disease (CHD) complicated by type 2 diabetes mellitus (T2DM). Methods: A cross-sectional study was conducted, selecting inpatients and healthy individuals undergoing physical examinations at the Affiliated Hospital of Qingdao University from October 2023 to October 2025. The study included 76 patients with CHD complicated by T2DM (comorbidity group), 57 patients with CHD (CHD group), 73 patients with T2DM (diabetes group), and 89 healthy individuals undergoing physical examinations (control group). Questionnaires were administered to the aforementioned patients to assess Type A behavior, anxiety and depression, and stress levels, along with the collection of data on lifestyle, medical history, and biochemical indicators. Statistical analysis was performed using R language. Comparisons between groups were conducted using analysis of variance or the rank-sum test, with Bonferroni correction applied for multiple comparisons. Multivariate logistic regression analysis was used to identify factors associated with comorbidity. The mediating effect of HbA1c on the relationship between depression and comorbidity was explored through mediation analysis, and the discriminatory ability of the model was evaluated using ROC curves and the DeLong test. Results: There were no statistically significant differences among the four groups in terms of gender, the proportion with a history of smoking and alcohol consumption, BMI, stress levels, RBC, Hb, PLT, WBC, and LYM (P > 0.05). Statistically significant differences were observed among the four groups in age, the proportion with a history of hypertension, Type A behavior, anxiety, depression, FPG, HbA1c, NE, MONO, TG, TC, HDL-C, and LDL-C. Multivariate logistic regression analysis revealed that Type A behavior, depression, HbA1c, age, and hypertension were independent factors associated with comorbidity. Depression was a significant factor when HbA1c was not included in the model; however, its effect significantly diminished after the inclusion of HbA1c. Mediation analysis results indicated that HbA1c played a significant mediating role between depression and comorbidity (indirect effect β = 0.00272, 95%CI: 0.00076~0.00503). ROC curve analysis showed that the inclusion of HbA1c increased the model’s AUC from 0.831 to 0.869, with a statistically significant difference (P < 0.005). Conclusion: Patients with CHD complicated by T2DM exhibit significant changes in psychological and behavioral characteristics. HbA1c may play a mediating role between depression and comorbidity and significantly enhance the model’s discriminatory ability. These findings suggest that psychological factors may contribute to the development of comorbidity through blood glucose control levels, warranting further validation through prospective studies.