臺灣博碩士論文加值系統

本研究旨在選取沒有代謝症候群的健康成人為受試者，探討敵意以及不同敵意元素在CAD病程初期，尤其是代謝症候群出現之前，敵意特質透過慢性化的過程，是否會影響血管之內皮細胞弁遄C採用橫斷性研究，研究參與者共62名(男性30位，女性32位)，平均年齡60歲(±10歲)全為慈濟醫院健檢之成人；以短式華人敵意量表測量其敵意特質，同時以血管超音波測量受試之內皮細胞弁鄎苤G包括中流中介血管擴張(FMD)及硝化甘油(NTG)；並搜集其血液動力指標，包括：心跳、收縮壓與舒張壓；及血液生化值指標，包括：總膽固醇、三酸甘油脂與飯前血糖。
本研究在排除了血管平滑肌弁鄋獐v響之後，控制了年齡、膽固醇及其他負向情緒(憂鬱、焦慮)的影響，結果發現敵意與內皮細胞弁鄑e顯著負相關，而且敵意也可以顯著的預測較差的內皮細胞弁遄C再者，比較敵意的各元素，發現敵意認知與內皮細胞弁鄑e顯著的負相關，並且敵意認知可顯著的預測較差的內皮細胞弁遄C顯示出長期認知上的人格特質的確是較其他元素更容易造成內皮細胞弁鄋熒l害。
再者，以階層迴歸分析，控制年齡、膽固醇與其他負向情緒，以檢驗敵意對內皮細胞弁鄋犒w測力。結果發現，在這群健康受試中，敵意更能有效預測較差的內皮細胞弁遄A並且此一機制獨立於代謝症候群的影響。顯示出在CAD病程初期，尤其是代謝症候群出現之前，敵意特質透過慢性化的過程，已經對內皮細胞弁鈳y成影響。

The purpose of present study was to investigate the relationship between hostility, especially different hostility components and endothelial function was examined in healthy subjects without metabolic syndrome. Examined whether hostility related to endothelial dysfunction through chronic process. This is a cross-sectional study. Subjects were 62 (30 men and 32 women) 50-70 yr old men who participated in tzichi hospital health examination. Hostility was measured with the Chinese Hostility Scale Short Form. Endothelial function index including FMD and NTG was measured by vascular ultrasound. Hemodynamic index: heart rate, systolic blood pressure, and diastolic blood pressure. Metabolic syndrome index including total cholesterol, triglycerides, and fasting glucose.
The hostility score was inversely related to endothelial function after adjusted age, cholesterol, and other negative emotion (depression and anxiety). Hostility could significantly predict poor endothelial function. This present study reveals that long-term cognition tendency of personality trait can affect poor endothelial function than other components.
To test the predictability of hostility, data was analyzed by hierarchical multiple regression analysis adjusted for age, cholesterol, and other emotion. Hostility could predict poor endothelial function, and this mechanism could independent of metabolic syndrome.
According to the conclusions of the main findings, in early phase of CAD stage, especially before metabolic syndrome, hostility could affect endothelial function through chronic process.

第一章、 緒論…………………………………………………………1
第一節、 研究動機與目的……………………………………………1

第二章、文獻回顧………………………………………………………2
第一節、冠狀動脈心臟病的病程及其病理機制................. 2
一、冠狀動脈心臟病的病程…………………...................3
二、CAD的生理病理機制………………………………………………5
三、CAD心理病理機制…………………………………………………11
第二節、敵意與CAD病理機制的關聯性………………………18
一、敵意的定義…………………………………………………………18
二、敵意的測量…………………………………………………………22
三、敵意與內皮細胞弁鄐ㄗ}的關聯性………………………………26
第三節、研究目的與假設……………………………………………29

第三章、研究方法………………………………………………….…30
第一節、 受試者………………………………………………………30
第二節、 研究工具……………………………………………………30
第三節、 研究程序……………………………………………………33
第四節、 資料統計與分析..................................33
第四章、結果……………………………………………………………34
第五章、討論……………………………………………………………39
第一節、 敵意與內皮細胞弁鄋疑鰜Y……………………………...39
一、研究結果……………………………………………………………39
二、與研究假設比較……………………………………………………39
三、討論…………………………………………………………………39
四、本研究貢獻…………………………………………………………41
五、本研究限制…………………………………………………………41

中文部分：
翁嘉英，林宜美(尚未發表)短式華人敵意量表之發展與信效度考驗。
駱重鳴(民72)。生活壓力、適應方式與身心健康。國立台灣大學心理學研究所碩士論文，未出版，台北市。
行政院衛生署(民93)。台灣地區代謝症候群診斷標準。

英文部分：
Almada, S. J., Zonderman, A. B., Shekelle, R. B., & Dver, A. R. (1991). Neuroticism and cynicism and risk of death in middle-men: the western electric study. Psychosomaitc Medicine, 53(2), 165-175.
Atchison, M., & Condon, J. (1993). Hostility and anger masures in coronary heart disease. Australian and New Zealand Journal of Psychiatry, 27, 436-442.
Averill, J. R. (1983). Studies on anger and aggression: implications for theories of emotion. American Psychologist, 1145-1160.
Baum, A., Gatchel, R. J., & Krantz, D. S. (Eds.). (1997). Cardiovascular Disorders and Behavior::An Introduction to Health Psychology (pp135-164). New York: The McGraw-Hill Companies.
Barefoot, J. C., Dahlstrom, W. G., Williams, R. B. (1983). Hostility, CAD incidence, and total mortality: A 25-year follow-up study of 255 physicians. Psychosomatic Medicine, 45, 46-57.
Barefoot, J. C., Peterson, B. L., Harrell, F. E., Hlatky, M. A., Pryor, D. B., Haney, T. L., Blumenthal, J. A., Siegler, I. C., & Williams, R. B. (1989). Type A Behavioral and survival: A follow-up study of 1,467 patients with coronary artery disease. The American Journal of Cardiology, 64(8), 427-432.
Benschop, R. J., Geenen, R., Mills, P. J., Naliboff, B. D., Kiecolt-Glaser, J. K., Herbert, T. B., van der Pompe, G., Miller, G. E., Matthews, K. A., Godaert, G. L., Gilmore, S. L., Glaser, R., Heijnen, C. J., Dopp, J. M., Bijlsma, J. W. J., Solomon, G. F., & Cacioppo, J. T. (1998). Cardiovascular and immune responses to acute psychological stress in young and old women: A meta-analysis. Psychosomatic Medicine, 60, 29-296.
Benton, D., Kumari, N., & Brain, P. (1982). Mild hypoglycaemia and questionnaire measures of aggression. Biological Psychology, 14(1), 129-135.
Biaggio, M. K. (1980). Assessmet of anger arousal. Journal of Personality Assessment, 44, 289-298.
Biaggion, M. K., & Maiuro, R. D. (1985). Recent advance in anger assessment. In J. N. Butcher & C. D. Spielberger (Eds.), Advance in Personality Assessment (vol.2). Hillscale: Lawarence Eblbaum Associates Publisher.
Buss A. H., & Durkee, A. (1957). An inventory for assessing different kinds of hostility. Journal of Consulting Psychology, 21, 343-349.
Buss, A. H. (1961). The psychology of aggression, New York: Wiley.
Buss, A. H., Fischer, H. & Simmons, A. J. (1962). Aggression and hostility in psychiatric patients. Journal of Consulting Psychology, 26(1), 84-96.
Buss, A. H., & Perry, M. (1992). The aggression questionnaire. Journal of Personality and Social Psychology, 63, 452-459.
Carney, R. M., Rich, M. W., Freedland, K. E., & Saini, J. (1988). Major depressive disorder predics cardiac events in patients with coronary artery disease, Psychosomatic Medicine, 50, 627-633.
Chen, C. C., Lu, F. H., Wu, J. S., & C, C. J. (2001). Correlation between serum lipid concentrations and psychological distress. Psychiatry Research, 102(2), 153-162.
Cody, R. J. (1992). The potential role of endothelin as a vasoconstrictor substrate in congestive heart failure. European Heart Journal, 13, 1573-1578.
Cook, W. W., & Medley, D. M. (1954). Proposed hostility and pharisaic-virtue scales for the MMPI. The Journal of Applied Psychology, 38, 414-418.
Cooper, D. C., & Waldstein, S. R. (2004). Hostility differentially predicts cardiovascular risk factors in African American and White young adults. Journal of Psychosomatic Research, 57(5), 491-499.
Costa, P. T., Jr., Zonderman, A. B., McCrae, R. R., & Williams, R. B., Jr. (1986). Cynicism and paranoid alienation in the Cook and Medley HO Scale. Psychosomatic Medicine, 48, 283-285.
Costa, P. T., Krantz, D. S., Blumenthal, J. A., Furberg, C. D., Rosenman, R. H., & Shekelle, R. B. (1987). Task force 2: psychological risk factor in coronary artery disease. Circulation, 76, I145-I149.
Dembroski, T. M., & Costa, P. T. (1987). Coronary prone behavioral: components of the type A pattern and hostility as predictors of sudden death and myocardial infarction in the multiple risk factor intervention trial. Psychosomatic Medicine, 51, 514-522.
Ducimetiere, P., Richard, J., & Cambien, F. (1986). The pattern of subcutaneous fat distribution in middle-aged men and the risk of oronary heart disease: the Paris Prospective Study. British Medical Journal, 10, 229-240.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Dection, Evaluation, and Treatment of High Blood Cholesterol in Adults. (Adult Treatment Panel III)(2001). JAMA, 285, 356-359.
Dujovne, V. F., & Houston, B. K. (1991). Hostility-related variables and plasma lipid levels. Journal of Behavioral Medicine, 14(6), 555-565.
Frasure-Simith, N., Lesperance, F., & Talajic, M. (1993). Depression following myocardial infarction: impact on 6-moonth survival. JAMA, 270, 1819-1861.
Friedman, M., & Rosenman, R. H. (1959). Association of specific overt behavior pattern with blood cardiovascular finding: blood cholesterol, blood clotting time, incidence of Arcus Senilis and clinical coronary artery disease. Journal of American Medicial Association, 169, 1286-1296.
Friedman, M., & Rosenman, R. H. (1974).Type A Behavioral and Your Heart. New York: Knopf.
Furchgott, R. F., Zawadzki, J. V. (1980). The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine, Nature, 288, 373-376.
Gidron, Y., Gilutz, H., Berger, R., & Huleihel, M. (2002). Molecular and cellular inerface between behavior and acute coronary syndromes. Cardiovascular Research, 56, 15-21.
Ghiadoni, L., Donald, A.E., Cropley, M., Mullen, M.J., Oakley, G., Taylor, M., O’Connor, G.., Betteridge, J., Klein, N., Steptoe, A., & Deanfield, J. E. (2000). Mental stress induces transient endothelial dysfunction in humans. Circulation, 102, 2473-2478.
Gonzalez, M. B., Snyderman, T. B., Colket, J. T., Arias, R. M., & Jiang, J. W. (1996). Depression in patients with coronary artery disease. Depression, 4, 67-62.
Gottdiener, J. S., Kop, W. J., Hausner, E., McCeney, M. K., Herrington, D., & Krantz, D. S. (2003). Effects of mental stress on Flow-Mediated Brachial Arterial Dilation and influence of behavioral factors and hypercholesterolemia in subjects without cardiovascular disease. The American of Cardiology, 92, 687-691.
Harris, K. F., Matthews, A., Sutton-Tyrrel, K., & Kuller, L. H. (2003). Associations between psychological traits and endothelial function in postmenopausal women. Psychosomatic Medicine, 65, 402-409.
Iribarren, C., Sidney, S., Bild, D.E., Liu, K., Markovitz, J.H., Roseman, J.M., & Matthews, K. (2000). Association of hostility with coronary artery calcification in young adults. JAMA, 283(19), 2546-2551.
Kawachi, I., Sparrow, D., Vokonas, P. S., Pantel, S., & Weiss, S. T. (1995). Decreased heart rate variability in men with phobic anxiety (data from the Normative Aging Study). The American Journal of Cardiology, 75, 882-885.
Knox, S. S., Jacobs, D. R., Chesney, M. A., & Raczynski, J. (1996). Psychosocial factors and plasma lipids in Black and White young adults: The coronary artery risk development in young adults study data. Psychosomatic Medicine, 58(4), 365-373.
Kop, W. M. (1999). Chronic and acute psychological risk factors for clinical manifestations of coronary artery disease. Psychosomatic Medicine, 61, 476-487.
Kubzansky, L. D., Kawachi, I., Weiss, S. T., & Sparrow, D. (1998). Environmenal stress and biobehavioral antecedents of coronary heart disease. Journal of Consulting and Clinical Psychology, 56(3), 333-341.
Larsson, B., Svardsudd, K., Welin, L., Wilhemsen, L., Bjorntorp, P., & Tibblin, G. (1984). Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13-year follow-up of participants in the study of men born in 1913. British Medical Journal, 288, 1401-1404
Luscher, T. F., Barton, M. (1997). Biology of the endothelium. Clinical Cardiology, 20, II3-II10
Martin, R., Watson, D., & Wan, C. K. (2000). A three-factor model of trait anger: Dimensions of affect, behavior, and cognition. Journal of Personality, 68(5), 869-897.
Markovitz, J.H., Matthews, K.A., Kiss, J., & Smitherman.T.C. (1996). Effect of hostility on platelet reactivity to psychological stress in coronary heart disease patients and in healthy controls. Psychosomatic Medicine, 58, 143-149.
Markovitz, J. (1998). Hostility is associated with increased platelet activation in coronary heart disease. Psychosomatic Medicine, 60, 586-591.
Matthews, K. A., Glass, D. C., Rosenman, R. H., & Bortner, R.W. (1977). Competitive drive, pattern A and coronary heart disease: A futher analysis of some data from the western collaborative group study. Journal of Chronic Disease, 30, 489-498.
Mausante, L., MacDougall, J. M., Dembroski, T. M., & Costa, P. T., Jr. (1989). Potential for hostility and dimensions of anger. Health Psychology, 8, 343-354.
Mayou, R. A., Gill, D., Thompson, D. R., Day, A., Hicks, N., Volmink, J., Neil, A. (2000). Depression and anxiety as predictors of outcome after myocardial infarction. Psychosomatic Medicine, 62, 212-219.
Megargee, E. I. (1985). The dynamics of aggression and their application to cardiovascular disorders. In M. A. Chesney & R. H. Rosenman (Eds.), Anger and Hostility in Cardiovascular and Behavioral Disorders (pp31-57). New York: McGraw-Hill.
McEwen, B. S., & Stellar, E. (1993). Stress and the Individual: Mechanisms leading to disease. Archives of Internal Medicine, 153, 2093-2101.
Mittleman, M.A., Maclure, M., Sherwood, J.B., Mulry, R.P., Tofler, G.H., Jacobs, S.C., Friedman, R., Benson, H., & Muller, J.E.(1995). Triggering of acute myocardial infarction onset by episodes of anger. Circulation, 92, 1720-1725.
Möller, J., Hallqvist, J., Diderichsen, F., Theorell, T., Reuterwall, C., & Ahlbom, M. (1999). Do episodes of anger trigger myocardial infarction? A case-crossover analysis in the Stockholm heart epidemiology progrom (SHEEP). Psychosomatic Medicine, 61, 842-849.
Moncada, S., Herman, A. G., Higgis, E. A., & Vane, J. R. (1977). Differential formation of prostacyclin (PGX or PGI2) by layers of the arterial wall: an explanation for the anti-thrombotic properties of vascular endothelium. Thrombosis Research, 11, 323-344.
Muller, M. M., Rau, H., Brody, S., Elbert, T., & Heinle, H. (1995). The relationship between habitual anger coping style and serum lipid and lipoprotein concerntrations. Biological Psychiatry, 41, 69-81.
Nagao, T., Illiano, S., & Vanhoutte, P. M. (1992). Hetergeneous distribution of endothelium-dependent relations resistant to N-nitro-1-arginine in rats. American Journal of Physiology, 263, H1090-H1094.
Niaura, R., Banks, S. M., Ward, K. D., Stonev, C. M., Spiro, A. I., Aldwin, C. M., Landsberg, L., & Weiss, S. (2000). Hostility and the metabolic syndrome in older males: the normative aging study. Psychosomatic Medicine, 62(1), 7-16.
Niaura, R., Spiro III, A., Ward, K.D., & Weiss, S. (2002). Hostility, the metabolic syndrome, and incident coronary heart disease. Health Psychology, 21(6), 588-593.
Novaco, R. W. (1979). The cognitive regulation of anger and stress. In P. Kendall & S. Hollon (Eds.), Cognitive-Behavioral Interventions: Theory, Research and Procedures, New York: Academic Press.
Raikkonen, K., Keltikangas-Jarvinen, L., & Hautanen, A. (1994). The role of psychological coronary risk factors in insulin and glucose metabolism. Psychosomatic Research, 38(7), 705-713.
Raikkonen, K., Matthews, K. A., & Salomon, K. (2003). Hostility predicts metabolic syndrome risk factors in children and adolescents. Health Psychology, 22(3), 279-286.
Raikkonen, K., Matthews, K., Sutton, T. K., & Kuller, L. (2004). Trait anger and the metabolic syndrome predict progression of carotid atherosclerosis in healthy middle-aged women. Psychosomatic Medicine, 6(6), 903-908.
Reaven, G. M. (1988). Role of insulin resistance in human disease. Diabetes, 37, 1595-1607.
Ross, R., & Glomset, J. A. (1973). Atherosclerosis and the arterial smooth muscle cell. Science, 180, 1332-1339.
Ross, R. (1999). Atherosclerosis : an inflammatory disease. New England Journal of Medicine, 340, 115-126.
Scherwitz, L., Perkins, L. Chesney, M., & Huqhes, G. (1991). Cook-Medley hostility scale and subsets: relationship to demographic and psychosocial characteristics in young adults in the CARDIA study. Psychosomatic Medicine, 53(1), 36-49.
Schleifer, S. J., Macari-Hinson, M. M., Coyle, D. A., Slater, W. R., Gorlin, R., & Zucker, H. D. The nature and course of depression following myocardial infarction. Arch of International Medicine, 149, 1785-1789.
Seeman, T. E., Singer, B., Horwitz, R., & McEwen, B. S. (1997). The price of adaptation－Allostatic load and its health consequences: MaArthur studies of successful aging. Archives of Internal Medicine, 157, 2259-2268.
Shekell, R. B., Gale, M., Ostfeld, A. M., & Paul, P. (1983). Hostility risk of coronary disease, and mortality. Psychosomatic Medicine, 45, 109-114.
Siegal, J. M. (1986). The Multidimensional Anger Inventory. Journal of Personality and Social Psychology, 51, 191-200.
Siegel, I. C., Peterson, B. L., Barefoot, J. C., & Williams, R. B. (1992). Hostility during late adolescence predicts coronary risk factors at mid-life. American Journal of Epidemiology, 136, 146-154.
Simth, D. F., Sterndorff, B., Ropcke, G., & Gustavsen, E. M. (1996). Prevalence and severity of anxiety, depression, and type A behaviorals in angina pectoris. [CD-ROM]. Scandinavian-Journal of Psychology, 37(3), 249-258. Abstract from: APA: PsycINFO Item: 1999-009880001.
Spielberger, C. D., Jacobs, G., Russell, S., & Crane, R. S. (1983). Assessment of anger: The State-Trait Scale. In J. N. Butcher & C. D, Spielberger (Eds.), Advances in Personality Assessment (Vol. 2, pp. 161-189). Hilsdale, NJ: Lawrence Erlbaum Associates.
Spielberger, C. D., Johnson, E. H., Russell, S. F. Crane, R. J., Jacobs, G. A., & Worden, T. J. (1985). The experience and expression of anger: Construction and validation of an Anger Expression Scale. In M. A. Chesney & R. H. Rosenman (Eds.), Anger and Hostility in Cardiovascular and Behaviorl Disorders (pp. 5-30). Washington, DC: Hemisphere Publishing.
Sterling, P., & J. Eyer. (1988). Allostasis: A New Paradigm to Explain Arousal Pathology. In S. Fisher & J. Reason (Eds.), Handbook of Life Stress, Cognition and Health (pp.629-649). New York, John Wiley & Sons.
Thayer, J. F., Friedman, B. H., & Borkovac, T. D. (1996). Automatic characteristics of generalized anxiety disorder and worry. Biological Psychiatry, 39, 255-266.
Waldstein, S. R., Polefrone, J. M., Bachen, E. A., & Muldoon, M. F. (1993). Relationship of cardiovascular reactivity and anger expression to serum lipid concentrations in healthy young men. Journal of Psychosomatic Research, 37(3), 249-256.
Watkins, I. Blumenthal, J. A., Carney, R. M. (2002). Association of anxiety with reduced baroreflex cardiac control in patient after acute myocardial infarction. American Heart Journal, 143, 460-466.
Wingard, D. L., Barett, C. E., Criqui, M., & Suarez, L. (1983). Clustering of heart disease risk factors in diabetic compared to nondiabetic adults. American Journal of Epidemiology, 117, 19-26.
Wu, K. K., & Thiagarajan, P. (1996). Role of endothelium in thrombosis and hemostasis. Annual Review Medicine, 47, 315-331.
Yanagisawa, M., Kurihara, H., Kimura, S, et al. (1988). Anovel potent vasoconstrictor peptide produced by vascular endothelial cells. Nature, 332, 411-415.
Zelin, M. L., Adler, G., & Myerson, P. G. (1972). Anger self-report: Anobjective questionnaire for the measurement of aggression. Journal of Consulting and Clinical Psychology, 39, 340.