心理行为因素影响颈动脉硬化的路径分析
Path Analysis of Psychological and Behavior-al Factors Affecting Carotid Atherosclerosis

目的：运用结构方程方法探究心理行为等因素影响颈动脉硬化(CAS)的路径模式。方法：横断面选取2021年10月~2023年3月于青岛大学附属医院住院或查体被试698例，根据颈动脉超声检查结果和健康资料，分为CAS组467例，正常对照组231例。所有被试均采集A型行为、心理应激、行为生活方式、人口学等因素资料，采用单因素分析和Logistic回归方法分析影响CAS的因素，利用结构方程方法探讨这些心理行为因素如何影响CAS的作用模式。结果：A型行为、心理应激、过度饮酒、烟草依赖、饮茶、睡眠质量、体育锻炼、业余爱好、年龄、性别是CAS的影响因素(P < 0.05)。结构方程模型显示，A型行为、体育锻炼、睡眠质量、饮茶、年龄、性别可直接影响CAS。心理应激增加了A型行为的负性行为而加重CAS；A型行为可以直接影响CAS，也通过降低睡眠质量促进CAS；体育锻炼可以直接影响CAS或间接通过调控A型行为而减轻CAS；业余爱好通过增加体育锻炼的积极性、过度饮酒通过减少体育锻炼而间接影响颈动脉硬化；烟草依赖促进A型行为影响CAS。结论：A型行为、体育锻炼、年龄、性别、饮茶、睡眠质量是直接影响CAS的因素；A型行为、体育锻炼、心理应激、烟草依赖、过度饮酒、业余爱好对CAS具有间接的影响作用。结构方程模型显示心理行为等因素影响CAS的路径模式。
Objective: To explore the path pattern of carotid atherosclerosis (CAS) influenced by psychological and behavioral factors by structural equation method. Methods: A cross-sectional study was con-ducted on 698 patients who were hospitalized or examined in the Affiliated Hospital of Qingdao University from October 2021 to March 2023. According to the results of carotid ultrasound exami-nation and health data, they were divided into CAS group with 467 cases and normal control group with 231 cases. All subjects collected data of type A personality, psychological stress, behavioral lifestyle, demography and other factors, and analyzed the factors influencing CAS by single factor analysis and Logistic regression, and discussed how these psychological and behavioral factors af-fected the mode of action of CAS by structural equation method. Results: Type A personality, psy-chological stress, excessive drinking, tobacco dependence, tea drinking, sleep quality, physical ex-ercise, hobbies, age and gender are the influencing factors of CAS (P < 0.05). Structural equation model shows that type A personality, physical exercise, sleep quality, tea drinking, age and gender can directly affect CAS. Psychological stress increases the negative behavior of type A personality and aggravates CAS. Type A personality can directly affect CAS and promote CAS by reducing sleep quality. Physical exercise can directly affect CAS or indirectly reduce CAS by regulating type A per-sonality; hobbies indirectly affect carotid atherosclerosis by increasing the enthusiasm of physical exercise and excessive drinking by reducing physical exercise; tobacco dependence promotes type A behavior and affects CAS. Conclusion: Type A personality, physical exercise, age, sex, tea drinking and sleep quality are the factors that directly affect CAS. Type A personality, physical exercise, psy-chological stress, tobacco dependence, excessive drinking and hobbies have indirect effects on CAS. Structural equation model shows that