颞下颌关节紊乱病不同症状患者心理因素调查

doi:10.3877/cma.j.issn.1674-1366.2015.05.007

中华口腔医学研究杂志(电子版) ›› 2015, Vol. 09 ›› Issue (05) : 390 -394. doi: 10.3877/cma.j.issn.1674-1366.2015.05.007

所属专题：文献；

临床研究

颞下颌关节紊乱病不同症状患者心理因素调查

陈妹玲¹, 张娟¹^,^†(

), 陈刚², 吕小康³, 黄昕²

^1. 300070　天津医科大学口腔医院修复科
^2. 300070　天津医科大学口腔医院口腔颌面外科
^3. 300071　天津，南开大学周恩来政府管理学院社会心理学系

收稿日期:2015-05-16 出版日期:2015-10-01
通信作者: 张娟
基金资助:
天津市高等学校科技发展基金(20080129); 天津市卫生局科技基金(2010KZ103)

Investigation of psychological factors in patients with different symptoms of temporomandibular disorders

Meiling Chen¹, Juan Zhang¹^,^†(), Gang Chen², Xiaokang Lyu³, Xin Huang²

^1. Rehabilitation Department, Stomatological Hospital of Tianjin Medical University, Tianjin 300070, China
^2. Oral and Maxillofacial Surgery, Stomatological Hospital of Tianjin Medical University, Tianjin 300070, China
^3. Department of Social Psychology, Zhou Enlai School of Government, Nankai University, Tianjin 300071, China

Received:2015-05-16 Published:2015-10-01
Corresponding author: Juan Zhang
About author:
Corresponding author: Zhang Juan, Email: kqzhangjuan@126.com

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引用本文：

陈妹玲, 张娟, 陈刚, 吕小康, 黄昕. 颞下颌关节紊乱病不同症状患者心理因素调查[J]. 中华口腔医学研究杂志(电子版), 2015, 09(05): 390-394.

Meiling Chen, Juan Zhang, Gang Chen, Xiaokang Lyu, Xin Huang. Investigation of psychological factors in patients with different symptoms of temporomandibular disorders[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2015, 09(05): 390-394.

目的

研究颞下颌关节紊乱病（TMD）不同症状患者心理社会因素，尤其是焦虑的差别，为心理治疗对策提供试验依据。

方法

206例就诊于天津医科大学口腔医院的TMD患者和201名无症状志愿者，填写症状自评量表（SCL-90）和状态-特质焦虑问卷（STAI），根据患者主诉分组。采用SPSS 17.0统计软件，采用独立样本t检验和单因素方差分析对所有数据进行统计学分析。

结果

（1）TMD患者SCL-90量表中的躯体化、抑郁、焦虑、敌对、精神病性因子得分及总分高于无症状志愿者，差异有统计学意义（t_躯体化 = 3.79，P_躯体化 = 0.000；t_抑郁 = 2.14，P_抑郁 = 0.033；t_焦虑 = 2.91，P_焦虑 = 0.004；t_敌对 = 3.93，P_敌对 = 0.000；t_精神病性 = 2.48，P_精神病性 = 0.013；t_总分 = 2.80，P_总分 = 0.005）；女性TMD患者的状态焦虑及特质焦虑得分均高于女性无症状志愿者（t_状态焦虑 = 3.52，P_状态焦虑 = 0.001；t_特质焦虑 = 4.26，P_特质焦虑 = 0.000），两组男性之间差异无统计学意义（t_状态焦虑 = 0.36，P_状态焦虑 = 0.718；t_特质焦虑 = 0.76，P_特质焦虑 = 0.453）；（2）不同症状TMD患者在躯体化和状态焦虑方面差异有统计学意义（F_躯体化 = 2.714，P_躯体化 = 0.046；F_特质焦虑 = 3.007，P_特质焦虑 = 0.031），具有单纯疼痛症状者躯体化得分高于单纯弹响患者（P = 0.005），单纯弹响及疼痛伴弹响患者的特质焦虑得分高于疼痛伴开口受限者（P = 0.016）。

结论

TMD患者心理健康水平比无症状人群低，主要表现在躯体化、抑郁、焦虑、敌对和精神病性方面。女性TMD患者有明显焦虑特征。单纯疼痛TMD患者躯体化比单纯弹响者更为明显。

关键词: 颞下颌关节紊乱病, 心理社会因素, 症状自评量表, 状态-特质焦虑问卷

Objective

To compare the psychosocial factors especially anxiety in patients with different symptoms of temporomandibular disorders (TMD) and provide evidence for psychotherapy strategies of patients with TMD.

Methods

Totally 206 patients visited TMD clinic of stomatological hospital of Tianjin Medical University and 201 asymptomatic volunteers were included in this study. Symptom Checklist 90 (SCL-90) and State-Trait Anxiety Inventory (STAI) were used to assess the psychological status. The patients were classified according to the chief complaints. The datas were analyzed by SPSS 17.0.

Results

There was a statistically significant difference (t_somatization = 3.79, P_somatization = 0.000; t_depression = 2.14, P_depression = 0.033; t_anxiety = 2.91, P_anxiety = 0.004; t_hostility = 3.93, P_hostility = 0.000; t_psychoticism = 2.48, P_psychoticism = 0.013; t_total = 2.80, P_total = 0.005) in the scores of SCL-90 between the patients and the volunteers, the patients got higher scores on the somatization, depression, anxiety, hostility, psychoticism and the total score of SCL-90. Both scores of state anxiety inventory and trait anxiety inventory in female patients were significantly higher than the female volunteers (t_S-AI = 3.52, P_S-AI = 0.001; t_T-AI = 4.26, P_T-AI = 0.000) , but there was no difference between male patients and volunteers (t_S-AI = 0.36, P_S-AI = 0.718; t_T-AI = 0.76, P_T-AI = 0.453) . The scores of somatization and trait-anxiety were different among patients with different TMD symptoms (F_somatization = 2.714, P_somatization = 0.046; F_T-AI = 3.007, P_T-AI = 0.031) . Patients with pain symptom had a higher somatization score than those with clicking symptom (P = 0.005) . The trait-anxiety score of patients who had clicking with or without pain were higher than those had pain with limited opening (P = 0.016) .

Conclusions

The level of psychological health of TMD patients were lower than the controls, focusing on somatization, depression, anxiety, hostility and psychoticism. The female TMD paients had the more obvious anxiety. Somatization in patients with pain were more obvious than patients with clicking.

Key words: Temporomandibular disorders, Psychosocial factors, Symptom Checklist 90, State-Trait Anxiety Inventory

表1 试验组与对照组SCL-90各因子得分的比较（ ± s）

组别	躯体化	强迫	人际关系	抑郁	焦虑	敌对	恐怖	偏执	精神病性	其他	总分
试验组	1.35 ± 0.42^a	1.59 ± 0.54	1.34 ± 0.42	1.37 ± 0.43^a	1.34 ± 0.38^a	1.46 ± 0.53^a	1.17 ± 0.27	1.29 ± 0.42	1.23 ± 0.32^a	1.40 ± 0.42^a	122.31 ± 30.26^a
对照组	1.22 ± 0.25	1.56 ± 0.36	1.31 ± 0.28	1.29 ± 0.27	1.25 ± 0.24	1.29 ± 0.33	1.17 ± 0.26	1.26 ± 0.26	1.16 ± 0.24	1.28 ± 0.29	115.34 ± 18.67
t值	3.79	0.76	0.98	2.14	2.91	3.93	0.23	0.97	2.48	3.55	2.80
P值	0.000	0.449	0.327	0.033	0.004	0.000	0.815	0.332	0.013	0.000	0.005

表1 试验组与对照组SCL-90各因子得分的比较（ ± s）

组别	躯体化	强迫	人际关系	抑郁	焦虑	敌对	恐怖	偏执	精神病性	其他	总分
试验组	1.35 ± 0.42^a	1.59 ± 0.54	1.34 ± 0.42	1.37 ± 0.43^a	1.34 ± 0.38^a	1.46 ± 0.53^a	1.17 ± 0.27	1.29 ± 0.42	1.23 ± 0.32^a	1.40 ± 0.42^a	122.31 ± 30.26^a
对照组	1.22 ± 0.25	1.56 ± 0.36	1.31 ± 0.28	1.29 ± 0.27	1.25 ± 0.24	1.29 ± 0.33	1.17 ± 0.26	1.26 ± 0.26	1.16 ± 0.24	1.28 ± 0.29	115.34 ± 18.67
t值	3.79	0.76	0.98	2.14	2.91	3.93	0.23	0.97	2.48	3.55	2.80
P值	0.000	0.449	0.327	0.033	0.004	0.000	0.815	0.332	0.013	0.000	0.005

表2 试验组与对照组STAI得分比较（ ± s）

组别	状态焦虑		特质焦虑
组别	男	女	男	女
试验组	34.79 ± 8.23	36.32 ± 9.93^a	36.31 ± 8.85	37.69 ± 9.84^a
对照组	34.37 ± 7.63	32.55 ± 7.98	35.12 ± 8.13	33.15 ± 8.26
t值	0.360	3.520	0.760	4.260
P值	0.718	0.001	0.453	0.000

表2 试验组与对照组STAI得分比较（ ± s）

组别	状态焦虑		特质焦虑
组别	男	女	男	女
试验组	34.79 ± 8.23	36.32 ± 9.93^a	36.31 ± 8.85	37.69 ± 9.84^a
对照组	34.37 ± 7.63	32.55 ± 7.98	35.12 ± 8.13	33.15 ± 8.26
t值	0.360	3.520	0.760	4.260
P值	0.718	0.001	0.453	0.000

表3 不同TMD症状患者的人数及年龄分布

症状	男	女	%	年龄（ ± s）
单纯疼痛	13	52	31.6	36.77 ± 15.23
单纯弹响	24	48	35.0	24.22 ± 8.38
疼痛伴开口受限	6	25	15.0	39.29 ± 17.51
疼痛伴弹响	9	29	18.4	30.79 ± 15.19

表3 不同TMD症状患者的人数及年龄分布

症状	男	女	%	年龄（ ± s）
单纯疼痛	13	52	31.6	36.77 ± 15.23
单纯弹响	24	48	35.0	24.22 ± 8.38
疼痛伴开口受限	6	25	15.0	39.29 ± 17.51
疼痛伴弹响	9	29	18.4	30.79 ± 15.19

表4 不同TMD症状患者之间各心理因子得分比较的方差分析（ ± s）

症状	躯体化	强迫	人际关系	抑郁	焦虑	敌对	恐怖	偏执	精神病性	其他	状态焦虑	特质焦虑
单纯疼痛	1.45 ± 0.55	1.55 ± 0.55	1.29 ± 0.44	1.39 ± 0.46	1.37 ± 0.47	1.40 ± 0.43	1.22 ± 0.32	1.25 ± 0.42	1.27 ± 0.39	1.43 ± 0.45	36.26 ± 10.30	36.20 ± 10.25
单纯弹响	1.25 ± 0.24	1.64 ± 0.46	1.35 ± 0.33	1.35 ± 0.34	1.33 ± 0.29	1.45 ± 0.47	1.18 ± 0.26	1.29 ± 0.32	1.21 ± 0.23	1.34 ± 0.31	36.31 ± 8.41	38.89 ± 7.99
疼痛伴开口受限	1.34 ± 0.37	1.52 ± 0.54	1.32 ± 0.53	1.34 ± 0.50	1.30 ± 0.33	1.47 ± 0.79	1.08 ± 0.19	1.28 ± 0.56	1.17 ± 0.30	1.47 ± 0.47	33.52 ± 9.64	33.74 ± 10.03
疼痛伴弹响	1.38 ± 0.45	1.65 ± 0.65	1.43 ± 0.45	1.38 ± 0.46	1.35 ± 0.40	1.56 ± 0.54	1.15 ± 0.24	1.38 ± 0.48	1.27 ± 0.32	1.43 ± 0.48	36.66 ± 10.17	39.32 ± 10.14
F值	2.714	0.668	0.842	0.147	0.276	0.732	1.974	0.691	1.072	0.926	0.797	3.007
P值	0.046	0.573	0.472	0.932	0.843	0.534	0.119	0.558	0.362	0.429	0.497	0.031

表4 不同TMD症状患者之间各心理因子得分比较的方差分析（ ± s）

症状	躯体化	强迫	人际关系	抑郁	焦虑	敌对	恐怖	偏执	精神病性	其他	状态焦虑	特质焦虑
单纯疼痛	1.45 ± 0.55	1.55 ± 0.55	1.29 ± 0.44	1.39 ± 0.46	1.37 ± 0.47	1.40 ± 0.43	1.22 ± 0.32	1.25 ± 0.42	1.27 ± 0.39	1.43 ± 0.45	36.26 ± 10.30	36.20 ± 10.25
单纯弹响	1.25 ± 0.24	1.64 ± 0.46	1.35 ± 0.33	1.35 ± 0.34	1.33 ± 0.29	1.45 ± 0.47	1.18 ± 0.26	1.29 ± 0.32	1.21 ± 0.23	1.34 ± 0.31	36.31 ± 8.41	38.89 ± 7.99
疼痛伴开口受限	1.34 ± 0.37	1.52 ± 0.54	1.32 ± 0.53	1.34 ± 0.50	1.30 ± 0.33	1.47 ± 0.79	1.08 ± 0.19	1.28 ± 0.56	1.17 ± 0.30	1.47 ± 0.47	33.52 ± 9.64	33.74 ± 10.03
疼痛伴弹响	1.38 ± 0.45	1.65 ± 0.65	1.43 ± 0.45	1.38 ± 0.46	1.35 ± 0.40	1.56 ± 0.54	1.15 ± 0.24	1.38 ± 0.48	1.27 ± 0.32	1.43 ± 0.48	36.66 ± 10.17	39.32 ± 10.14
F值	2.714	0.668	0.842	0.147	0.276	0.732	1.974	0.691	1.072	0.926	0.797	3.007
P值	0.046	0.573	0.472	0.932	0.843	0.534	0.119	0.558	0.362	0.429	0.497	0.031

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