摘要
目的比较医院-社区一体化管理模式和传统的社区综合干预模式对糖尿病肾病(DN)预后的影响。方法将325例2型DN患者随机分为一体化管理组160例和标准化管理组165例,随访1年后观察两组患者尿白蛋白肌酐比(ACR)、24h尿微量白蛋白(UMA)、血肌酐(Cr)、肾小球滤过率(GFR)的变化,比较两组DN的控制率。对两组可能影响DN控制效果的危险因素如糖尿病病程、年龄、收缩压(SBP)、舒张压(DBP)、TC、TG、HDL-C、LDL-C、糖化血红蛋白(HbA1C)、空腹血糖(FBG)、餐后2h血糖(2h PBG)、体重指数(BMI)、胰岛素抵抗指数(HOMA-IR)、腰围、吸烟、饮酒的比例等进行记录、检测并分析,比较干预前后两组之间指标的差异。DN与各变量的关系采用logistic回归分析。结果(1)干预前一体化管理组病程比标准化管理组更长(P<0.05);干预后一体化管理组在吸烟、饮酒比例、SBP、DBP、FBG、HbA1C、ACR、UMA等指标比标准化管理组更低,而GFR、DN控制率则要高于标准化管理组(均P<0.05)。(2)一体化管理组的BMI、腰围、SBP、DBP、TC、LDL-C、FBG、HbA1C、ACR、UMA、Cr等指标下降程度均高于标准化管理组,而GFR上升程度则高于标准化管理组(均P<0.05)。(3)文化程度(初中以下)、高血压、HbA1C(>8.3%)、LDL-C(≥3.40mmol/L)、ACR(≥213.5mg/g)、UMA(≥288.6mg)、吸烟是DN未控制的危险因素(均P<0.05)。结论一体化管理模式能更好的改善血压,改善糖尿病患者不良的生活方式,减轻体重和腰围,改善血脂、血糖等代谢指标,降低DN的蛋白尿,提高DN控制率。低学历、高血压、高血糖、高LDL-C、尿蛋白增多、吸烟是DN控制不良的独立危险因素。
Objective To compare the effects of hospital-community integrated management model and conventional community comprehensive intervention model on the disease control in patients with diabetic nephropathy(DN).Methods One hundred sixty patients with DN in the integrated management group and 165 DN patients in the standardized management group were recruited in a prospective RCT study.After follow-up for 1 year,the urine albumin creatinine ratio(ACR),24-h urinary microalbumin(UMA),serum creatinine and glomerular filtration rate(GFR)were observed.The control rate of DN was compared between the two groups.Risk factors including duration of diabetes,age,SBP,DBP,TC,TG,HDL-C,LDL-C,HbA1 C,fasting plasma glucose(FBG),postprandial 2-h blood glucose(2 h PBG),BMI,HOMA-IR,waist circumference,rates of smoking and drinking were were compared between two groups.Results The integrated management group had longer disease duration before interventions(P<0.05).After the interventions,the integrated management group had lower rate of smoking and drinking,and lower levels of SBP,DBP,FBG,HbA1 C,ACR and UMA.The GFR and the control rate of DN were higher than those of standardized management group(P<0.05).The BMI,waist circumference,SBP,DBP,TC,LDL-C,FBG,HbA1 C,ACR,UMA,CR of the integrated management group were decreased more than those of the standardized management group,and the GFR was increased more markedly than that of the standardized management group(P<0.05)..Multivariate Logistic regression analysis showed that education(below junior high school),hypertension,HbA1 C(>8.3%),LDL-C(≥3.40 mmol/L),ACR(≥213.5 mg/g),UMA(≥288.6 mg),smoking were risk factors for uncontrolled DN.Conclusion The integrated management model can improve blood pressure and the lifestyle of diabetics;reduce weight and waist circumference;improve blood lipids and blood glucose;reduce proteinuria and increase the control rate of DN.Low education,hypertension,hyperglycemia,increased LDL-C and urinary protein,smoking are risk factors for poorly controlled DN.
作者
吴炜飞
李顺斌
李冰
尹陆黎
白轶
黄孔丽
WU Weifei;LI Shunbin;LI Bin(Department of Nephrology,Huzhou Central Hospital,Huzhou 313000,China)
出处
《浙江医学》
CAS
2019年第22期2408-2412,2416,共6页
Zhejiang Medical Journal
基金
湖州市科技局公益性研究项目(A类)(2016GY48)
关键词
糖尿病肾病
医院-社区一体化管理
管理模式
预后
Diabetic nephropathy
Hospital-community integrated management
Management model
Prognosis
