健康管理对早期糖尿病肾病的影响

Effects of health management on early diabetic nephropathy

目的探讨健康管理对延缓早期糖尿病肾病（DN）进展的效果。方法随机选取早期糖尿病肾病患者98例。随机分为实验组和对照组各49例。对所有患者填写调查问卷、并测定体重、尿微量白蛋白／肌酐（ACR）、血糖、餐后2h血糖、糖化血红蛋白、血压、血脂、肾功、尿蛋白等客观指标。同时全部健康资料归档管理，所有患者继续门诊治疗，实验组采用健康管理模式和疾病管理措施，对该组人群进行干预、教育3年。对照组不进行干预、教育。3年后两组患者再次填写问卷，并测定上述相关客观指标。结果我们通过3年的健康管理，实验组ACR在明显下降，对照组不降，反而升高，两组比较具有统计学意义（P〈0．05）。对照组15例患者出现尿蛋白，3例患者发展至终末期’肾病，而实验组没有出现尿蛋白阳性和终末期肾病患者。对于DN的高危因素如高血糖、高血压、血脂异常明显下降，与对照组比较均有统计学意义（所有P〈0．05）。结论对早期DN患者进行有效地健康管理，可以使其得到更加充分、全面的治疗，减轻导致肾脏病加重的危险因素，达到延缓DN患者病情进展的目的。

objective To investigate the effects of health management on the progress of early diabetic nephropathy （DN）. Methods A total of 98 patients with early stage DN were randomly assigned to the study group （ n = 49） and the control group （ n = 49）. Questionnaire survey was performed, and urinary albumin to creatinine rate （ ACR）, body weight, fasting glucose, postprandial 2 h glucose, blood pressure, and lipid profiles were measured. The patients of the study group received health and disease management for 3 years; however, those of the control group received no additional intervention other than essential treatment. At 3 years, all the participants completed the questionnaires and above-mentioned measurements. Results In comparison with the control group, ACR of the study group was significantly decreased at 3 years （P 〈 0. 05 ）. In the control group, urinary protein was found in 15 patients and 3 participants developed end-stage renal disease. However, neither urinary protein nor end-stage renal disease was found in the study group. Risk factors of DN, including high blood glucose, high blood pressure, and high cholesterol, were significantly decreased in the study group （all P 〈 0.05 ）. Conclusion Early effective health management of DN may contribute to decreased risk factors of renal disease and delayed disease progression.