上海市老西门街道早期糖尿病肾病患者社区干预效果评估

Community intervention effect evaluation of patients with diabetic nephropathy in early stage in Laoximen Street of Shanghai

目的评价目前社区卫生服务中心对早期糖尿病肾病进行干预的有效性。方法在本辖区内2个居委的2型糖尿病管理人群中,采用尿微量白蛋白/尿肌酐(UAlb/UCr)值筛查出48例病情稳定的早期糖尿病肾病患者,将患者随机分为干预组24例,对照组24例。干预组在社区慢病管理基础上,采用控制血糖、血脂及血压的综合干预措施;对照组只进行慢病管理。观察患者的UAlb/UCr值、空腹血糖(FBG)、Hb A1c、血脂、血压等相关指标的变化情况。结果干预后,干预组的各相关指标均达到控制目标,UAlb/UCr值为(8.33±3.42)mg/mmol,FBG为(6.04±1.83)mmol/L,Hb A1c为(6.42±0.38)%,TC为(4.39±0.57)mmol/L,TG、LDL-C、血压等指标与干预前比较,差异有统计学意义(P<0.05),且干预组干预后的各检测指标与对照组比较,差异有统计学意义(P<0.05)。干预后,对照组的UAlb/UCr值、TG水平有所上升,与干预前比较,差异有统计学意义(P<0.05)。结论以社区卫生资源为基础的干预措施对早期糖尿病肾病进行干预具有重要意义。

Objective To evaluate the effectiveness of community health service center on intervening diabetic nephropathy（DN） in early stageat present. Methods Among the type 2 diabetes management crowd of by two residents′committees in this area,48 stable patients with diabetic nephropathy in early stage were screened using urinary albumin/urinary creatinine（UAlb/UCr） value,and they were evenly divided into intervention group and control group in random.In the intervention group,on the basis of chronic disease management,comprehensive intervention measures like blood glucose control,blood lipid control,and blood pressure control were applied. In the control group,only chronic disease management was used.Change of UAlb/UCr value,fasting blood glucose（FBG）,Hb A1 c,blood lipid,blood pressure and other related indexes were observed. Results After intrevwntion,the related indexes of intervention group reached control goal,UAlb/UCr value was（8.33±3.42） mg/mmol,FBGwas（6.04±1.83） mmol/L,Hb A1 c was（6.42 ±0.38）%,TC was（4.39±0.57） mmol/L,above-mentioned indexes and TG,LDL-C,blood pressure and other indicators were compared with before intervention,and there was a statistical difference（P 0.05）.After intervention,these indexes in the intervention group also displayed statistical difference compared with those in control group（P〈0.05）.In control group,UAlb/UCrvalue and TG level were improved and the two indexes were compared with before intervention,and there was a statistical difference（P 0.05）. Conclusion Intervening measures based on community health resources have important significance in intervention of DN in early stage.