对代谢综合征患者进行家庭医生健康管理的效果评价

Evaluation of the effect of health management in patients with metabolic syndrome by family doctors

目的探讨家庭医生健康管理模式对代谢综合征（MS）患者的干预效果。方法选择健康体检中筛查的MS患者417例，用随机数字表法分为干预组和对照组分别为206例、211例。干预组在常规健康随访的基础上，增加家庭医生式健康管理干预，而对照组仅进行常规健康随访。1年后观察两组患者体质指数（BMI）、血压、三酰甘油（TG）、空腹血糖（FPG）、高密度脂蛋白胆固醇（HDL-C）的变化，采用配对设计的t检验和卡方检验分析干预效果。结果干预组在干预1年后BMI（25.04±2.92）kg/m2、收缩压（121.5±15.6）mmHg（1mmHg=0.133 kPa）及TG、FPG分别为（2.02±1.24）、（5.92±1.75）mmol/L，低于干预前的（25.66±2.64）kg/m2、（128.4±16.5）mmHg、（2.43±1.06）、（6.34±1.62）mmol/L，差异有统计学意义（t=2.437、3.598、3.536、2.983，P均〈0.05）；HDL-C（1.32±0.26）mmol/L高于干预前的（1.26±0.32）mmol/L，差异有统计学意义（t=-2.218，P〈0.05）；干预组在干预后BMI、血压、FPG高于正常参考值、HDL-C低于正常参考值的患者比例分别是62.6%、75.2%、14.6%、52.9%，低于干预前的92.7%、85.4%、23.3%、63.6%，差异有统计学意义（χ2=53.795、6.777、5.124、4.832，P均〈0.05）。对照组在1年后仅BMI（24.52±2.69）kg/m2低于干预前的（25.79±2.85）kg/m2，差异有统计学意义（t=2.421，P〈0.05），其他收缩压、舒张压、TG、HDL-C、FPG的变化均无统计学意义。结论家庭医生健康管理通过对MS患者的生活方式干预，能有效降低体重、血压、血脂、血糖水平。

ObjectiveTo explore the effect of the health management service in patients with metabolic syndrome （MS） by family doctors. MethodsA total of 417 patients with MS were screened during a health examination and divided into the intervention and control groups （206 and 211 cases, respectively）, using a random digital table. Based on routine health follow-up, the intervention group received increased health management intervention by the family doctor, while the control group was only had followed-up with routine health check-ups. After 1 year, the changes in body mass index （BMI）, blood pressure, triglyceride （TG） levels, fasting blood glucose （FBG） levels, and high-density lipoprotein cholesterol （HDL-C） in the two groups of patients were observed. The effect of intervention was analyzed using the paired design t-test and chi-square test.ResultsIn the intervention group, the BMI （25.04±2.92） kg/m2, systolic blood pressure （121.5±15.6） mmHg （1 mmHg=0.133 kPa）, TG levels （2.02±1.24） mmol/L, and FBGlevels（5.92±1.75） mmol/L after the intervention, were lower than those before the intervention （25.66±2.64） kg/m2, （128.4±16.5） mmHg, （2.43±1.06） mmol/L, （6.34±1.62） mmol/L; respectively, and these differenceswerestatistically significant （t=2.437, 3.598, 3.536, 2.983, respectively; P〈0.05）. HDL-C levels after the intervention （1.32±0.26） mmol/L were higher than thosebefore the intervention （1.26±0.32） mmol/L, and the difference was statistically significant （t=-2.218, P〈0.05）. In the intervention group, blood pressure, BMI, FBGlevels, and HDL-C levels after the intervention were higher than the normal reference values.The proportion of patients with normal reference valuesafter the intervention were 62.6%, 75.2%, 14.6%, and 52.9%, respectively, which were lower than those before the intervention（92.7%, 85.4% 23.3%, and 63.6%, respectively）; thesedifferenceswerestatistically significant （χ2=53.795, 6.777, 5.124, and 4.832, respectively;P〈0.05）. After 1 year, the control group had lower BMI （24.52±2.69） kg/m2 than that before the intervention （25.79±2.85） kg/m2; thisdifference was statistically significant （t=2.421, P〈0.05）.There were no significant differences in the systolic and diastolic blood pressure, TG levels, HDL-C levels, and FBG levels.ConclusionHealth management byfamily doctors can effectively reduce weight, blood pressure, blood lipids, and blood sugar by interfering with the lifestyle of patients with MS.