“三级医院—社区一体化”中医管治结合方案干预糖尿病肾脏疾病患者60例实施效果评价

Evaluation of the effect of the"tertiary hospital-community integrated"TCM-based management and treatment program in 60 patients with diabetic kidney disease

目的观察“三级医院—社区一体化”中医管治结合方案干预糖尿病肾脏疾病患者的实施效果。方法选取朝阳区将台社区卫生服务中心、崔各庄社区卫生服务中心患者共126例,随机分为试验组63例、对照组63例。试验组实施“三级医院—社区一体化”中医管治结合方案(包括中医辨证养生、慢病管理、中西医诊疗综合方案),对照组执行目前社区现有慢病诊疗管理方案(包括定期复诊的慢病管理、西医诊疗方案)。3个月为1个疗程,共观察6个月。比较2组患者24 h尿蛋白定量(24 hUTP)、血肌酐(Scr)、肾小球滤过率估算值(eGFR),以及24 hUTP、Scr、eGFR有效率,糖脂代谢指标[低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、糖化血红蛋白(GHB)]达标率,患者慢性病管理水平和医疗服务利用度的差异。结果最终纳入120例患者,试验组60例、对照组60例。3个月后,试验组和对照组24 hUTP差异具有统计学意义(P<0.05),Scr、eGFR差异无统计学意义。6个月后,24 hUTP、Scr、eGFR差异具有统计学意义(均P<0.05);试验组24 hUTP、Scr、eGFR的有效率均高于对照组(试验组分别为78.3%、48.3%、50.0%,对照组分别为35.0%、18.3%、15.0%),差异具有统计学意义(P<0.05);试验组LDL-C、TG、GHB的达标率均高于对照组(试验组分别为75.0%、83.3%、71.7%,对照组分别为56.7%、63.3%、46.7%),差异具有统计学意义(P<0.05)。对2组患者治疗3、6个月后自我管理水平进行比较,试验组患者自我管理行为总分和自我效能总分均高于对照组,差异有统计学意义(P<0.05);2组患者随访6个月内住院次数和住院费用比较,试验组住院次数减少,住院费用明显下降,差异均有统计学意义(P<0.05)。结论“三级医院—社区一体化”中医管治结合方案的应用具有改善患者肾功能及糖脂代谢水平、提高患者自身管理水平的临床疗效;可以减轻患者家庭经济负担,节省社会医疗资源,提高医疗服务利用度。

Objective We aimed to observe the effect of the traditional Chinese medicine(TCM)-based"tertiary hospital-community integrated"treatment program in patients with diabetic kidney disease.Methods A total of 126 patients from the Jiangtai and Cuigezhuang Communities in Chaoyang District were randomly divided into the experimental group and the control group(n=63 patients per group).In the experimental group,the"tertiary hospital-community integrated"treatment program was implemented(including TCM differentiated health preservation,chronic disease management,comprehensive diagnosis and treatment program of integrated Chinese and Western medicine),while in the control group,the existing chronic disease diagnosis,treatment,and management program in the community was implemented(including chronic disease management with regular follow-ups,diagnosis and treatment program of Western medicine).The observation period was 6 months,with 3 months as a course of treatment.The 24 h urine total protein level(24 hUTP),the serum level of creatinine(Scr),and the estimated glomerular filtration rate(eGFR)were compared between the two groups,as well as the effective rates of 24 hUTP,Scr,and eGFR,the rate of achieving standard glucose levels and normal lipid metabolism,including low-density lipoprotein-cholesterol(LDL-C),triglyceride(TG),and glycosylated hemoglobin(GHB),the level of patients′self-management,and the medical service in utilization.Results There were 120 patients included for analysis(60 in the experimental group and 60 in the control group).The difference in 24 hUTP was significantly different(P<0.05),while Scr and eGFR were not statistically different between the experimental and control groups after 3 months of treatment.The differences in 24 hUTP,Scr,and eGFR were statistically significant after 6 months(P<0.05).After 6 months of treatment in both groups,the effective rates of 24 hUTP,Scr,and eGFR were higher in the experimental group than in the control group(78.3%,48.3%,and 50.0% in the experimental group and 35.0%,18.3%,and 15.0% in the control group,respectively)(P<0.05);after 6 months,the LDL-C,TG,and GHB qualified rates were higher in the experimental group than in the control group(75.0%,83.3%,and 71.7% in the experimental group and 56.7%,63.3%,and 46.7%in the control group,respectively;P<0.05);comparing the self-management levels of the two groups after 3 and 6 months of treatment,the total self-management score and the total self-efficacy score were both higher in the experimental group than in the control group(P<0.05);comparing the time of hospitalization and hospitalization costs of the two groups 6 months after enrollment,the time of hospitalization and hospitalization costs were lower in the experimental group(P<0.05).Conclusion The"tertiary hospital-community integrated"TCM-based treatment program improves renal function,glucose and lipid metabolism,and patients′self-management;it can reduce the economic burden of families,save medical resources,and improve the utilization of medical services.