上海市大团社区2型糖尿病患者慢性并发症筛查结果分析

Analysis on screening results of chronic complications in type 2 diabetes patients in Datuan Community in Shanghai

目的糖尿病多种慢性并发症严重危害患者健康、生活质量和预期寿命,本研究旨在分析上海市浦东新区大团地区2型糖尿病患者慢性并发症发病情况,为社区防治糖尿病并发症提供依据。方法 2017-10-17-2017-10-24大团社区利用病史问卷和相关项目筛查对辖区内1 000例40~75岁已确诊的2型糖尿病患者,进行糖尿病慢性并发症筛查,统计分析大团社区糖尿病慢性病并发症检出率、血和尿生化异常检出率,以及患者转诊情况。结果 1 000例患者中,患有1种或多种并发症913例,检出率为91.3%;并发视网膜病变419例(41.9%);周围神经病变375例(37.5%);周围血管病变286例(28.6%);血和尿生化检查异常193例(19.3%)。血和尿生化异常检出率在男性不同年龄段差异无统计学意义,χ2=4.533,P=0.209;女性不同年龄段差异有统计学意义,χ2=11.898,P=0.008。尿酮体阳性检出率,男性和女性差异有统计学意义,χ2=7.704,P=0.006;尿蛋白肌酐比(χ2=0.056,P=0.814)、肾小球滤过率(χ2=0.036,P=0.849)、血糖失控(χ2=0.099,P=0.753)和低血糖(P=0.156)发生率在男性和女性之间比较,差异均无统计学意义。筛选出的913例指标异常者中,465例需转诊至上级医院进行诊疗,实际转诊治疗86例,转诊就诊率为18.4%。结论大团地区糖尿病患者并发症较高,但至二三级医院转诊治疗率较低,需要加强健康教育的同时,加强社区与医院的联合互动,形成衔接有序、医防融合的防治服务模式。

OBJECTIVE A variety of chronic complications of diabetes seriously harm the health,quality of life and life expectancy of patients.This study aims to analyze the incidence of chronic complications of type 2 diabetes patients in Datuan Community of Pudong new area in Shanghai,so as to provide a basis for community prevention and treatment of diabetes complications.METHODS The medical history questionnaire and related items were used to screen 1 000 patients with type 2 diabetes who were diagnosed between 40 and 75 years old in the Datuan Community.The detection rate of chronic diabetic complications,the detection rate of biochemical abnormalities in blood and urine,and the referral status of the patients were statistically analyzed.RESULTS Among the 1 000 patients,913 had one or more complications,with a detection rate of 91.3%.Retinopathy occurred in 419 cases(41.9%).Peripheral neuropathy was found in 375 cases(37.5%).Peripheral vascular disease were found in 286 cases(28.6%).There were 193 cases(19.3%)of abnormal blood and urine biochemical examination.There was no significant difference in the detection rate of blood and urine biochemical abnormalities between the different age groups in the male,but was significant difference in the female(male:χ2=4.533,P=0.209;female:χ2=11.898,P=0.008).The positive urinary ketone body detection rate was statistically significant between male and female,χ2=7.704,P=0.006.Urinary protein creatinine ratio(χ2=0.056,P=0.814),glomerular filtration rate(χ2=0.036,P=0.849),incidence of uncontrolled blood glucose(χ2=0.099,P=0.753)and hypoglycemia(P=0.156)were not statistically significant between males and females.Among the 913 cases with abnormal indicators screened out,465 cases needed to be referred to superior hospitals for diagnosis and treatment,and 86 cases were actually referred for treatment,with a referral consultation rate of 18.4%.CONCLUSIONS In Datuan community,diabetes patients have higher complications,but the rate of referral to the second and third-level hospitals is low.Therefore,it is necessary to strengthen health education and strengthen the joint interaction between community-hospital,so as to form a prevention and treatment service mode that is connected orderly and integrated with medical treatment and prevention.