中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
10期
662-666
,共5页
朱文华%方力争%陈丽英%陈周闻%戴红蕾%陈建华
硃文華%方力爭%陳麗英%陳週聞%戴紅蕾%陳建華
주문화%방력쟁%진려영%진주문%대홍뢰%진건화
尿酸%早期干预(教育)%心血管疾病
尿痠%早期榦預(教育)%心血管疾病
뇨산%조기간예(교육)%심혈관질병
Uric acid%Early intervention (education)%Cardiovascular diseases
目的 观察高尿酸血症的程序干预对改善代谢指标及防治心血管病变的影响.方法 采用前瞻性研究,对531例高尿酸血症患者,分为干预组和对照组,管理及随访36个月;对干预组进行程序化管理及随访,对照组进行基础评估及终期评估;分析比较干预组与对照组生活方式改善情况、各项代谢指标变化情况及亚临床心血管病变发生情况.结果 (1)干预组干预前后除吸烟、饮酒外的生活方式包括低嘌呤饮食、低脂饮食、高盐控制、规律运动的依从性均有明显提高,分别为37.1%、26.2%、25.7%和24.8%,差异有统计学意义(P<0.01);对照组低嘌呤饮食、低脂饮食依从性随访前后分别提高为8.7%和6.6%(P<0.05),高盐控制、规律运动依从性随访前后提高为2.2%和2.1%,差异无统计学意义(P>0.05).(2)干预组尿酸、甘油三酯、腰围、体质指数、收缩压与舒张压干预前分别是(449±3)mmol/L,(3.62±0.30)mmol/L,(93.8±0.6)cm,(27.13±0.19)kg/m~2,(129.1 ±1.0)mm Hg及(80.7±0.7)mm Hg,干预后指标有改善分别是(410±3)mmol/L,(1.98±0.02)mmol/L,(90.2±0.5)cm,(25.67±0.17)kg/m2,(123.8±0.6)mm Hg及(78.5±0.8)mm Hg(P<0.01);干预前后高密度脂蛋白胆固醇、血糖有改变[干预前(1.06±0.02)mmol/L和(5.54 ±0.08)mmol/L,干预后(1.12±0.18)mmol/L和(5.36 ±0.04)mmol/L,P<0.05].对照组随访前后血压、体质指数、甘油三酯、血糖有下降(P<0.05),其余代谢指标尿酸、胆固醇、高密度脂蛋白胆固醇、腰围随访前后比较,差异无统计学意义(P>0.05).(3)干预前超敏C反应蛋白及B型钠尿肽分别为(1.62±0.12)mg/L和(6.76 ±0.10)ng/L,干预后分别为(1.33±0.11)mg/L和(5.88±0.17)ng/L,差异有统计学意义(p<0.01),而对照组随访前后差异无统计意义(P>0.05);干预后颈动脉B超显示动脉硬化、眼底病变、心脏超声阳性改变分别为3.81%,5.71%及2.85%,对照组为12.56%,13.66%及10.92%,两组比较差异有统计学意义(P<0.01);心电图ST-T改变、平板运动试验阳性、冠状动脉CT阳性的发生分别为5.23%、0.92%及0,对照组为12.02%、4.91%及2.73%,差异有统计学意义(P<0.05).结论 高尿酸血症的程序干预有助于生活方式、代谢指标及心血管病变的改善,对防治亚临床心血管病变有重要意义.
目的 觀察高尿痠血癥的程序榦預對改善代謝指標及防治心血管病變的影響.方法 採用前瞻性研究,對531例高尿痠血癥患者,分為榦預組和對照組,管理及隨訪36箇月;對榦預組進行程序化管理及隨訪,對照組進行基礎評估及終期評估;分析比較榦預組與對照組生活方式改善情況、各項代謝指標變化情況及亞臨床心血管病變髮生情況.結果 (1)榦預組榦預前後除吸煙、飲酒外的生活方式包括低嘌呤飲食、低脂飲食、高鹽控製、規律運動的依從性均有明顯提高,分彆為37.1%、26.2%、25.7%和24.8%,差異有統計學意義(P<0.01);對照組低嘌呤飲食、低脂飲食依從性隨訪前後分彆提高為8.7%和6.6%(P<0.05),高鹽控製、規律運動依從性隨訪前後提高為2.2%和2.1%,差異無統計學意義(P>0.05).(2)榦預組尿痠、甘油三酯、腰圍、體質指數、收縮壓與舒張壓榦預前分彆是(449±3)mmol/L,(3.62±0.30)mmol/L,(93.8±0.6)cm,(27.13±0.19)kg/m~2,(129.1 ±1.0)mm Hg及(80.7±0.7)mm Hg,榦預後指標有改善分彆是(410±3)mmol/L,(1.98±0.02)mmol/L,(90.2±0.5)cm,(25.67±0.17)kg/m2,(123.8±0.6)mm Hg及(78.5±0.8)mm Hg(P<0.01);榦預前後高密度脂蛋白膽固醇、血糖有改變[榦預前(1.06±0.02)mmol/L和(5.54 ±0.08)mmol/L,榦預後(1.12±0.18)mmol/L和(5.36 ±0.04)mmol/L,P<0.05].對照組隨訪前後血壓、體質指數、甘油三酯、血糖有下降(P<0.05),其餘代謝指標尿痠、膽固醇、高密度脂蛋白膽固醇、腰圍隨訪前後比較,差異無統計學意義(P>0.05).(3)榦預前超敏C反應蛋白及B型鈉尿肽分彆為(1.62±0.12)mg/L和(6.76 ±0.10)ng/L,榦預後分彆為(1.33±0.11)mg/L和(5.88±0.17)ng/L,差異有統計學意義(p<0.01),而對照組隨訪前後差異無統計意義(P>0.05);榦預後頸動脈B超顯示動脈硬化、眼底病變、心髒超聲暘性改變分彆為3.81%,5.71%及2.85%,對照組為12.56%,13.66%及10.92%,兩組比較差異有統計學意義(P<0.01);心電圖ST-T改變、平闆運動試驗暘性、冠狀動脈CT暘性的髮生分彆為5.23%、0.92%及0,對照組為12.02%、4.91%及2.73%,差異有統計學意義(P<0.05).結論 高尿痠血癥的程序榦預有助于生活方式、代謝指標及心血管病變的改善,對防治亞臨床心血管病變有重要意義.
목적 관찰고뇨산혈증적정서간예대개선대사지표급방치심혈관병변적영향.방법 채용전첨성연구,대531례고뇨산혈증환자,분위간예조화대조조,관리급수방36개월;대간예조진행정서화관리급수방,대조조진행기출평고급종기평고;분석비교간예조여대조조생활방식개선정황、각항대사지표변화정황급아림상심혈관병변발생정황.결과 (1)간예조간예전후제흡연、음주외적생활방식포괄저표령음식、저지음식、고염공제、규률운동적의종성균유명현제고,분별위37.1%、26.2%、25.7%화24.8%,차이유통계학의의(P<0.01);대조조저표령음식、저지음식의종성수방전후분별제고위8.7%화6.6%(P<0.05),고염공제、규률운동의종성수방전후제고위2.2%화2.1%,차이무통계학의의(P>0.05).(2)간예조뇨산、감유삼지、요위、체질지수、수축압여서장압간예전분별시(449±3)mmol/L,(3.62±0.30)mmol/L,(93.8±0.6)cm,(27.13±0.19)kg/m~2,(129.1 ±1.0)mm Hg급(80.7±0.7)mm Hg,간예후지표유개선분별시(410±3)mmol/L,(1.98±0.02)mmol/L,(90.2±0.5)cm,(25.67±0.17)kg/m2,(123.8±0.6)mm Hg급(78.5±0.8)mm Hg(P<0.01);간예전후고밀도지단백담고순、혈당유개변[간예전(1.06±0.02)mmol/L화(5.54 ±0.08)mmol/L,간예후(1.12±0.18)mmol/L화(5.36 ±0.04)mmol/L,P<0.05].대조조수방전후혈압、체질지수、감유삼지、혈당유하강(P<0.05),기여대사지표뇨산、담고순、고밀도지단백담고순、요위수방전후비교,차이무통계학의의(P>0.05).(3)간예전초민C반응단백급B형납뇨태분별위(1.62±0.12)mg/L화(6.76 ±0.10)ng/L,간예후분별위(1.33±0.11)mg/L화(5.88±0.17)ng/L,차이유통계학의의(p<0.01),이대조조수방전후차이무통계의의(P>0.05);간예후경동맥B초현시동맥경화、안저병변、심장초성양성개변분별위3.81%,5.71%급2.85%,대조조위12.56%,13.66%급10.92%,량조비교차이유통계학의의(P<0.01);심전도ST-T개변、평판운동시험양성、관상동맥CT양성적발생분별위5.23%、0.92%급0,대조조위12.02%、4.91%급2.73%,차이유통계학의의(P<0.05).결론 고뇨산혈증적정서간예유조우생활방식、대사지표급심혈관병변적개선,대방치아림상심혈관병변유중요의의.
Objective To investigate the beneftcial impact of programmed hyperuricemic intervention upon the alterations of metabolic parameters and the prevention of cardiovascular morbid change.Methods A total of 531 subjects of hyperuricemia were randomly divided into two groups: intervention group and control group.There was a 36-month follow-up by this prospective study. The intervention group was managed and followed up while the control group received only the baseline and finalassessments.The improved way of life,changes of metabolic parameters and sub-clinical cardiovascular lesions were compared between two groups.Results (1)Except for smoking and drinking habits.such lifestyle aspects as low-purine diet,low-fat diet, high-salt control and regular exercise had improved significantly and their percentages increased 37.1%,26.2%,25.7%,24.8% respectively after management in the intervention group(P<0.01).Except for low-purine and low-fat diets.the lifestyle aspects had not improved significantly after follow-up in the control group.The incremental percentages of high-salt control and regular exercise were 2.2% and 2.1% respectively and there was no statistical difference(P>0.05).(2)The pre-intervention and post-intervention levels of uric acid,body mass index, waist circumference,triglycerides and blood pressure were(449±3)vs(410±3)mmol/L,(3.62 ±0.30)vs(1.98 ±0.02)mmol/L,(93.8±0.6)vs(90.2 ±0.5)cm,(27.13±0.19)vs(25.67±0.17)ks/m~2, (129.1±1.0)vs(123.8±0.6)mm Hg and(80.7±0.7)vs(78.5±O.8)mm Hg respectively(P<0.01). Those for high density lipoprotein and blood glucose were(1.06±0.02)vs(1.12 ±0.18)mmol/L and (5.54±0.08)vs(5.36±0.04.)mmol/L respectively(P<0.05).The levels of cholesterol showed no decline(P>0.05).During follow-up,the level of blood pressure,body mass index,blood glucose and triglyceride in the control group had been reduced(P<0.05);the level of other metabolic indicators did not (P>0.05).(3)The pre-intervention and post-intervention levels of hs-CPR and B-type natriuretic peptide were(1.62±0.12)vs(1.33±0.11)mg/L and(6.76 ±0.10)vs(5.88±0.17)ng/L respectively. Compared with the control group,there were statistical differences(P<0.01).The proportions of positive lesions of carotid artery ultrasound type B, ocular fondus disease and cardiac ultrasound in intervention group were 3.81%,5.71%,2.85%vs 12.56%,13.66%,10.92%in control group(P<0.01).The proportions of positive incidences of ECG ST-T changes.treadmill exercise test and coronary CT in intervention group was 5.23%,0.92%,0 vs 12.02%,4.91%,2.73% in control group(P<0.05). Conclusion Programmed hypemricemic intervention can improve the lifestyles of patients and optimize their metabolic parameters and cardiovascular lesions.These measures are of great importance in the prevention and treatment of sub-clinical cardiovascular morbid change.
