CAJ | 학술논문

目的探讨糖尿病前期合并高血压患者社区纵向管理后血压、血糖、血脂等控制效果.方法 2008年7月至2011年7月对北京社区糖尿病研究中纳入的7个社区的糖尿病前期合并高血压患者共283例进行纵向随访管理3年,分析管理前后患者的血压、血糖、血脂等临床指标,降压药物应用情况及血压等各指标的达标情况.结果管理后患者脱落39例,资料完整244例.与管理前比较,244例患者管理3年后收缩压[(126±9)比(130±14)mmHg,1 mmHg=0.133 kPa]、舒张压[(75±7)比(77±9)mmHg]、空腹血糖[(5.7±1.0)比(6.0±0.8)mmol/L]、餐后血糖[(7.8±1.8)比(8.2 ±2.3)mmol/L]、尿酸[(313 ±77)比(329±88) μmol/L]、LDL-C [(2.9±0.8)比(3.1±0.9) mmol/L]水平均有显著下降(t值分别为4.535、4.699、4.383、3.363、3.548、2.016,P＜0.01或＜0.05).降压药物应用上,与管理前比较,管理3年后应用血管紧张素受体Ⅱ拮抗剂(ARB)比例增加(19％比13％,x2=4.238,P＜0.05);管理前后钙离子拮抗剂(CCB)都是应用最多的降压药(50％比54％,x2=2.534,P＞0.05);因部分服用1种降压药患者生活方式管理后血压达标停药,未服降压药患者比例从16％升高至22％.与管理前比较,管理3年后患者血压达标率明显增加(36％比25％,x2=7.043,P＜0.01),LDL-C达标率无明显改变(32％比29％,x2=0.616,P＞0.05),血糖、血压和血脂联合达标率明显增加(12％比5％,x2=8.441,P＜0.01).结论糖尿病前期合并高血压患者经过规范的社区管理,患者降压药物的应用更加规范,其血压达标率以及血糖、血压、血脂联合达标率均有增加,但仍然比较低;社区对糖尿病前期患者不仅应重视血糖控制,同时也应对血压、血脂等大血管病变的危险因素进行综合管理.
목적 탐토당뇨병전기합병고혈압환자사구종향관리후혈압、혈당、혈지등공제효과.방법 2008년7월지2011년7월대북경사구당뇨병연구중납입적7개사구적당뇨병전기합병고혈압환자공283례진행종향수방관리3년,분석관리전후환자적혈압、혈당、혈지등림상지표,강압약물응용정황급혈압등각지표적체표정황.결과 관리후환자탈락39례,자료완정244례.여관리전비교,244례환자관리3년후수축압[(126±9)비(130±14)mmHg,1 mmHg=0.133 kPa]、서장압[(75±7)비(77±9)mmHg]、공복혈당[(5.7±1.0)비(6.0±0.8)mmol/L]、찬후혈당[(7.8±1.8)비(8.2 ±2.3)mmol/L]、뇨산[(313 ±77)비(329±88) μmol/L]、LDL-C [(2.9±0.8)비(3.1±0.9) mmol/L]수평균유현저하강(t치분별위4.535、4.699、4.383、3.363、3.548、2.016,P＜0.01혹＜0.05).강압약물응용상,여관리전비교,관리3년후응용혈관긴장소수체Ⅱ길항제(ARB)비례증가(19％비13％,x2=4.238,P＜0.05);관리전후개리자길항제(CCB)도시응용최다적강압약(50％비54％,x2=2.534,P＞0.05);인부분복용1충강압약환자생활방식관리후혈압체표정약,미복강압약환자비례종16％승고지22％.여관리전비교,관리3년후환자혈압체표솔명현증가(36％비25％,x2=7.043,P＜0.01),LDL-C체표솔무명현개변(32％비29％,x2=0.616,P＞0.05),혈당、혈압화혈지연합체표솔명현증가(12％비5％,x2=8.441,P＜0.01).결론 당뇨병전기합병고혈압환자경과규범적사구관리,환자강압약물적응용경가규범,기혈압체표솔이급혈당、혈압、혈지연합체표솔균유증가,단잉연비교저;사구대당뇨병전기환자불부응중시혈당공제,동시야응대혈압、혈지등대혈관병변적위험인소진행종합관리.
Objective To evaluate the effectiveness of longitudinal community management of prediabetic patients with hypertension.Methods Two hundred and eighty three pre-diabetic patients with hypertension were recruited in Beijing Community Diabetes Study from seven communities of Beijing,and the patients received longitudinal community management from July 2008 to July 2011.The blood pressure,blood glucose,blood lipids were measured;and the antihypertensive medication,blood pressure control and other indicators were examined before and after management.Results During the 3-year period,39 cases dropped off and 244 patients completed the study.Compared with the baseline levels,systolic blood pressure [(126 ±9) vs.(130 ±14) mmHg,1 mmHg =0.133 kPa],diastolic blood pressure [(75 ±7) vs.(77 ±9) mmHg],fasting glucose [(5.7 ± 1.0) vs.(6.0 ± 0.8) mmol/L],postprandial glucose [(7.8 ± 1.8)vs.(8.2 ±2.3) mmol/L],uric acid [(313 ±77) vs.(329 ±88) μmol/L],LDL-C [(2.9 ±0.8) vs.(3.1 ±0.9) mmol/L] were significantly decreased (t =4.535,4.699,4.383,3.363,3.548,2.016,P ＜ 0.01 or ＜ 0.05) in 244 patients.After 3-year management,the medication of angiotensin Ⅱ receptor antagonist (ARB) was increased (19％ vs.13％,x2 =4.238,P ＜ 0.05);while the proportion of calcium channel blockers (CCB) remained the highest medication (50％ vs.54％,x2 =2.534,P ＞ 0.05) after the management.The proportion of non-drug treatment patients rose from 16％ to 22％,because of medication withdrawing after effective lifestyle management.The blood pressure control rate was significantly increased (36％ vs.25％,x2 =7.043,P ＜0.01) after 3-year management;however,the control rate of LDL-C had no significant changes (32％ vs.29％,x2 =0.616,P ＞ 0.05).The proportion of patients who reached all three goal of blood glucose,blood pressure and blood lipids increased significantly (12％ vs.5％,x2 =8.441,P ＜ 0.01).Conclusion The longitudinal community management may improve rational antihypertensive drug use and increase control rate of blood pressure,blood glucose and blood lipids in some extent for pre-diabetic patients;the management should be focused on all risk factors of vascular diseases not just on the blood glucose alone.