【摘要】 背景2型糖尿病(T2DM)已经成为严重影响国人身心健康的重要公共卫生问题。T2DM管理的最终目标是减少慢性并发症,以提高患者生活质量、延长寿命。社区卫生服务中心是防治T2DM及其并发症的主战场。目前国内还没有关于社区T2DM规范管理10年的相关报道。左家庄社区卫生服务中心(以下简称左家庄社区)为第一批参与北京社区糖尿病研究(BCDS)项目的社区,本研究为左家庄社区关于T2DM规范管理10年后慢性并发症发病情况研究的分支内容。目的探讨规范管理10年后T2DM合并高血压与否慢性并发症的发病情况。方法选取2008年8—12月左家庄社区T2DM患者246例为研究对象,根据患者是否合并高血压,分为单纯T2DM组(T2DM组),T2DM合并高血压组(T2DM+HTN组)。按照BCDS项目的统一要求进行规范管理,定期随访、转诊、复查,两组患者均每年全面复查1次,包括体格检查(BMI、颈围、腰围、收缩压、舒张压)、生化指标[空腹血糖、餐后2 h血糖、糖化血红蛋白(HbA1c)、三酰甘油、总胆固醇、高密度脂蛋白、低密度脂蛋白、丙氨酸氨基转移酶、尿素氮、肌酐、尿酸]、尿微量清蛋白排泄率(UAER),记录并比较两组患者随访前后复查结果。随访开始时间为入组时间,随访至2018年12月,以心血管事件、脑血管事件、肾病事件、眼底事件、复合终点事件为终点事件。结果失访26例,失访率10.6%,最终纳入资料完整者220例,T2DM组47例,T2DM+HTN组173例。随访前T2DM+HTN组患者腰围、收缩压、舒张压、总胆固醇大于T2DM组(P<0.05)。随访结束后T2DM+HTN组患者餐后2 h血糖高于T2DM组(P<0.05)。两组患者10年管理期间,T2DM组血压波动不大,而T2DM+HTN组在2008—2011年下降较明显,其后小幅波动。两组患者心血管事件、脑血管事件、肾病事件、眼底事件发生率比较,差异无统计学意义(P>0.05);T2DM+HTN组复合终点事件发生率高于T2DM组(P<0.05)。两组患者生存曲线比较,差异有统计学意义(χ2=4.274,P=0.038)。Cox回归分析结果显示,高血压对心血管事件、脑血管事件、肾病事件、眼底事件无影响(P>0.05);高血压对复合终点事件有影响(P<0.05)。结论经10年规范管理T2DM合并高血压较单纯T2DM明显增加复合终点事件,更应重视早发现、早干预,以降低病死率,提高患者生存质量。更多还原

【Abstract】 Background Type 2 diabetes mellitus(T2 DM) has become an important public health problem that seriously affect the physical and mental health of Chinese people.The ultimate goal of T2 DM management is to reduce the chronic complications to improve the quality of life and prolong the life-time of patients.Community health centers are the main battlefield for preventing and treating T2 DM and its complications.At present,there is no report on the effectiveness of 10-year communitybased management of T2 DM in China.Zuojiazhuang Community is one of the communities initially participating in the Beijing Community Diabetes Research(BCDS) project.This article is a branch study on the incidence of chronic complications in T2 DM patients following 10-year standardized management in the community.Objective To investigate the incidence of chronic complications in T2 DM patients with and without hypertension(HTN) after 10 years’ standardized management.Methods 246 patients with T2 DM from Zuojiazhuang Community were enrolled from August to December 2008.Among them,those with HTN and without were assigned to T2 DM+HTN group,and T2 DM group,respectively.Both groups received the unified standardized management required by the BCDS project,including regular follow-up,and referral services.Moreover,they also received review services,which were performed once a year,including physical examination[BMI,neck circumference,waist circumference,systolic blood pressure(SBP),diastolic blood pressure(DBP)],biochemical indicators[fasting blood glucose(FBG),2-hour postprandial glucose(2 h PG),glycosylated hemoglobin(HbA1 c),triglyceride(TG),total cholesterol(TC),high-density lipoprotein(HDL) and low-density lipoprotein(LDL) ],ALT,blood urea nitrogen,serum creatinine,serum uric acid,and urinary albumin excretion rate(UAER).All of them were followed up from the enrollment to December 2018.And review results before and after follow-up period were collected.Endpoint events include cardiovascular events,cerebrovascular events,nephropathy,retinopathy and compound endpoint events.Results After excluding 26 cases(10.6%) who were lost to follow up,220 cases with complete data,including 47 in T2 DM group and 173 in T2 DM + HTN group,were finally included.At baseline,the levels of waist circumference,SBP,DBP,and TC in T2 DM + HTN group were significant higher than those in T2 DM group(P<0.05).At the end of follow-up,the level of 2 h PG in T2 DM + HTN group was significant higher than that of T2 DM group(P<0.05).During the period of management,the blood pressure fluctuated slightly in T2 DM group,but in T2 DM + HTN group,it decreased significantly from 2008 to 2011,and then fluctuated slightly.There were no significant differences in the incidence rates of end-point events between the two groups(P>0.05),including cardiovascular events,cerebrovascular events,nephropathy and retinopathy.But the incidence rate of compound endpoint events in T2 DM + HTN group was significant higher than that of T2 DM group(P<0.05).There was a significant difference in the survival curve between the two groups(χ2=4.274,P=0.038).Cox regression analysis showed that hypertension had no effect on cardiovascular events,cerebrovascular events,nephropathy and retinopathy(P>0.05),but had effect on compound endpoint events(P<0.05).Conclusion After 10 years’ standardized management,compared with the simple T2 DM,the incidence rate of the compound endpoint events significantly increased in T2 DM with hypertension.Therefore,more attention should be paid to the intervention for T2 DM patients with hypertension.Early detection of complications and timely intervention can reduce the mortality and improve the quality of life.更多还原