社区干预在糖尿病肾病患者中的实施效果观察  

Effect observation on community intervention in patients with diabetic nephropathy

作　　者：宋锐[1] 蔡惠勇 徐虹霞 李文昌[3] 李红美[1] 

机构地区：[1]苏州大学医学部公共卫生学院,江苏苏州215123 [2]上海市黄浦区打浦桥街道社区卫生服务中心,上海200023 [3]复旦大学附属中山医院,上海200032

出　　处：《上海预防医学》2016年第1期37-40,共4页Shanghai Journal of Preventive Medicine

基　　金：上海市卫生计生委青年科研基金项目(20114Y047);上海市黄浦区卫生计生委科研基金项目(LWK1134)

摘　　要：目的分析社区干预对糖尿病肾病(DN)患者尿微量白蛋白肌酐比(ACR,mg/g)及肾小球滤过率(GFR)的影响,为DN社区防治工作提供参考意见。方法本研究将尿微量白蛋白筛查阳性的糖尿病患者(183例)随机分为观察组(94例)和对照组(89例),组内再分为微量白蛋白尿亚组和大量白蛋白尿亚组。通过在社区开展自我管理小组活动的形式对DN患者进行干预,随访2年后评估干预效果。结果社区干预前,两组间ACR、GFR等临床指标间差异均无统计学意义(P>0.05);社区干预后微量白蛋白尿亚组组间ACR差异有统计学意义(P<0.01)。大量白蛋白尿亚组间ACR、GFR指标间差异均无统计学意义(P>0.05)。结论社区干预措施不能显著改善DN大量白蛋白尿期患者的肾功能,但能够显著降低微量白蛋白尿期患者的ACR。早期开展以自我管理小组活动为中心的社区干预能延缓DN微量白蛋白尿期患者的病情进展。Objective To analyze the effect of community intervention on urine microalbumin and creatinine ratio （ACR, mg/g） and glomerular filtration rate （GFR） of diabetic nephropathy （DN） patients and provide a reference for prevention and control of DN in community. Methods The microalbuminuria screening positive patients with diabetes （183 cases } were randomly divided into observation group （94 cases） and control group （89 cases）, and two groups were re-divided into microalbuminuria and macroalbuminuria subgroups. By means of self-management group activities, interventions were taken in patients with DN in community. After two-year follow up the effect of intervention was assessed. Results Before community intervention, there was no significant difference between the two groups in clinical indicators, such as ACR, GFR and so on. After community intervention, significant differences were found in ACR between the two subgroups of diabetic nephropathy with microalbuminuria. There were no significant differences in ACR and GFR between the two subgroups with macroalbuminuria. Conclusion Community intervention measures cannot significantly improve the renal function of DN patients in macroalbuminuria stage, but can significantly reduce the ACR of patients with microalbuminuria. Early self-management group activities in the community can delay the progression of DN in patients with microalbuminuria.

关 键 词：糖尿病肾病 社区干预 肾小球滤过率 尿微量白蛋白肌肝比 

分 类 号：R587.2[医药卫生—内分泌]