血糖、血压和血脂达标次数对2型糖尿病终点事件的影响  

Effect of achieving the control target numbers of blood glucose,pressure and lipids on endpoint events of type 2 diabetes mellitus patients

作　　者：赵辰梅 崔学利 万钢[2] 路玉蛰 牛玉琴 曹硕 李靖 邓志云 于学慧 李建华 张雪莲[3] 袁申元[3] ZHAO Chen-mei;CUI Xue-li;WAN Gang;LU Yu-zhe;NIU Yu-qin;CAO Shuo;LI Jing;DENG Zhi-yun;YU Xue-hui;LI Jian-hua;ZHANG Xue-lian;YUAN Shen-yuan(Sanlitun Community Health Service Center,Beijing 100027,China;Medical Records and Statistics Department,Beijing Ditan Hospital,Capital Medical University;Department of Endocrinology,Beijing Tongren Hospital,Capital Medical University)

机构地区：[1]北京市三里屯社区卫生服务中心,北京100027 [2]首都医科大学附属地坛医院 [3]首都医科大学附属北京同仁医院

出　　处：《中国公共卫生管理》2018年第4期534-537,共4页Chinese Journal of Public Health Management

基　　金：首都卫生发展科研专项(2016-1-2057;2016-2-2054)

摘　　要：目的探讨北京市三里屯社区2型糖尿病(T2DM)9年连续管理过程中年度血糖、血压、血脂及联合达标≥3次对终点事件发生的影响。方法北京社区糖尿病研究(BCDS)项目对三里屯社区2008年入选的224例T2DM患者连续管理随访9年,以收缩压、舒张压、糖化血红蛋白(Hb A1c)和低密度脂蛋白胆固醇(LDL-C)为主要指标,以主要指标及联合达标次数是否≥3次分组,用生存分析(Kaplan-Meier法)比较终点事件的组间差异。结果 9年连续管理过程中全死因死亡23例,在血压、Hb A1c、LDL-C及三项联合达标≥3次者中死亡发生少且与达标<3次者差异有统计学意义(P<0.05);新发脑血管事件、大动脉狭窄或闭塞、微血管病变在Hb A1c(χ~2分别为7.17,9.65和4.39)及三项联合达标≥3次者(χ~2分别为11.35,6.15和5.66)中死亡发生少且与达标<3次者差异有统计学意义(P<0.05);新发冠心病事件与达标次数是否≥3次者间死亡发生差异无统计学意义(χ~2分别为0.01,2.04,0.06,P>0.05)。结论社区T2DM管理中达标率尤其是联合达标次数≥3次,可减少全死因死亡、新发脑血管事件、大动脉狭窄或闭塞和微血管病变等终点事件的发生,提高患者生存质量。Objective To investigate the effect of achieving the target control more than 3 times on endpoint events during 9 consecutive year＇s annual assessment in type 2 diabetes mellitus in Sanlitun Community Health Service Center in Beijing,including blood glucose,blood pressure,lipids profiles and the joint target control. Methods Two hundred and twenty-four patients with T2 DM who were enrolled in Sanlitun community Health Service Center in 2008 from Beijing Community Diabetes Research（ BCDS） were consecutively followed up for 9 years. Systolic blood pressure（ SBP）,diastolic blood pressure（ DBP）,glycosylated hemoglobin（ Hb A1 c） and low-density lipoprotein cholesterol（ LDL-C） were detected as the main indexes. The endpoint events were analyzed by using survival analysis（ Kaplan-Meier method） based on whether the main indexes and the joint target control achieving the target control more than 3 times or not. Results During the 9 year followup,all-cause death is 23 cases,in which patients who achieved the target control（ Hb A1 c,LDL-C） and the joint target control more than 3 times were significant lower than that of less than 3 times（ χ^2= 13. 49,7. 77,4. 90,8. 63,P〈0. 05）. There were less incidence of new onset cerebrovascular events,stenosis or occlusion of large arteries and diabetic microvascular complications in patients who achieved target control of Hb A1 c（ χ^2= 7. 17,9. 65,4. 39,P〈0. 05） and the joint target control more than 3 times（ χ^2= 11. 35,6. 15,5. 66,P〈0. 05） than those with target control less than 3 times. As far as newly onset coronary heart disease was concerned,there were no significant differences on the afore endpoint events between the two groups based on target control more than 3 times or not（ P〈0. 05）. Conclusions The incidence of all-cause death and the other endpoint events decreases in T2 DM who achieving the joint target control more than 3 times during the nine-year-management,which can improve patient＇s life quality.

关 键 词：2型糖尿病 终点事件 达标 生存分析 Kaplan-Merier分析 

分 类 号：R587.1[医药卫生—内分泌] R915.4[医药卫生—内科学]