社区2型糖尿病患者糖化血红蛋白控制现况及影响因素分析  

Glycosylated Hemoglobin Control and Associated Factors in Patients with Type 2 Diabetes Mellitus in the Community

作　　者：杨黎娟 朱文奎[1] 徐绮[1] 杜兆辉 张林影[1] 唐晓春 薛伟斌 曹奕 乔慧华 赵辉[1] 薛锦花[1] 薛峰[1] YANG Lijuan;ZHU Wenkui;XU Qi;DU Zhaohui;ZHANG Linying;TANG Xiaochun;XUE Weibin;CAO Yi;QIAO Huihua;ZHAO Hui;XUE Jinhua;XUE Feng(Shanghai Pudong New Area Hudong Community Health Center,Shanghai 200129,China;Shanghai Pudong New Area Shanggang Community Health Center,Shanghai 200126,China)

机构地区：[1]上海市浦东新区沪东社区卫生服务中心,200129 [2]上海市浦东新区上钢社区卫生服务中心,200126

出　　处：《中国全科医学》2019年第25期3104-3109,共6页Chinese General Practice

基　　金：上海市中西医结合学会社区医学与健康管理课题研究专项基金项目(SH201711);上海市“浦东新区卫生系统重要薄弱学科”建设专项基金项目(PWZbr2017-07)

摘　　要：背景社区管控糖尿病有着地域便利、定期监测的优势,研究社区糖尿病患者糖化血红蛋白(Hb A1c)控制情况对糖尿病防治工作具有重要意义。目的调查上海市沪东社区2型糖尿病患者Hb A1c控制情况及其影响因素。方法采用整群随机抽样法选取沪东社区692例2型糖尿病患者进行面对面询问、体格检查及实验室检查。692例患者按照Hb A1c水平分为3组,Hb A1c<7%为达标组(n=314),7%≤Hb A1c<9%为控制较好及一般组(n=276),Hb A1c≥9%为控制差组(n=102)。比较3组间体质指数(BMI)、腰围、血压、血糖、血脂、肾功能等指数的差异,并探讨影响Hb A1c的因素。结果692例2型糖尿病患者空腹血糖(FPG)达标217例(31.4%),Hb A1c达标314例(45.4%),总胆固醇(TC)达标256例(37.0%),三酰甘油(TG)达标450例(65.0%),低密度脂蛋白胆固醇(LDL-C)达标222例(32.1%),高密度脂蛋白胆固醇(HDL-C)达标481例(69.5%)。Hb A1c控制较好及一般组患者的FPG、TG水平高于Hb A1c达标组,差异有统计学意义(P<0.05)。Hb A1c控制差组患者的FPG、尿清蛋白/肌酐比值(UACR)高于Hb A1c控制较好及一般组、达标组,血尿酸(SUA)、估算肾小球滤过率(e GFR)低于控制较好及一般组、达标组,差异有统计学意义(P<0.05)。Spearman相关性分析显示,腰围、FPG、TG、UACR与Hb A1c呈正相关(rs=0.077、0.584、0.114、0.142,P<0.05),HDL-C、SUA与Hb A1c呈负相关(rs=-0.087、-0.156,P<0.05)。Logistic回归分析显示,FPG、SUA是Hb A1c水平的影响因素(P<0.05)。结论沪东社区2型糖尿病患者Hb A1c控制情况有待进一步提高,Hb A1c水平与血脂、腰围相关。社区糖尿病管理应该在控制血糖的前提下,同时强化体质量、血脂等多方面的综合干预。Background Community-based management of diabetes has the advantages of geographical convenience and regular monitoring.Researching the control status of glycosylated hemoglobin(Hb A1 c)of diabetic patients in the community is of great significance for diabetes prevention and treatment.Objective To investigate the control status of Hb A1 c and its influencing factors in patients with type 2 diabetes mellitus(T2 DM)in Hudong Community of Shanghai.Methods By use of random cluster sampling,692 T2 DM patients from Hudong Community were enrolled and received a face-to-face survey,a physical examination and a laboratory test.By the level of Hb A1 c,they were divided into 3 groups:standard-reaching group(Hb A1 c<7%,n=314),good and fair control group(7%≤Hb A1 c<9%,n=276),and poor control group(Hb A1 c≥9%,n=102).Body mass index(BMI),waist circumference,blood pressure,blood glucose,blood lipid,renal function and other factors in the three groups were compared and the factors influencing Hb A1 c were analyzed.Results Among the 692 cases,the rates of achieving fasting plasma glucose(FPG)target,Hb A1 c target,total cholesterol(TC)target,triacylglycerol(TG)target,low-density lipoprotein cholesterol(LDL-C)target and high-density lipoprotein cholesterol(HDL-C)target were 31.4%(n=217),45.4%(n=314),37.0%(n=256),65.0%(n=450),32.1%(n=222),and 69.5%(n=481),respectively.Mean FPG and TG levels in good and fair control group were significantly higher than those of the standard-reaching group(P<0.05).Poor control group showed much higher mean FPG and urinary albumin to creatinine ratio(UACR),and lower mean serum uric acid(SUA)and estimated glomerular filtration rate(e GFR)compared with other two groups(P<0.05).Spearman correlation coefficient analysis showed that waist circumference,FPG,TG and UACR were positively associated with Hb A1 c(rs=0.077,0.584,0.114,0.142;P<0.05),and HDL-C and SUA were negatively associated with Hb A1 c(rs=-0.087,-0.156;P<0.05).Logistic regression analysis showed that FPG and SUA were the influencing factors

关 键 词：糖尿病 2型 社区卫生服务 糖化血红蛋白 影响因素分析 

分 类 号：R587.1[医药卫生—内分泌]