慢病管理对颈动脉粥样硬化的影响及相关指标分析  

Effects of chronic disease management on patients with carotid atherosclerosis and the analysis of the related indicators

作　　者：徐静[1] 孟欣欣[1] 赵娣[1] 赵昕[1] 刘丹丹[1] 于美娜[1] 姜宏宇[1] Xu Jing;Meng Xinxin;Zhao Di;Zhao Xin;Liu Dandan;Yu Meina;Jiang Hongyu(Physical Examination Center,The First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院体检中心,长春130021

出　　处：《中华健康管理学杂志》2019年第5期446-451,共6页Chinese Journal of Health Management

基　　金：产业技术研究与开发项目(2016C055-2);国际科技合作项目(20160414004GH);医药健康(20190304129Y Y)吉林省科技创新中心建设项目(20190902012TC);吉林省医疗卫生人才专项项目。

摘　　要：目的探讨慢病管理对颈动脉粥样硬化的影响。方法选取2016年5至10月在吉林大学第一医院体检中心进行体检且符合纳入排除标准的体检者500例,年龄55~65(60.7±3.5)岁,采用随机数字表法分为对照组(n=250)和干预组(n=250),研究结束时,失访20例,其中对照组13例,干预组7例。对照组仅进行抗动脉粥样硬化治疗,干预组在对照组的基础上实施慢病管理,开展为期1年的随访。入组时和研究结束时评估所有研究对象的健康档案,采用χ2检验、两独立样本t检验和秩和检验,评估慢病管理对颈动脉粥样硬化进展情况的影响。结果干预后1年,干预组不良生活方式(吸烟、过量饮酒、高盐饮食、高脂饮食、缺乏运动、超重或肥胖)比例较干预前减少(10.3%,13.1%,7.8%,8.6%,6.2%,28.0%比28.8%,35.0%,21.0%,22.6%,13.2%,39.5%;χ2=26.49,33.01,17.09,18.03,6.80,7.21;P均<0.05)、服药依从比例增加(44.4%比35.4%,χ2=4.15,P<0.05)、各生化指标(总胆固醇、三酰甘油、低密度脂蛋白胆固醇、空腹血糖、尿酸)及血压达标率增加(91.8%,73.3%,83.1%,83.1%,52.3%,76.5%比74.1%,60.5%,67.5%,72.8%,28.0%,58.8%;χ2=26.86,8.92,15.97,7.49,29.81,17.39;P均<0.05);干预组不良生活方式、各生化指标及血压控制情况均优于对照组(P<0.05)、服药依从性差异无统计学意义(P>0.05)。干预后1年,干预组颈动脉粥样硬化程度明显低于对照组(P<0.05)。结论通过对颈动脉粥样硬化患者施行慢病管理,可以对动脉粥样硬化形成的可控危险因素,吸烟、饮酒、超重或肥胖、血压、空腹血糖、血脂及尿酸等进行有效干预,提高用药依从性,在一定程度上延缓动脉粥样硬化进展,为动脉粥样硬化慢病管理模式的构建提供依据。Objective To evaluate the effects of chronic disease management on carotid atherosclerosis.Methods From May 2016 to October 2016,500 subjects with carotid atherosclerosis diagnosed by ultrasound at the Physical examination center of the First Hospital of Jilin University were enrolled.The participants were aged 55-65(60.7±3.5)years.They were divided into the control group(n=250)and intervention group(n=250)using a random number table;a total of 20patients,13 in the control group and 7 in the intervention group,were lost to follow-up at the end of the study.The control group only received anti-atherosclerosis treatment,while the intervention group underwent additional chronic disease management,and a 1-year follow-up study was conducted.The health of all the subjects was assessed at the beginning of the study and after the study,based on the health file.The chi-square test,two independent sample t-tests,and rank sum test were used to evaluate the effect of chronic disease management on carotid atherosclerosis.Results After 1 year of intervention,the proportion of patients with an unhealthy lifestyle(smoking,excessive drinking,high-salt diet intake,high-fat diet intake,lack of exercise,and overweight/obesity)decreased in the intervention group(10.3%,13.1%,7.8%,8.6%,6.2%,28.0%,vs.28.8%,35.0%,21.0%,22.6%,13.2%,39.5%;χ2=26.49,33.01,17.09,18.03,6.80,7.21;P<0.05),while the drug compliance increased(44.4%vs.35.4%,χ2=4.15,P<0.05),and the total cholesterol(TC),triglyceride(TG),low density lipoproteincholesterol(LDL-C),fasting plasma glucose(FPG),uric acid(UA)and blood pressure(BP)compliance rate also increased(91.8%,73.3%,83.1%,83.1%,52.3%,76.5%,74.1%,60.5%,vs.67.5%,72.8%,28.0%,58.8%,respectively;χ2=26.86,8.92,15.97,7.49,29.81,17.39,respectively;P<0.05);all indicators,except the drug compliance control rate,were better than those in the control group.After 1 year of intervention,the degree of carotid atherosclerosis in the intervention group was significantly reduced compared to that in the control group.Conclusions Ch

关 键 词：动脉粥样硬化 危险因素 生活方式 慢病管理 

分 类 号：R54[医药卫生—心血管疾病]