综合干预对社区老年代谢综合征患者血尿酸、超敏C反应蛋白及脑钠肽水平的影响

摘要

目的 探讨综合干预对社区老年代谢综合征(MS)患者血尿酸(SUA)、超敏C反应蛋白(hs-CRP)及脑钠肽(BNP)水平的影响.方法 2016年7月,将苏州市汾湖高新区20个行政村、4个社区逐一编号,随机抽取其中10个行政村、2个社区的老年MS患者291例作为干预组,另外10个行政村、2个社区的老年MS患者272例作为对照组.对照组患者给予常规诊疗及健康知识教育,干预组患者给予以健康教育、治疗性生活方式改变(TLC)、药物干预、自我监测为主的综合干预.两组患者均随访12个月,比较两组患者干预前及干预6个月、12个月空腹血糖(FPG)、血脂指标、体格指数、血压、SUA、hs-CRP、BNP,干预6个月、12个月治疗达标率及转变为非MS者所占比例.结果 随访12个月,对照组患者失访、死亡6例,干预组患者失访、死亡5例.干预前两组患者FPG、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、腰围(WC)、腰臀比(WHR)、体质指数(BMI)、收缩压(SBP)、舒张压(DBP)比较,差异无统计学意义(P>0.05);干预6个月、12个月干预组患者FPG、TG、TC、LDL-C、WHR、BMI、SBP、DBP低于对照组,HDL-C高于对照组,WC小于对照组(P<0.05).干预组患者干预6个月、12个月治疗达标率及转变为非MS者所占比例高于对照组(P<0.05).干预前两组患者SUA、hs-CRP、BNP水平比较,差异无统计学意义(P>0.05);干预6个月、12个月干预组患者SUA、hs-CRP、BNP水平低于对照组(P<0.05).结论 综合干预能有效控制社区老年MS患者血糖、血压,减轻体质量,纠正脂代谢异常,降低SUA、hs-CRP、BNP水平.%Objective To investigate the impact of comprehensive intervention on SUA,hs-CRP and BNP in elderly patients with metabolic syndrome in community.Methods In July 2016,20 administrative villages and 4 communities were enrolled in Fenhu New High-tech District in Suzhou,291 elderly patients with metabolic syndrome were randomly selected as intervention group from 10 administrative villages and 2 communities,and 272 elderly patients with metabolic syndrome were randomly selected as control group from the other 10 administrative villages and 2 communities. Patients in control group received routine diagnosis,treatment and health knowledge education,while patients in intervention group received comprehensive intervention mainly including health education,therapeutic lifestyle change(TLC),pharmacological intervention and self-surveillance. Patients in the two groups were followed up for 12 months,FPG,blood lipids index,physical index, blood pressure,SUA,hs-CRP and BNP before intervention,6 months and 12 months after intervention,good control rate of treatment and fade rate of metabolic syndrome 6 months and 12 months after intervention were compared between the two groups.Results During the 12-month follow-up,6 cases in control group and 5 cases in intervention group lost or died. No statistically significant differences of FPG,TG,TC,LDL-C,HDL-C,WC,WHR,BMI,SBP or DBP was found between the two groups before intervention(P>0.05);FPG,TG,TC,LDL-C,WHR,BMI,SBP and DBP in intervention group were statistically significantly lower than those in control group 6 months and 12 months after intervention,and HDL-C in intervention group were statistically significantly higher than that in control group,and WC in intervention group was statistically significantly less than that in control group,respectively(P<0.05). Good control rate of treatment and fade rate of metabolic syndrome in intervention group were statistically significantly higher than those in control group 6 months and 12 months after intervention(P<0.05). No statistically significant differences of SUA,hs-CRP or BNP was found between the two groups before intervention(P>0.05),while SUA,hs-CRP and BNP in intervention group were statistically significantly lower than those in control group 6 months and 12 months after intervention(P<0.05).Conclusion In elderly patients with metabolic syndrome in community,comprehensive intervention can effectively control the blood glucose and blood pressure,reduce the body mass,SUA,hs-CRP and BNP,correct the lipid metabolism abnormality.