健康管理对老年代谢综合征合并下肢动脉疾病患者的疗效观察

目的研究健康管理对老年代谢综合征患者下肢动脉疾病的疗效。方法老年代谢综合征伴下肢动脉疾病118例，分为对照组60例和健康管理组58例，于入组当时和研究结束后分别测量血压、踝臂指数（ABI）、血脂、血糖等指标，并进行健康问卷。对照组由专人监督用药；健康管理组由专人制定全面的健康管理计划，并监督实施。随访12个月。结果两组基线数据无统计学差异。两组观察前后比较收缩压和空腹血糖均显著下降，健康管理组的收缩压（141±10）、（146±11）]mmHg（1mmHg=0．133kPa）（t=2．581，P=0．011）和空腹血糖（5．32±1．33）、（5．92±1．61）]mmol／L（t=2．231，P=0．028）的改善优于对照组。健康管理组的三酰甘油（5．51±0．51）、（5．11±0．49）]mmol／L（t=4．307，P=0．000）和ABI（0．77±0．17）、（0．84±0．19）（t=2．091，P=0．039），较干预前也有显著改善。其他指标干预前后和两组间无显著性变化。SF-36量表中的8个方面评分，两组均有不同程度的改善，健康管理组在因生理功能角色受限（72．2±12．4）、（65．2±20．1）（t=2．268，P=0．025）、情绪角色受限（73．9±18．0）、（65．6±21．1）（t=2．295，P=0．023）和心理健康（63．9±13．3）、（58．3±12．5）（t=2．358，P=0．020）改善优于对照组。结论健康管理可以改善老年代谢综合征伴下肢动脉疾病患者的临床指标和生活质量，效果优于单纯药物治疗。

Effects of health management on elderly metabolic syndrome patients combined with low extremity arterial disease

Objective To study the effects of health management on elderly patients with metabolic syndrome and lower extremity arterial disease. Methods A total of 118 metabolic syndrome （MS） patients with ankle-brachial index（ABI） 〈 0.9 and no intermittent claudication were randomly assigned to the control group（n = 60, receiving pharmacologic therapy） or health management group （n = 58, receiving intensive health management ＋ pharmacologic therapy）. Blood pressure, ABI, total cholesterol （ TC ）, and fasting blood glucose（FBS） were tested before and 12 after the intervention. Results Clinical data were comparable between the two groups at baseline. After 12-months＇ intervention, systolic blood pressure（SBP） and FBS in both groups were significantly decreased, especially in the health management group SBP： （141 ±10） mm Hg（1 mmHg=0. 133 kPa） vs（146＋11） mmHg,t=2.581,P=0.011; FBS：（5.32 ±1.33） mmol/L vs（5.92±1.61） mmol/L,t=2.231,P=0. 028].TC（5.51±0.51） mmol/Lvs（5.11±0.49） mmol/L, （t=4.307,P=0. 000） and ABI（0.77 ±0.17 vs 0.84 ±0.19,t=2.091,P=0.039） of the health management group were significantly improved at 12 months. Patients in the health management group also showed higher SF-36 scores than those in the eontrol group（ physical functioning： 72. 2 ±12.4 vs 65.2 ±20. 1,t = 2. 268,P = 0. 025 ; emotion： 73.9 ± 18.0 vs 65.6 ±21.1, t = 2. 295, P = 0. 023 ; mental health ： 63.9 ±13.3vs 58.3 ±12. 5, t = 2. 358, P = 0. 020 ）. Conclusion Compared with medication, health management and pharmaeologie therapy could signifieantly improve elinieal parameters and quality of life of elderly MS patients combined with peripheral arterial disease.