社区动态健康管理对代谢综合征干预的效果评价

目的 探讨基于家庭医生责任制的社区动态健康管理对代谢综合征人群的干预效果.方法 2010年5月至2011年7月,对山东省荣成市崖头社区代谢综合征285例患者进行监测评估,通过咨询指导及危险因素干预,实施为期1年的健康管理,对比分析管理前后患者的日均膳食（摄入量、种类、达标比例）影响,与代谢相关的临床生化指标,评价心脏功能的超声指标变化与生活方式的改变.结果 最终回收完整调查资料268份,有效应答率为94％.基于家庭医生责任制的社区动态健康管理1年后,蔬菜、水果、奶类和蛋类日均摄入量为（478±122）g、（256±178）g、（159±84）g和（46±22）g;与管理前相比明显上升,人群摄入达标率提高,差异有统计学意义（Х^2=3.412、2.781、1.104、1.124,P＜0.05）.畜禽肉类、盐、谷类、豆类和烹调用油的日均摄入量分别为（61±54）g、（6±2）g、（327±123）g、（52±28）g、（28±21）g,较管理前下降,人群摄人达标率差异有统计学意义（Х^2=2.986、3.987、1.754、2.374、2.683,P＜0.05）.管理1年后体质指数、腰围、收缩压、舒张压、空腹血糖、空腹胰岛素、胰岛素抵抗指数、餐后2h血糖、糖化血红蛋白、三酰甘油、低密度脂蛋白胆固醇、尿酸明显降低,高密度脂蛋白胆固醇升高,差异有统计学意义（t=2.740、1.608、3.498、2.613、2.280、2.317、1.381、1.238、2.714、0.572、1.027、0.125、0.693,P＜0.05）.管理后主动脉根部内径、左心房内径、左室舒张末期容积、左室射血分数均较管理前变化不明显,差异无统计学意义（t=2.136、2.967、2.838、2.586,P＞0.05）;但是反映心室舒张功能的指标二尖瓣舒张早期峰值血流速度、二尖瓣舒张晚期峰值血流速度以及E/A比值的变化,差异均有统计学意义（t=2.935、3.214、0.131,P＜0.05）.结论 基于社区家庭医生责任制的动态健康管理模式可以对代谢综合征人群实施有效管理.随着管理时间的延长,危险因素得到有效干预,监测的临床指标均值呈趋好发展,生活方式有明显改善.

Effectiveness of community-based dynamic health management on metabolic syndrome

Objective To evaluate the effectiveness of community-based health management on metabolic syndrome.Methods A total of 285 metabolic syndrome patients living at Yatou Community of Rongcheng City were enrolled in this study during May 2010 and July 2011.All the participants received one-year health management.Daily diet,clinical and biochemical indicators of metabolism,ultrasound evaluation of cardiac function index and lifestyle changes were compared before and after the intervention.Results The effective response rate was 94% （268/285）.After one-year community-based dynamic health management,daily intake of vegetables,fruits,milk and eggs were significantly increased to （478 ± 122）,（256± 178）,（159±84） and （46±22） g （Х^2 values were 3.412,2.781,1.104 and 1.124,respectively; all P〈0.05）.However,poultry meat,salt,grains,beans,and cooking oil daily intake were significantly decreased to （61±54）,（6±2）,（327± 123）,（52±28） and （28±21） g （Х^2 values were 2.986,3.987,1.754,2.374 and 2.683,respectively; all P〈0.05）.After 1 year,body mass index （BMI）,waist circumference （WC）,blood pressure （BP）,fasting plasma glucose （FPG）,fasting insulin,insulin resistance index,2-h postprandial blood glucose,glycosylated hemoglobin,triglyceride,low-density lipoprotein （LDL） and uric acid （UA） were significantly reduced,although high-density lipoprotein （HDL） was increased （t values were 2.740,1.608,3.498,2.613,2.280,2.317,1.381,1.238,2.714,0.572,1.027,0.125 and 0.693,respectively; all P〈0.05）.Aortic root diameter,left atrial diameter,left ventricular end-diastolic volume and left ventricular ejection fraction showed no significant changes （t values were 2.136,2.967,2.838 and 2.586,respectively; all P〉0.05）,but peak early diastolic mitral flow velocity,peak late diastolic mitral flow velocity and E/A ratio changed （t values were 2.935,3.214 and 0.131,respectively; all P〈0.05）.Conclusion Community-based dynamic health management could effectively control the risk factors and improve litestyle of the patients with metabolic syndrome.