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目的 探讨健康管理对社区代谢综合征(MS)患者代谢的影响.方法 在广州市人民街社区中随机选取MS患者180例,并随机分为实验组(n=90)和对照组(n=90).对对照组采取传统的医学治疗和健康指导,对实验组采取健康管理干预,共观察18个月,比较两组研究前后体格状况、血糖、血脂、胰岛素抵抗指数,以及MS患病率和其各组分异常的改善状况.结果 纳入统计资料的实验组为88例,对照组83例.实验组研究后的腰围(88.78±7.17)cm、体重指数(23.79±2.26)kg/m2、体脂率(32.35±6.35)%、收缩压[(134.98±17.22)mm Hg,1 mm Hg=0.133 kPa]和舒张压(81.47±7.54)mm Hg等体格指标结果比研究前显著降低,而且,腰围、BMI和舒张压显著低于同期对照组[分别为(91.17±7.19)cm,(24.98±2.50)kg/m2,(85.93±9.45)mmHg],差异均有统计学意义(P＜0.05).实验组研究后的生化结果,如空腹血糖(5.43±2.16)mmol/L、胰岛素抵抗指数(1.99±2.39)、三酰片油(2.05±1.28)mmol/L、总胆固醇(5.41±0.90)mmoI/L和低密度脂蛋白胆固醇(3.35±0.59)mmol/L均比研究前显著降低,并均低于同期对照组[分别为(5.97±2.46)mmol/L;(2.40±2.43);(2.36±1.42)mmol/L;(5.75±0.94)mmol/L;(3.50±0.76)mmol/L],差异均有统计学意义(P＜0.05);实验组研究后的高密度脂蛋白胆固醇(1.44±0.49)mmol/L高于研究前,并高于同期对照组(1.32±0.36)mmol/L,差异均有统计学意义(P＜0.05).研究后,实验组MS患病率低于对照组(48%vs 78%),两组的不同项异常组合的比例有差异,其中,≥2项异常的,实验组低于对照组(67.05%vs 90.36%),差异均有统计学意义(P＜0.05).结论 相比于传统的医学治疗和健康指导,健康管理更有效地改善MS患者的血糖、血脂等代谢水平,降低胰岛素抵抗,控制MS的发展.

Objective To investigate the effects of community health management on patients with metabolic syndrome (MS) . Methods The 180 MS patients from one community in Guangzhou were randomly assigned to the control group (routine medical treatment and consultation, n = 90)or study group(health management intervention, n = 90). At 18 months,body status, blood glucose, lipid profile, and insulin resistance index were compared. Results A total of 171 patients(88 in the study group,83 in the control group) were analyzed. For the study group,the waist circumference [(88. 78 +7. 17)cm] .body mass index[(23. 79 ± 2. 26)kg/m2],diastolic blood pressure [(81.47± 7.54)mm Hg, 1 mm Hg = 0. 133 kPa],fasting blood glucose [(5.43 ± 2. 16 ) mmoL/L], HOMA-IR ( 1.99± 2. 39 ), triglycefide [(2. 05 ± 1.28 )mmol/L],total cholesterol[(5.41 ± 0. 90 ) mmoL/L],and low-density lipoprotein cholesterol[(3. 35 + 0. 59 ) mmoL/L] were significantly decreased compared with the control group [(91.17 ± 7. 19) cm, (24. 98 ± 2. 50) kg/m2, (85. 93 ± 9. 45 ) mm Hg,(5.97±2.46)mmol/L,2. 40 ± 2. 43, (2. 36 ± 1.42) mmol/L,(5. 75 ± 0. 94)retool/L,and(3.50±0.76)mmol/L,respectively]( P < 0. 05 ) ; however, high-density lipoprotein cholesterol[( 1.44 ±0. 49) mmol/L vs. (1.32 ±0. 36) mmol/L)] was significantly increased (P < 0. 05 ). The percent of the patients with MS and abnormal parameters in the study group was significantly decreased in comparison with the control group (P< 0. 05). Conclusions Health management may be effective in blood glucose and lipid control and insulin resistance improvement in MS patients.