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目的 探讨健康管理对延缓早期糖尿病肾病(DN)进展的效果.方法 随机选取早期糖尿病肾病患者98例.随机分为实验组和对照组各49例.对所有患者填写调查问卷、并测定体重、尿微量白蛋白/肌酐(ACR)、血糖、餐后2h血糖、糖化血红蛋白、血压、血脂、肾功、尿蛋白等客观指标.同时全部健康资料归档管理,所有患者继续门诊治疗,实验组采用健康管理模式和疾病管理措施,对该组人群进行干预、教育3年.对照组不进行干预、教育.3年后两组患者再次填写问卷,并测定上述相关客观指标.结果 我们通过3年的健康管理,实验组ACR在明显下降,对照组不降,反而升高,两组比较具有统计学意义(P＜0.05).对照组15例患者出现尿蛋白,3例患者发展至终末期肾病,而实验组没有出现尿蛋白阳性和终末期肾病患者.对于DN的高危因素如高血糖、高血压、血脂异常明显下降,与对照组比较均有统计学意义(所有P ＜0.05).结论 对早期DN患者进行有效地健康管理,可以使其得到更加充分、全面的治疗,减轻导致肾脏病加重的危险因素,达到延缓DN患者病情进展的目的.

objective To investigate the effects of health management on the progress of early diabetic nephropathy (DN).Methods A total of 98 patients with early stage DN were randomly assigned to the study group (n =49 ) and the control group (n =49 ).Questionnaire survey was performed,and urinary albumin to creatinine rate (ACR),body weight,fasting glucose,postprandial 2 h glucose,blood pressure,and lipid profiles were measured.The patients of the study group received health and disease management for 3 years; however,those of the control group received no additional intervention other than essential treatment. At 3 years, all the participants completed the questionnaires and above-mentioned measurements.Results In comparison with the control group,ACR of the study group was significantly decreased at 3 years ( P ＜ 0.05 ).In the control group,urinary protein was found in 15 patients and 3participants developed end-stage renal disease.However,neither urinary protein nor end-stage renal disease was found in the study group.Risk factors of DN,including high blood glucose,high blood pressure,and high cholesterol,were significantly decreased in the study group (all P ＜ 0.05 ).Conclusion Early effective health management of DN may contribute to decreased risk factors of renal disease and delayed disease progression.