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目的 探讨俱乐部健康教育模式对2型糖尿病合并焦虑状态患者代谢指标及其精神心理状态的影响.方法 2016年1月1日至12月31日就诊于北京市第一中西医结合医院的60例2型糖尿病合并焦虑状态患者,分为干预组(30例)和对照组(30例),干预组在糖尿病常规治疗基础上加用俱乐部健康教育模式;对照组仅进行糖尿病常规治疗及常规教育,干预12周后,比较两组患者干预前后空腹血糖(fasting plasma glucose,FPG)、餐后2小时血糖(2 hour plasma glucose,2 h PG)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、体质指数(body mass index,BMI)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评分、症状自评量表(symptom checklist-90,SCL-90)评分各项指标.主要统计学方法包括χ2检验、独立样本的t检验、配对t检验和非参数检验.结果 代谢指标方面:干预12周后,干预组FPG、2hPG、TC、TG、BMI[(6.11±0.94)mmol/L、(7.75±1.96)mmol/L、(4.85±0.87)mmol/L、(1.45±0.26)mmol/L、(27.13±3.38)kg/m2],与干预前[(7.42±1.18)mmol/L、(9.38±1.17)mmol/L、(5.58± 1.48)mmol/L、(1.74±0.41)mmol/L、(29.11±3.36)kg/m2]比较均明显下降,差异有统计学意义(t=5.110、5.080、2.807、4.283、2.3387,P均<0.05);干预组干预后各项指标均低于对照组,组间比较差异具有统计学意义(P均<0.05).精神心理状态方面:干预组干预后HAMA评分(14.24±1.68)分,低于干预前(27.77±1.24)分,差异具有统计学意义(t=36.062,P=0.000);低于对照组干预后(26.48±1.21)分,差异具有统计学意义(t=-31.152,P=0.000).干预组干预后SCL-90评分在症状总分及躯体化、强迫、人际关系、抑郁、焦虑、恐怖6个维度方面,与干预前比较评分下降,差异具有统计学意义(P均<0.05);干预组干预后在症状总分及躯体化、强迫、抑郁、焦虑、恐怖5个维度方面与对照组干预后比较,差异具有统计学意义(P均<0.05).结论 在2型糖尿病常规干预基础上联合俱乐部健康教育模式,可明显改善2型糖尿病合并焦虑状态患者的代谢指标,并对患者的焦虑、人际关系敏感等不良精神状态有明显缓解.

Objective To explore the effect of club health education on metabolic parameters and mental state in patients with type 2 diabetes mellitus and anxiety.Methods From January 1 to December 31, 2016, 60 patients with type 2 diabetes mellitus and anxiety who were admitted to the Beijing First Hospital of Integrated Chinese and Western Medicine were divided into the intervention group(30 patients) and control group(30 patients).In the intervention group,a club health education model was used based on conventional diabetes treatment. The control group only received conventional diabetes treatment and routine education.After 12 weeks,fasting plasma glucose(FPG)levels,2-hour postprandial plasma glucose (2-h PG) levels, total cholesterol (TC), triglycerides (TGs), body mass index (BMI), Hamilton anxiety scale(HAMA)scores,and symptom checklist-90(SCL-90)scores were compared before and after the intervention. The main statistical methodology included the χ2test, t-test for independent samples, paired t-test, and nonparametric test.Results FPG levels,2-h PG levels,TC,TGs,and BMI in the intervention group after 12 weeks were (6.11 ± 0.94) mmol/L, (7.75 ± 1.96) mmol/L, (4.85 ± 0.87) mmol/L, (1.45 ± 0.26) mmol/L, and (27.13±3.38)kg/m2,respectively.These metabolic parameters before intervention were(7.42±1.18)mmol/L, (9.38±1.17)mmol/L,(5.58±1.48)mmol/L,(1.74±0.41)mmol/L,and(29.11±3.36)kg/m2,respectively.The differences were statistically significant(t=5.110,5.080,2.807,4.283,and 2.3387,respectively;P<0.05). Indicators were lower than in the control group, and the differences between the groups were statistically significant (all P< 0.05). Regarding mental and psychological status, after 12 weeks in the intervention group, the HAMA scores (14.24 ± 1.68) were lower than those before intervention (27.77 ± 1.24), and the difference was statistically significant(t=36.062,P=0.000).The scores were lower than in the control group after intervention(26.48±1.21),and the difference was statistically significant(t=-31.152,P=0.000).After intervention, the SCL-90 scores in the six dimensions, including symptom total score, somatization, compulsion,interpersonal relationships,depression,and anxiety and horror,decreased compared with those before intervention, and the differences were statistically significant (all P<0.05). After intervention, the differences between the intervention and control groups were statistically significant (P<0.05) in five dimensions, including symptom score, somatization, compulsion, depression, and anxiety and horror. Conclusion Based on the routine intervention for type 2 diabetes, a club health education model can significantly improve the metabolic index of patients with type 2 diabetes mellitus complicated with anxiety. In addition,anxiety,interpersonal sensitivity,and other adverse mental states may be significantly alleviated.