本文選題：糖尿病　切入點(diǎn)：干預(yù)　出處：《青島大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)社區(qū)對(duì)“青島市糖尿病預(yù)防項(xiàng)目”的大規(guī)模調(diào)查人群進(jìn)行3年隨訪研究,比較項(xiàng)目區(qū)和非項(xiàng)目區(qū)通過(guò)飲食和體育鍛煉干預(yù)對(duì)糖尿病預(yù)防的長(zhǎng)期影響,驗(yàn)證飲食和體育鍛煉干預(yù)在社區(qū)人群中實(shí)施的現(xiàn)實(shí)可行性,為對(duì)無(wú)癥狀人群進(jìn)行早期干預(yù)推遲糖尿病發(fā)病提供依據(jù)。方法:采用“青島市糖尿病預(yù)防項(xiàng)目”自2009年進(jìn)行大規(guī)模基線調(diào)查的6100名研究對(duì)象,實(shí)際調(diào)查5110名,應(yīng)答率為83.77%,剔除糖尿病患者831人,對(duì)剩余的4279名研究對(duì)象進(jìn)行為期3年的隨訪研究。其中市北區(qū)、市南區(qū)、膠南市、黃島區(qū)為項(xiàng)目區(qū),原四方區(qū)、即墨市為非項(xiàng)目區(qū),對(duì)項(xiàng)目區(qū)進(jìn)行3年飲食和體育鍛煉干預(yù),非項(xiàng)目區(qū)不給予任何干預(yù)措施。對(duì)基線人群和隨訪人群均進(jìn)行問(wèn)卷調(diào)查、體格檢查和實(shí)驗(yàn)室檢測(cè)。比較干預(yù)前后項(xiàng)目區(qū)和非項(xiàng)目區(qū)糖尿病發(fā)病及體重、空腹血糖、餐后兩小時(shí)血糖、總膽固醇、甘油三酯和高密度脂蛋白等血糖和血脂指標(biāo)的變化。結(jié)果:2009年基線調(diào)查糖尿病患病率為16.3%,對(duì)4279名研究對(duì)象進(jìn)行3年隨訪共回收有效問(wèn)卷2312例,其中項(xiàng)目區(qū)為1456例,非項(xiàng)目區(qū)為856例。3年隨訪新發(fā)糖尿病患者200人,糖尿病累計(jì)發(fā)病率為8.7%。飲食和體育鍛煉干預(yù)與糖尿病發(fā)病成負(fù)相關(guān),飲食和體育鍛煉干預(yù)、血壓、糖尿病家族史能預(yù)測(cè)糖尿病發(fā)病,但是吸煙、飲酒、BMI、肥胖和血脂的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。飲食和體育鍛煉的RR值及其(95%CI)為0.58(0.41~0.81),是糖尿病發(fā)病的保護(hù)因素。血壓的RR值及其(95%CI)為2.02(1.45~2.81),糖尿病家族史的RR值及其(95%CI)為2.03(1.39~2.95),兩者均是是糖尿病發(fā)病的危險(xiǎn)因素。體重、收縮壓在項(xiàng)目區(qū)中降低,在非項(xiàng)目區(qū)中增加,兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05);空腹血糖、高密度脂蛋白在非項(xiàng)目區(qū)和項(xiàng)目區(qū)中均降低,但在項(xiàng)目區(qū)中降低明顯,兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05);腰圍、腰臀比都有增加,項(xiàng)目區(qū)增加低于非項(xiàng)目區(qū),兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05);舒張壓略有增加,但項(xiàng)目區(qū)增加高于非項(xiàng)目區(qū),兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05);餐后2小時(shí)血糖均有增加,項(xiàng)目區(qū)中變化高于非項(xiàng)目區(qū),兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05);甘油三酯、總膽固醇、Hb A1c在非項(xiàng)目區(qū)中降低,在項(xiàng)目區(qū)中增加,兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05);研究對(duì)象體質(zhì)指數(shù)在兩組之中差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:飲食和體育鍛煉干預(yù)能夠改善患者體重、有效控制血糖和調(diào)節(jié)血脂的代謝,降低高危人群糖尿病的發(fā)病風(fēng)險(xiǎn),對(duì)無(wú)癥狀人群進(jìn)行早期的飲食和體育鍛煉干預(yù)推遲糖尿病發(fā)病提供了科學(xué)依據(jù)。
[Abstract]:Objective: to compare the long-term effects of diet and physical exercise intervention on diabetes prevention between the project area and the non-project area through a 3-year follow-up study on the large scale survey population of "Qingdao Diabetes Prevention Project" in the community. To verify the practical feasibility of diet and physical exercise intervention in community population, Methods: 6100 subjects of large-scale baseline survey conducted by Qingdao Diabetes Prevention Project since 2009, 5110 actual subjects, were selected to provide evidence for the early intervention of asymptomatic population to delay the onset of diabetes. The response rate was 83.77, 831 patients were excluded from diabetes mellitus, and the remaining 4279 subjects were followed up for three years. Among them, Shibei District, Southern District, Jiaonan City, Huangdao District were project area, original Sifang District, Jimo City was non-project area, Three years diet and physical exercise intervention were carried out in the project area, and no intervention measures were given in the non-project area. The baseline population and the follow-up population were investigated with questionnaires. Physical examination and laboratory tests. Diabetes incidence and body weight, fasting blood glucose, two hours postprandial blood glucose, total cholesterol were compared before and after intervention. Results: the baseline survey of diabetes mellitus prevalence rate in 2009 was 16.3. A total of 2312 effective questionnaires were collected from 4279 subjects for 3 years, including 1456 cases in the project area. There were 856 cases in non-project area, 200 newly diagnosed diabetes patients were followed up for 3 years, the cumulative incidence of diabetes was 8.7. Diet and physical exercise intervention was negatively correlated with diabetes, diet and physical exercise intervention, blood pressure, diet and physical exercise intervention, A family history of diabetes can predict the onset of diabetes, but smoking, The RR value of diet and physical exercise and its 95 CI) were 0.58 ~ 0.41 ~ 0.81, which were the protective factors of diabetes. The RR value of blood pressure and its 95 ~ (95) CI were 2.02 ~ 1.45 ~ 2.81, the RR value of diabetic family history and its 95 ~ (95) CI were 2.03 ~ 1.39 ~ 2.95 ~ (-1), respectively. They are all risk factors for diabetes. Systolic blood pressure decreased in the project area and increased in the non-project area, the difference between the two groups was statistically significant (P 0.05), fasting blood glucose and high density lipoprotein decreased in both the non-project area and the project area, but significantly decreased in the project area. The differences between the two groups were statistically significant (P 0.05), waist circumference and waist-to-hip ratio were all increased, the increase in the project area was lower than that in the non-project area, and the difference between the two groups was statistically significant (P 0.05). The diastolic blood pressure increased slightly, but the increase in the project area was higher than that in the non-project area. The difference between the two groups was statistically significant (P 0.05), the blood glucose increased in 2 hours after meal, the change in the project area was higher than that in the non-project area, the difference between the two groups was statistically significant (P 0.05), the triglyceride, total cholesterol HbA1c decreased in the non-project area, and increased in the project area. There was no significant difference in body mass index between the two groups. Conclusion: diet and physical exercise intervention can improve the body weight, control blood sugar and regulate the metabolism of blood lipids. Reducing the risk of diabetes in high risk groups and providing scientific basis for the early intervention of diet and physical exercise to delay the onset of diabetes in the asymptomatic population.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R587.1

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