深圳市福田区II型糖尿病患者ASCVD风险级别的影响因素分析及综合干预策略效果对比研究

Analysis of Influence Factors of ASCVD Risk Level in Patients with Type II Diabetes Mellitus in Futian District of Shenzhen City and Comparative Study of Effects of Comprehensive Intervention Strategies

摘要: 背景：近年来随着人们生活方式的改变，我国糖尿病(Diabetes Mellitus type 2, T2DM)患病人数快速增加。动脉粥样硬化性心血管疾病(Atherosclerotic Cardiovascular Disease, ASCVD)是T2DM患者死亡的主要原因，该疾病对我国人民健康造成严重威胁。目的：调查并探讨深圳市福田区居民ASCVD风险级别的影响因素，分析社康中心综合干预策略效果。方法：通过EPM (Electronic Patient Management, EPM)家庭医生签约信息平台收集2023年度在深圳市福田区4家社康中心签约就诊的患者个人信息及体检数据并对干预效果进行对比，分析相关影响因素。结果：共回收有效数据1011份，有效回收率为98.06%。ASCVD终生风险低风险组占19.29% (195/1011)；ASCVD终生风险高风险组80.71% (816/1011)。二元Logistic回归分析结果显示，年龄、男性、BMI、LDLC、HDLC是风险级别从低风险到高风险转变的重要因素，同时提示干预措施并未显著降低风险级别可能性，干预组社康的干预策略仍然需要进一步调整。结论：深圳市福田区II型糖尿病患者中，有心血管疾病家族史的男性患者处于ASCVD的高风险机率更高，因此这类患者要加强用药管理与饮食管理，家庭医生也应以家庭为单位指导居民健康的膳食模式，同时注重配合患者搭建自我用药管理方案，避免漏服拒服的情况发生。家庭医生需针对个体的ASCVD影响因素来设定疾病防控目标才能获得群体更显著的干预效果。

Abstract: Background: In recent years, with the change in people’s lifestyles, the number of patients with diabetes mellitus type 2 (T2DM) in our country has increased rapidly. Atherosclerotic Cardiovascular Disease (ASCVD) is the main cause of death for T2DM patients and poses a serious threat to the health of our people. Objective: To investigate and explore the influencing factors of Atherosclerotic Cardiovascular Disease (ASCVD) risk levels among residents in Futian District, Shenzhen, and to analyze the effectiveness of comprehensive intervention strategies implemented by community health centers. Methods: Data was collected through the Electronic Patient Management (EPM) platform for family doctors, which included personal information and physical examination data of patients who registered and visited at four community health centers in Futian District, Shenzhen, during the year 2023. The intervention effects were compared, and relevant influencing factors were analyzed. Results: A total of 1011 valid data entries were collected, with an effective recovery rate of 98.06%. The low-risk group for ASCVD lifetime risk accounted for 19.29% (195 out of 1011); the high-risk group for ASCVD lifetime risk accounted for 80.71% (816 out of 1011). Binary Logistic regression analysis showed that age, male gender, BMI, LDL-C, and HDL-C are significant factors in the transition from low risk to high risk for ASCVD. It also indicated that intervention measures did not significantly reduce the likelihood of risk level, and the intervention strategies of the intervention group at the community health centers still need further adjustment. Conclusion: Among type 2 diabetes patients in Futian District, Shenzhen, male patients with a family history of cardiovascular diseases have a higher probability of being at high risk for ASCVD. Therefore, these patients need to strengthen medication management and dietary management. Family doctors should also guide residents in healthy dietary patterns on a family basis, while focusing on assisting patients in establishing self-medication management plans to avoid missing or refusing medication. Family doctors need to set disease prevention and control goals based on individual ASCVD risk factors to achieve more significant intervention effects in the community.