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目的对已接受基础治疗仍不达标的老年男性代谢综合征(MS)患者进行多因素干预,观察干预前后各代谢指标达标率变化及其影响因素。方法选取189例老年男性MS(CDS标准)患者进行10个月的随访观察,其中代谢指标控制较差者75例行6个月综合干预,余114例为对照。综合干预包括:强化饮食、运动和健康教育,调整药物治疗(分别针对血糖、血脂、血压、血尿酸水平进行治疗)。随访结束时干预组中56例参加填写MS知识问卷。结果 (1)干预组干预后血总胆固醇(TC)、甘油三酯(TG)及低密度脂蛋白胆固醇(LDL-C)水平有显著改善(P<0.01),血尿酸水平亦有改善(P<0.05)。(2)对照组各代谢指标达标率除LDL-C增加(P<0.05)外,余指标均无改善。(3)调脂药物可明显降低血TC、TG及LDL-C水平,比单纯生活方式干预更有效。(4)MS知识问卷统计,85.11%的患者认为代谢指标控制不佳原因为自我约束力差,48.94%的患者认为是对MS的危害没有充分认识、缺乏调整治疗知识。结论本组老年男性MS患者各代谢指标达标率以血压、体重最差;对于病程长、已行多种药物联合治疗仍未达标的老年MS患者,体重、血糖、血压达标为治疗难点;加大调脂治疗力度,可使血TG、TC、LDL-C显著改善。
Objective To investigate the multifactorial intervention of elderly men with metabolic syndrome (MS) who have not received basic treatment and to observe the compliance rate of each metabolic index and its influencing factors before and after intervention. Methods A total of 189 elderly men with MS (CDS criteria) were followed up for 10 months. Among them, 75 patients with poor control of metabolic syndrome had comprehensive intervention for 6 months and 114 patients as control. Comprehensive interventions include: intensive diet, exercise and health education, medication adjustment (for blood glucose, blood lipids, blood pressure, blood uric acid levels were treated). At the end of follow-up, 56 patients in the intervention group participated in completing the MS Knowledge Questionnaire. Results (1) The level of blood total cholesterol (TC), triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) in the intervention group were significantly improved (P <0.01) <0.05). (2) In the control group, except for the increase of LDL-C (P <0.05), the remaining indexes did not improve. (3) lipid-lowering drugs can significantly lower blood TC, TG and LDL-C levels, more than simple lifestyle interventions more effective. (4) According to the MS knowledge questionnaire, 85.11% of the patients think that the metabolic control is poor due to the poor self-restraint, 48.94% of the patients think it is not fully aware of the harm of MS, and lack of adjustment of treatment knowledge. CONCLUSIONS: The metabolic rate of MS patients in this group is the lowest among all the MS patients. For long-term patients with MS who have not reached the standard of multi-drug combination treatment, the body weight, blood glucose and blood pressure reach the standard for treatment difficulty. Lipid treatment efforts, can make blood TG, TC, LDL-C significantly improved.