北京市通州区和顺义区747例2型糖尿病患者生存质量影响因素

doi:10.19723/j.issn.1671-167X.2021.03.014

摘要/Abstract

摘要：

目的: 探讨北京市通州区和顺义区747例2型糖尿病患者的生存质量现状及影响因素。方法: 对纳入研究的747例2型糖尿病患者进行问卷调查和抽血实验室血生化检查。以糖化血红蛋白(hemoglobin A1c,HbA1c)作为血糖控制指标,以糖尿病患者特异性生存质量量表(diabetes specific quality of life scale,DSQL)评分为患者生存质量指标,采用多元线性回归和结构方程模型(structural equation modeling,SEM)分析生存质量的影响因素。结果: 调查747例患者,HbA1c平均水平(7.1±1.2)%,血糖控制达标率为35.1% (262/747)。血糖控制好和血糖控制差两组患者的病程、服药和使用胰岛素、吸烟情况及体重指数(body mass index,BMI)差异有统计学意义(P<0.05)。DSQL总分为(44.92±13.32)分,生理维度条目平均分最高,其次是心理维度。多元线性回归结果显示,家庭月收入、并发症、抑郁、病程时间、胰岛素、住院及自我效能是DSQL总分的影响因素(P<0.05)。SEM结果显示,血糖对于生存质量的生理维度(标准化效应值为0.166)、心理维度(0.076)及社会维度(0.124)存在影响,抑郁对于生存质量的生理维度(0.342)、心理维度(0.217)及治疗维度(0.050)存在影响,差异有统计学意义(P<0.05)。结论: 北京市通州区和顺义区2型糖尿病患者HbA1c控制水平欠佳,生存质量尚可,仍有非常大的提升空间。应提高对男性、病程长、处于不服药状态、不使用胰岛素、吸烟、处于抑郁状态、糖尿病技能得分水平低的患者的关注和管理,同时应在临床治疗中提高对患者心理需求的重视,加强对患者及其家属的心理健康教育,采取相应的心理干预措施,以达到有效控制血糖的目的,从而提高患者的生活质量。

关键词: 糖尿病,2型, 生活质量, 血红蛋白A,糖基化, 抑郁

Abstract:

Objective: To investigate the situation of quality of life in patients with type 2 diabetes and its associated factors. Methods: Questionnaires, physical examination and glycated hemoglobin test were conducted in 747 patients with type 2 diabetes. Hemoglobin A1c (HbA1c) was a proxy for glycemic control, diabetes specific quality of life scale (DSQL) score was a proxy for quality of life. Factors associa-ted with DSQL were analyzed by multiple linear regression and structural equation modeling (SEM). Results: A total of 747 patients were included in this study. The mean HbA1c level was (7.1±1.2)%, with 35.1% reaching the target (262/747). There were significant differences in disease duration, me-dication and use of insulin, smoking, and body mass index (BMI) between the two groups with good and poor glycemic control (P<0.05). The total score of DSQL was 44.92±13.32, in which average phy-siological factors were the highest, then followed by scores of psychological factors. Multiple linear regression showed that monthly household income, comorbidities, depression, duration of illness, insulin, hospitalization, and self-efficacy were significantly associated with the total score of DSQL (P<0.05). SEM showed that blood glucose control was significantly associated with the scores of physical factors (0.166), psychological factors (0.076), and social factors (0.124) of DSQL, respectively. Depression had effects on the physical factors (0.342), psychological factors (0.217), and treatment factors (0.050) of DSQL (P<0.05). Conclusion: Glycemic control in our study is relatively poor but the quality of life remains well. More attention should be paid to patients who are male, with long diagnosis duration, poor medication adherence, smoking, with depression and with low diabetes-related skills. In practice, health practitioners should be aware of psychological needs of patients, and offer mental health education to patients and their families, in order to help patients manage blood glucose and improve their quality of life.

Key words: Diabetes mellitus,type 2, Quality of life, Hemoglobin A,glycosylated, Depression

中图分类号:

R587.1

樊理诗,高敏,Edwin B.FISHER,孙昕霙. 北京市通州区和顺义区747例2型糖尿病患者生存质量影响因素[J]. 北京大学学报（医学版）, 2021, 53(3): 523-529.

FAN Li-shi,GAO Min,Edwin B. FISHER,SUN Xin-ying. Factors associated with quality of life in 747 patients with type 2 diabetes in Tongzhou District and Shunyi District of Beijing[J]. Journal of Peking University (Health Sciences), 2021, 53(3): 523-529.

图/表 5

表1

研究对象的基本信息及血糖控制情况"

Items	n (%) or $\bar{x} \pm s$	Glycemic control, n (%)		χ²	P value
Items	n (%) or $\bar{x} \pm s$	Good	Bad	χ²	P value
Gender				1.182	0.277
Male	359 (48.1)	133 (50.8)	226 (46.6)
Female	388 (51.9)	129 (49.2)	259 (53.4)
Age/years	59.7±7.6			2.056	0.358
≤50	81 (10.8)	23 (8.8)	58 (12.0)
51-60	268 (35.9)	93 (35.5)	175 (36.1)
≥61	398 (53.3)	146 (55.7)	252 (52.0)
Education level				2.858	0.414
Primary school	81 (10.8)	25 (9.5)	56 (11.5)
Middle school	533 (71.4)	184 (70.2)	349 (72.0)
University/College	125 (16.7)	51 (19.5)	74 (15.3)
Graduate school	8 (1.1)	2 (0.8)	6 (1.2)
Marital status				3.459	0.326
Unmarried	3 (0.4)	2 (0.8)	1 (0.2)
Married	703 (94.1)	243 (92.7)	460 (94.8)
Divorced	11 (1.5)	3 (1.1)	8 (1.6)
Widowed	30 (4.0)	14 (5.3)	16 (3.3)
Personal monthly income/Yuan				1.569	0.666
0-3 000	217 (29.0)	72 (27.5)	145 (29.9)
3 001-5 000	331 (44.3)	124 (46.9)	208 (42.9)
5 001-10 000	155 (20.7)	54 (20.6)	101 (20.8)
≥10 000	44 (5.9)	12 (5.0)	31 (6.4)
Course of disease/years	5.0±4.6			19.070	<0.001
0-5	414 (55.4)	172 (65.6)	242 (49.9)
6-10	278 (37.2)	79 (30.2)	199 (41.0)
11-15	39 (5.2)	9 (3.4)	30 (6.2)
≥16	16 (2.1)	2 (0.8)	14 (2.9)
HbA1c/%	7.1±1.2
Complication				0.047	0.828
Yes	607 (81.3)	215 (81.7)	392 (80.8)
No	140 (18.7)	48 (18.3)	92 (19.2)
Smoke				6.953	0.031
Now	180 (24.1)	51 (19.5)	129 (26.6)
Used	116 (15.5)	50 (19.1)	66 (13.8)
Never	451 (60.4)	161 (61.5)	290 (59.8)
BMI				9.633	0.022
Thin	3 (0.4)	3 (1.1)	0 (0)
Normal	168 (22.5)	69 (26.3)	99 (20.4)
Overweight	263 (35.2)	90 (34.4)	173 (35.7)
Obesity	313 (41.9)	100 (38.2)	213 (43.9)
Medication				11.036	<0.001
Yes	649 (86.9)	213 (81.3)	436 (89.9)
No	98 (13.1)	49 (18.7)	49 (10.1)
Insulin				15.074	<0.001
Yes	97 (13.0)	17 (6.5)	80 (16.5)
No	650 (87.0)	245 (93.5)	405 (83.5)
Depressed				0.010	0.919
Yes	124 (16.6)	43 (16.4)	81 (16.7)
No	623 (83.4)	219 (83.6)	404 (16.7)

表1

表2

表3

表4

图1

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Items	Entries, n	Quality of life scores		Entries evenly split, $\bar{x} \pm s$
Items	Entries, n	Range	$\bar{x} \pm s$	Entries evenly split, $\bar{x} \pm s$
DSQL-total	27	33-98	44.92±13.32	1.66±0.49
DSQL-physiology	12	13-48	21.38±7.52	1.78±0.63
DSQL-psychology	8	12-32	13.19±5.01	1.65±0.63
DSQL-sociology	4	4-10	5.83±2.13	1.46±0.53
DSQL-cure	3	4-8	4.52±2.02	1.51±0.67

Items	Correlation coefficient	Items	Correlation coefficient
Gender	0.082^*	Smoke	0.065^*
Marriage	0.091^*	Alcohol	0.089^*
Hospitalization	0.159^#	HbA1c	0.072^*
Complication	0.124^#	Course of disease	0.148^*
Depression	0.443^#	BMI	0.026^*
Medication	-0.066^*	Self-efficacy	-0.146^#
Insulin	-0.083^*	Skill	-0.063^*

Items	B	S.E.	β	t	P	B (95%CI)
Constant term	24.954	3.888	-	6.418	<0.001	17.320 to 32.587
Income	-0.874	0.510	-0.056	-1.716	0.045	-0.159 to -0.039
Complication	3.706	1.118	0.109	3.316	<0.001	1.512 to 5.900
Depressed	15.284	1.176	0.427	12.997	<0.001	12.975 to 17.592
Course of disease	1.389	0.640	0.072	2.168	0.030	0.131 to 2.646
Insulin	-2.637	1.315	-0.067	-2.006	0.045	-5.219 to -0.056
Hospitalization	5.690	1.593	0.115	3.572	<0.001	1.683 to 2.229
Self-efficacy	0.401	0.122	0.106	3.278	<0.001	0.161 to 0.641