慢病健康管理对狼疮肾炎患者疾病活动度及肾损害的影响

    The effect of chronic disease health management on disease activity and renal injury in patients with lupus nephritis

      摘要
    • 摘要:
      目的  探讨慢病健康管理对狼疮肾炎（lupus nephritis,LN）患者的疾病活动度及肾损伤的影响。
      方法  选取武汉大学中南医院2022年5月至 2022年11月期间就诊的97例LN患者作为研究对象。根据管理模式进行分组，慢病管理组49例，予以慢病健康管理模式管理，对照组48例，予以出院后常规管理。6个月后比较两组患者的疾病活动度、血尿、蛋白尿、白细胞、红细胞、白蛋白、肌酐、尿素氮、用药依从性、生活质量（SF-36量表评估）、医师信任度。
      结果  两组患者干预后，血液、尿液指标均较治疗前有所改善，且慢病管理组的血液、尿液指标优于对照组，慢病管理组红细胞由（3.74 ± 0.61）×1012/L升至（4.37 ± 0.58）×1012/L，白蛋白由（34.99 ± 6.91）g/L升至（39.82 ± 4.59）g/L，肌酐水平由（63.66 ± 26.18）μmol/L降至（58.37 ± 17.11）μmol/L，尿素氮由（5.03 ± 1.95）mmol/L升至（5.13 ± 1.39）mmol/L，血尿例数由23例降至10例，蛋白尿例数由26例降至13例，对照组红细胞由（3.68 ± 0.71）×1012/L升至（4.07 ± 0.65）×1012/L，白蛋白由（35.11 ± 6.42）g/L升至（36.76 ± 7.54）g/L，肌酐水平由（60.66 ± 18.06）μmol/L升至（72.38 ± 39.57）μmol/L，尿素氮由（5.03 ± 1.94）mmol/L升至（5.72 ± 1.32）mmol/L，血尿例数由24例降至19例，蛋白尿由24例降至22例，差异具有统计学意义（P＜0.05）。两组患者的疾病活动度均降低，其中慢病管理组低于对照组，差异具有统计学意义（P＜0.05）。干预后，慢病管理组的用药依从性高于对照组，差异具有统计学意义（P＜0.05）。慢病管理组生活质量方面生理功能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、精神健康方面评分均明显高于对照组（P＜0.05）。慢病管理组的医师信任度显著高于对照组，差异具有统计学意义（P＜0.05）。
      结论  慢病健康管理有助于降低LN患者疾病活动度，改善肾损害，提高用药积极性，提升生活质量和医师信任度。

       

      Abstract:
      Objective  To evaluate the effect of chronic disease health management on disease activity and renal injury in patients with lupus nephritis (LN).
      Methods  A total of 97 LN patients diagnosed with lupus nephritis were randomizedly assigned to into two groups of chronic disease health management (n=49) and conventional management (n=48). and followed up for a median of 6 months. The disease activity index (SLEDAI), and blood and urinarye parameters and medicine compliance and living quality-of-life (SF-36) and trust in doctor physician were recordedobserved in at Month 6.
      Results  Patients who managed by of chronic disease health management had lower disease activity compared to conventional group (P<0.05) and had better blood and urinarye parameters than conventional group (P<0.05)（chronic disease health management:red blood cells rise from（3.74±0.61）×1012/L to （4.37±0.58）×1012/L, albumin rise from(34.99±6.91)g/L to(39.82±4.59)g/L, creatinine drop from （63.66±26.18）μmol/L to （58.37±17.11）μmol/L, urea nitrogen rise from（5.03±1.95）mmol/L to （5.13±1.39）mmol/L, the number of hematuria cases decreased from 23 to 10, and the number of proteinuria cases decreased from 26 to 13 cases, conventional management red blood cells rise from （3.68±0.71）×1012/L to（4.07±0.65）×1012/L, albumin rise from（35.11±6.42）g/L to （36.76±7.54）g/L, creatinine rise from（60.66±18.06）μmol/L to （72.38±39.57）μmol/L, urea nitrogen rise from（5.03±1.94）mmol/L to （5.72±1.32）mmol/L, the number of cases of hematuria decreased from 24 to 19, and the number of cases of proteinuria decreased from 24 to 22（P<0.05）. And chronic disease health managed group was significantly higher than conventional group in terms of medication compliance, SF-36 scores and trust in doctor physician (P<0.05).
      Conclusions  Chronic disease health management of LN patients may help reduced lower disease activity, in patients with lupus nephritis and improve renal injury, and increased theboost medication compliance and enhance and living quality-of-life and trust in physician.

       

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