康復干預對糖尿病伴抑郁癥患者抑郁癥狀和糖脂代謝的影響

盧雪芬　符鴻俊　應麗娜

[摘要] 目的 探討康復干預對糖尿病伴抑郁癥患者的抑郁癥狀和糖脂代謝的影響。 方法 選取92例糖尿病伴抑郁癥患者，隨機分為康復組和對照組。兩組均予以飲食調整、適當運動及藥物降血糖等基礎治療。對照組常規干預。康復組在對照組基礎上予以綜合性康復干預，兩組均干預12周。評估兩組干預前后糖脂代謝指標變化，并評估其抗抑郁療效。 結果 干預12周后，兩組FBG、2hPG和HbA1C較前均不同幅度下降（P<0.05或P<0.01），且康復組下降幅度更明顯（P<0.05）；兩組TC、TG和LDL-C水平均較前不同幅度下降，HDL-C水平較前不同幅度上升（P<0.05或P<0.01）。且康復組下降或上升幅度更顯著（P<0.05）；同時康復組抗抑郁臨床總有效率較對照組更佳（χ2=5.06，P<0.05）。 結論 康復干預用于糖尿病伴抑郁癥患者的效果確切，可改善抑郁癥狀及糖脂代謝指標，有利于血糖及血脂的達標，改善其預后。

[關鍵詞] 糖尿病；抑郁；康復干預；糖脂代謝

[中圖分類號] R587.1 [文獻標識碼] B [文章編號] 1673-9701（2017）36-0101-04

[Abstract] Objective To investigate the effect of rehabilitation intervention on depression symptoms and glycolipid metabolism in patients with diabetes mellitus and depression. Methods A total of 92 cases of diabetic patients with depression were selected and randomly divided into rehabilitation group and control group. Both groups were given basic treatment including dietary adjustments， appropriate exercise and drugs to lower blood sugar. The control group was given routine intervention. The rehabilitation group was given a comprehensive rehabilitation intervention based on the treatment of the control group. And both groups were intervened for 12 weeks. The changes in indicators of glycolipid metabolism in the two groups before and after intervention were evaluated. And the antidepressant efficacy was evaluated. Results After intervention for 12 weeks， FBG， 2hPG and HbA1C in two groups decreased significantly decreased in different degrees compared with those before intervention（P<0.05 or P<0.01）. And the rehabilitation group decreased more significantly（P<0.05）. The TC， TG and LDL- C levels in the two groups decreased in different degrees compared with those before intervention， and the HDL-C level in the two groups increased in different degrees compared with those before intervention（P<0.05 or P<0.01）. And the magnitude of decline or increase was even more significant（P<0.05）. At the same time， the total effective rate of antidepressant in the rehabilitation group was better than that in the control group（χ2=5.06， P<0.05）. Conclusion Rehabilitation intervention is effective in patients with diabetes mellitus and depression， which can improve depressive symptoms and indicators of glycolipid metabolism， and is conducive to the blood glucose and lipid compliance and improves prognosis.

[Key words] Diabetes mellitus；Depression；Rehabilitation intervention；Glycolipid metabolism

糖尿病是一種常見的慢性心身性疾病，與患者的情緒障礙關系密切，其中抑郁癥狀較常見，發生率約30%～45%[1，2]。而糖尿病伴抑郁可使患者長期處于應激狀態，下丘腦-垂體-靶腺軸功能紊亂，導致升糖激素水平明顯上升及胰島細胞分泌量下降，引起血糖升高，加重其病情，影響其預后[3-5]。對糖尿病伴抑郁癥患者的干預以往多采用健康教育、心理安慰及用藥干預等常規手段，雖有一定效果，但療效欠理想[6，7]。康復干預是在心理干預基礎上建立起的一種綜合性康復干預模式，逐漸應用于糖尿病伴抑郁癥的干預治療中，療效較好[8，9]。本研究觀察了康復干預對糖尿病伴抑郁癥患者抑郁癥狀和糖脂代謝的影響，現報道如下。

1 對象與方法

1.1 研究對象

選取糖尿病伴抑郁癥患者92例，均為2016年4月～2017年2月我院內科門診就診患者。納入標準：（1）均符合《中國2型糖尿病防治指南》的診斷標準[10]；……