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目的:探讨个体化医学营养治疗对不同糖化血红蛋白(HbA1c)水平的2型糖尿病(T2DM)病人感染率的影响。方法:将97例T2DM病人随机分为干预组(n=51)和对照组(n=46),分别对其进行个体化医学营养治疗配合糖尿病综合治疗和单纯糖尿病综合治疗,连续观察6个月。在研究开始前和研究结束时行人体组织成分分析、血生化和CD4+、CD8+测定,同时记录饮食、运动、药物治疗和感染等情况。结果:干预组病人HbA1c≤6.5%为15例,>6.5%为36例;对照组HbA1c≤6.5%为14例,>6.5%为32例。与对照组比,研究后干预组各亚组的CD4+和CD4+/CD8+比值明显升高(P<0.05),CD8+降低(P<0.05)。与研究前比较,两组HbA1c>6.5%者CD4+升高(P<0.01),CD8+降低(P<0.01)。与对照组比较,干预组发热时体温升高和持续时间均显著降低(P<0.05),HbA1c>6.5%者发热、上呼吸道感染、肺部感染、皮肤脓肿与破溃的发生率降低(P<0.05),而HbA1c≤6.5%者泌尿系感染和口腔溃疡的发生率降低(P<0.01)。结论:无论HbA1c控制如何,个体化医学营养治疗均可提高T2DM病人的免疫功能,减少感染患病率。而不同HbA1c水平下各组织中细菌繁殖能力亦不同。
Objective: To investigate the effect of individualized medical nutrition therapy on the infection rate of type 2 diabetes mellitus (T2DM) patients with different HbA1c levels. Methods: Ninety-seven patients with T2DM were randomly divided into intervention group (n = 51) and control group (n = 46). Individualized medical nutrition therapy combined with diabetes mellitus and simple diabetes mellitus treatment were respectively followed up for 6 months . Body composition analysis, blood biochemistry and CD4 +, CD8 + determinations were taken before and at the end of the study, with diet, exercise, medication and infections recorded. Results: In the intervention group, HbA1c≤6.5% was 15 cases and> 6.5% was 36 cases. In control group, HbA1c≤6.5% was 14 cases and> 6.5% was 32 cases. Compared with the control group, the ratios of CD4 + and CD4 + / CD8 + in the intervention group were significantly increased (P <0.05) and CD8 + decreased (P <0.05). Compared with the pre-study, the CD4 + and CD4 + levels of HbA1c> 6.5% were significantly increased (P <0.01) and CD8 + decreased (P <0.01). Compared with the control group, the body temperature and duration of fever in the intervention group were significantly lower (P <0.05), HbA1c> 6.5% of the fever, upper respiratory tract infection, lung infection, skin abscess and rupture rate decreased (P <0.05), while the incidence of urinary tract infection and oral ulcer decreased with HbA1c≤6.5% (P <0.01). CONCLUSIONS: Regardless of HbA1c control, individualized medical nutrition therapy can improve immune function and reduce the prevalence of infection in T2DM patients. However, the ability of bacteria to proliferate in different tissues at different levels of HbA1c is also different.