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目的目前关于2型糖尿病筛查对人群发病率长期影响的研究并不多见,本研究探讨了糖尿病筛查对人群心血管疾病发病率、自测健康及健康行为的长期影响。方法采用平行、队列随机对照试验(ADDITIONCambridge study),在英格兰东部32家全科诊所(采用随机的方法抽取27家诊所,其他5家诊所未进行控制试验)中抽取年龄为40~69岁的糖尿病高危人群18 875名。对满足筛查条件的人群进行筛查,其中466名(2.9%)被诊断为糖尿病。7年后,随机抽取患者进行问卷调查:筛查组(包括出席筛查和未出席筛查的人群)占15.0%,控制组占40.0%。比较两组自报心血管疾病患病率、自测健康〔采用健康调查评分表(SF-8)和欧洲生命质量量表(EQ-5D)〕及健康行为。结果共寄出3 286份调查问卷,回收1 995份,其中有效问卷1 945份(筛查组1 373份,控制组572份)。7年后,两组心脏病/卒中报告比例〔OR=0.90,95%CI(0.71,1.15)〕,SF-8得分〔β=-0.33,95%CI(-1.80,1.14)〕,EQ-5D视觉类比得分〔β=0.80,95%CI(-1.28,2.87)〕,总身体活动得分〔β=0.50,95%CI(-4.08,5.07)〕,吸烟情况〔OR=0.97,95%CI(0.72,1.32)〕及饮酒情况〔β=0.14,95%CI(-1.07,1.35)〕比较,差异无统计学意义。结论糖尿病筛查对人群心血管疾病发病率、自测健康及健康行为的长期影响较为有限。
Purpose There are few studies on the long-term impact of type 2 diabetes screening on population morbidity. This study explored the long-term impact of diabetes screening on cardiovascular disease morbidity, self-rated health and health behaviors in people. Methods A total of 32 age-40 diabetic patients aged 40-69 years were enrolled in a study conducted by the ADDITIONCambridge study in 32 general practice clinics in East England (27 clinics were randomized and 5 were not controlled by other clinics) 18,875 high-risk groups. Screening was performed to meet the screening criteria, of which 466 (2.9%) were diagnosed with diabetes. Seven years later, patients were randomized to a questionnaire: 15.0% of the screening group (including those who attended the screening and did not attend the screening), and 40.0% of the control group. The self-reported prevalence of cardiovascular disease, self-rated health [using the Health Survey Scale (SF-8) and the European Quality of Life Scale (EQ-5D)] and healthy behaviors were compared between the two groups. Results A total of 3 286 questionnaires were sent and 1,995 copies were returned, of which 1 945 were valid questionnaires (1 373 in the screening group and 572 in the control group). Seven years later, the proportion of reported heart disease / stroke (OR = 0.90, 95% CI, 0.71, 1.15), SFQ-8 score 5D visual analogue score (β = 0.80,95% CI -1.28,2.87), total physical activity score (β = 0.50,95% CI -4.08,5.07), smoking status [OR = 0.97,95% CI (0.72,1.32)] and alcohol consumption 〔β = 0.14,95% CI (-1.07,1.35)〕〕, the difference was not statistically significant. Conclusion The long-term impact of diabetes screening on the incidence of cardiovascular disease, self-rated health and healthy behavior is relatively limited.