Abstract: Background　With the implementation of hierarchical medical system，and supportive policies for special disease outpatient management，a great number of type 2 diabetes mellitus （T2DM） patients can obtain management from community health centers （CHCs）．However，it is unclear whether the prevalence of statins treatment and rate of reaching the target low-density lipoprotein cholesterol （LDL-C） in this population can be benefited from such management.Objective　To evaluate the effect of special disease outpatient management on the prevalence and efficacy of statin treatment in T2DM patients in CHCs in Wuhou District，Chengdu.Methods　We conducted this retrospective study in 13 CHCs in Chengdu's Wuhou District from June 15，2017 to June 15，2018.From the electronic patient management （EPM） platform of the CHCs，we enrolled T2DM patients who received family doctor services.We collected their data such as gender，age，body mass index （BMI），hypertension，occupation，education level，special disease outpatient management，statins treatment，and LDL-C level.Multiple linear regression analysis was used to explore the factors affecting LDL-C level with stepping technique.Results　A total of 10 593 cases were included，and 5 184 （48.94%）of them received special disease outpatient management.There were significant differences in gender ratio，average age，prevalence of hypertension，distribution of occupation and education level between those with and without special disease outpatient management （P<0.05）．The prevalence of statins use was 28.00%（2 966/10 593）．The prevalence of statins use was higher in those with special disease outpatient management than that of those without （P<0.05）．Compared with those without special disease outpatient management，those receiving such management had much lower average LDL-C and obviously higher rate of control of LDL-C （P<0.05）．Those receiving both statins treatment and special disease outpatient management had much lower average LDL-C and obviously higher rate of control of LDL-C than those only receiving statins treatment （P<0.05）．Multiple linear regression analysis showed that gender 〔β=-0.077，95%CI（-0.122，-0.032）〕，age 〔β=-0.005，95%CI（-0.007，-0.003）〕，BMI 〔β=0.010，95%CI（0.003，0.017）〕，hypertension 〔β=-0.097，95%CI（-0.145，-0.049）〕，occupation 〔β=0.026，95%CI（0.009，0.042）〕，special disease outpatient management 〔β=-0.160，95%CI（-0.209，-0.111）〕，use of statins 〔β=-0.163，95%CI（-0.217，-0.108）〕 independently influenced LDL-C level in T2DM patients（P<0.05）．Conclusion　The prevalence of special disease outpatient management in T2DM patients from CHCs in Chengdu's Wuhou District is not high.And those with special disease outpatient management showed higher rates of statins treatment and reaching the target LDL-C compared with those without.

Key words: Diabetes mellitus, type 2 ；Community health services；Outpatient special disease management；Statin

摘要： 背景　随着分级诊疗制度的落地和门诊特殊疾病管理政策的施行，大量2型糖尿病患者落地到社区卫生服务中心，患者能否通过门诊特殊疾病管理的办理影响其他汀类药物治疗率及低密度脂蛋白胆固醇（LDL-C）达标率仍是尚待回答的问题。目的　评估门诊特殊疾病管理对成都市武侯区社区卫生服务中心2型糖尿病患者他汀类药物治疗率和治疗效果的影响。方法　本研究为回顾性研究，以2017-06-15至2018-06-15成都市武侯区13所社区卫生服务中心家庭医生签约服务平台（EPM）上在管的2型糖尿病患者为研究对象，记录患者的性别、年龄、体质指数（BMI）、是否合并高血压、职业、文化程度、是否纳入门诊特殊疾病管理、是否使用他汀类药物以及LDL-C水平。采用步进法进行多重线性回归分析LDL-C水平的影响因素。结果　共纳入10 593例2型糖尿病患者，其中5 184例（48.94%）患者纳入门诊特殊疾病管理。纳入门诊特殊疾病管理者与未纳入者性别、年龄、合并高血压比例、职业、文化程度比较，差异均有统计学意义（P<0.05）。使用他汀类药物治疗2 966例，他汀类药物治疗率为28.00%。纳入门诊特殊疾病管理者他汀类药物治疗率高于未纳入者，LDL-C水平低于未纳入者，LDL-C控制率高于未纳入者（P<0.05）。纳入门诊特殊疾病管理使用他汀类药物治疗者LDL-C水平低于未纳入门诊特殊疾病管理使用他汀类药物治疗者，LDL-C控制率高于未纳入门诊特殊疾病管理使用他汀类药物治疗者（P<0.05）。多重线性回归分析结果显示，性别〔β=-0.077，95%CI（-0.122，-0.032）〕、年龄〔β=-0.005，95%CI（-0.007，-0.003）〕、BMI〔β=0.010，95%CI（0.003，0.017）〕、合并高血压〔β=-0.097，95%CI（-0.145，-0.049）〕、职业〔β=0.026，95%CI（0.009，0.042）〕、纳入门诊特殊疾病管理〔β=-0.160，95%CI（-0.209，-0.111）〕、使用他汀类药物〔β=-0.163，95%CI（-0.217，-0.108）〕是2型糖尿病患者LDL-C水平的独立影响因素（P<0.05）。结论　成都市武侯区社区卫生服务中心2型糖尿病患者门诊特殊疾病管理办理率不高，但纳入门诊特殊疾病管理的2型糖尿病患者他汀类药物治疗率、LDL-C达标率相较于未纳入者明显提高。

关键词: 糖尿病, 2型；社区卫生服务；门诊特殊疾病管理；他汀类药物