卢雪芬　符鸿俊　应丽娜

[摘要] 目的 探讨康复干预对糖尿病伴抑郁症患者的抑郁症状和糖脂代谢的影响。 方法 选取92例糖尿病伴抑郁症患者，随机分为康复组和对照组。两组均予以饮食调整、适当运动及药物降血糖等基础治疗。对照组常规干预。康复组在对照组基础上予以综合性康复干预，两组均干预12周。评估两组干预前后糖脂代谢指标变化，并评估其抗抑郁疗效。 结果 干预12周后，两组FBG、2hPG和HbA1C较前均不同幅度下降（P<0.05或P<0.01），且康复组下降幅度更明显（P<0.05）；两组TC、TG和LDL-C水平均较前不同幅度下降，HDL-C水平较前不同幅度上升（P<0.05或P<0.01）。且康复组下降或上升幅度更显著（P<0.05）；同时康复组抗抑郁临床总有效率较对照组更佳（χ2=5.06，P<0.05）。 结论 康复干预用于糖尿病伴抑郁症患者的效果确切，可改善抑郁症状及糖脂代谢指标，有利于血糖及血脂的达标，改善其预后。

[关键词] 糖尿病；抑郁；康复干预；糖脂代谢

[中图分类号] R587.1 [文献标识码] B [文章编号] 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

糖尿病是一种常见的慢性心身性疾病，与患者的情绪障碍关系密切，其中抑郁症状较常见，发生率约30%～45%[1，2]。而糖尿病伴抑郁可使患者长期处于应激状态，下丘脑-垂体-靶腺轴功能紊乱，导致升糖激素水平明显上升及胰岛细胞分泌量下降，引起血糖升高，加重其病情，影响其预后[3-5]。对糖尿病伴抑郁症患者的干预以往多采用健康教育、心理安慰及用药干预等常规手段，虽有一定效果，但疗效欠理想[6，7]。康复干预是在心理干预基础上建立起的一種综合性康复干预模式，逐渐应用于糖尿病伴抑郁症的干预治疗中，疗效较好[8，9]。本研究观察了康复干预对糖尿病伴抑郁症患者抑郁症状和糖脂代谢的影响，现报道如下。

1 对象与方法

1.1 研究对象

选取糖尿病伴抑郁症患者92例，均为2016年4月～2017年2月我院内科门诊就诊患者。纳入标准：（1）均符合《中国2型糖尿病防治指南》的诊断标准[10]；……