Abstract: Background　Combined hyperlipidemia is the most common type of abnormal lipoprotein metabolism or transport in the general population with dyslipidemia in China.A series of clinical studies at home and abroad have confirmed that mixed hyperlipidemia is an important cause of atherosclerotic cardiovascular disease（ASCVD），such as coronary heart disease，stroke and peripheral vascular disease.To prevent and control chronic disease at primary care level，it is essential for community general practitioners（GPs） to conduct comprehensive interventions including lifestyle intervention and medication selection according to related guidelines.Objective　To explore the effects of community-based interventions in mixed hyperlipidemia.Methods　329 eligible patients with mixed hyperlipidemia were recruited from Fangshan Community Health Center during March 2014 to September 2018，including healthcare seekers and physical examinees，as well as downward referrals from specialty hospitals.They were divided into low-to-medium risk group（n=204），high risk group（n=93） and extremely high risk group（n=32） by the baseline plasma lipid level according to the criteria defined in Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults（2016 Revision）.All participants received multiple comprehensive interventions from community GPs，such as diet regulation，appropriate exercise，drug treatment，health education and so on.The patients were followed up for 12 months to observe the improvement of adherence to treatment，plasma lipid indices（TC，LDL-C，HDL-C，and TG） and BMI.Results　The adherence to treatment in all participants after intervention was better than before（Z=256.206，P<0.05）.The mean levels of post-intervention TC，LDL-C and TG were all lower than the baseline levels（P<0.05）.However，there was no significant difference between mean pre-and post-intervention HDL-C levels（P>0.05）.The mean BMI in extremely high risk，high risk and low-to-medium risk groups after intervention improved significantly after intervention（Z=30.019，230.882 and 184.877，respectively，P<0.01）.Conclusion　Through comprehensive interventions，such as community health education，scientific lifestyle intervention and rational selection of lipid-lowering drug treatment，the adherence to treatment，plasma lipid indices and BMI in people with mixed hyperlipidemia were effectively improved.The interventions are worthy of community promotion.

Key words: Hyperlipidemias, Mixed hyperlipidemia, Community health services, Intervention studies, Treatment outcome

摘要： 背景　混合性高脂血症是我国血脂异常人群中最常见的脂蛋白代谢或运转异常类型。国内外一系列临床研究证实，混合型高脂血症是动脉粥样硬化性心血管疾病（ASCVD）包括冠心病、脑卒中和外周血管疾病发病的重要原因。作为慢性病防控的基层关卡，社区全科医生有必要对各种来源的社区相关人群进行包括生活方式在内的综合干预和按有关指南进行选择性用药治疗。目的　探讨混合性高脂血症的社区干预措施及治疗结果。方法　选取2014年3月—2018年9月在方山社区卫生服务中心通过社区接诊、健康体检及承接上级专科医院下转的符合研究标准的329例混合性高脂血症患者。按照《中国成人血脂异常防治指南（2016年修订版）》将患者分为极高危（n=32）、高危（n=93）和中低危（n=204）。入组后由社区医生为其提供多方面的综合干预，如饮食调节、适量运动、药物治疗、健康宣教等。随访时间为12个月，观察患者干预前后依从性、血脂指标〔总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、三酰甘油（TG）〕、体质指数（BMI）改善情况。结果　329例患者干预后依从性优于干预前（Z=256.206，P<0.05）。患者干预后TC、LDL-C、TG低于干预前（P<0.05）；患者干预前后HDL-C比较，差异无统计学意义（P>0.05）。极高危、高危、中低危患者干预后BMI改善情况均优于干预前（Z值分别为30.019、230.882、184.877，P<0.01）。结论　混合性高脂血症通过社区健康教育、制定科学的生活方式干预、合理选用降脂药物治疗，治疗依从性得到有效提高，血脂指标及BMI均有改善，值得社区推广。

关键词: 高脂血症, 混合性高脂血症, 社区卫生服务, 干预性研究, 治疗结果