120例初治耐多药肺结核患者治疗依从性的影响因素分析

目的 分析初治耐多药肺结核(MDR-PTB)患者治疗依从性的影响因素,为探索制定MDR-PTB患者诊疗、管理政策和措施提供依据。方法 采用整群抽样方法,收集2015年10月至2017年3月在河南省传染病医院确诊并接受治疗,且完成24个月追踪随访的120例初治MDR-PTB患者的病历和随访记录资料。由经培训的调查员对研究对象结核病防治核心信息认知水平进行问卷调查,发出问卷120份,收回有效问卷120份,有效率100.00%。对120例患者的治疗依从性及其影响因素进行非条件二分类logistic回归分析。结果 120例初治MDR-PTB患者中治疗依从性较好者85例,依从性较差者35例。logistic多因素回归分析显示:家庭经济状况差 Wald χ ²=5.483;P=0.019;OR(95%CI)=6.27(2.51~13.92)]、发生药物不良反应Wald χ ²=7.038;P=0.008;OR(95%CI)=4.73(1.95~10.17)]、对结核病防治核心信息的认知水平差Wald χ ²=4.621;P=0.032;OR(95%CI)=2.07(1.03~5.65)]及服药方式为自服药Wald χ ²=5.925;P=0.010;OR(95%CI)=2.45(1.92~7.01)]是导致治疗依从性差的主要危险因素。结论 家庭经济状况差、药物不良反应、自服药及对结核病防治核心信息的认知水平差是导致MDR-PTB患者治疗依从性差的主要危险因素,在探索制定MDR-PTB患者诊疗、管理政策和措施方面可供参考。

Analysis of influencing factors of medication adherence among 120 newly diagnosed patients with multi-drug resistant pulmonary tuberculosis

Objective To analyze the influencing factors of medication adherence among patients with multidrug-resistant pulmonary tuberculosis (MDR-PTB) and to provide a basis for exploring and formulating diagnosis and treatment, management policies and measures for patients with MDR-PTB. Methods The cluster sampling method was used to collect the medical records and follow-up records of 120 newly diagnosed MDR-PTB patients who were diagnosed and treated and completed 24 months of follow-up at Henan Infectious Diseases Hospital during October 2015 to March 2017. A questionnaire survey on core knowledge of tuberculosis prevention was conducted by trained questionnaire surveyors to 120 newly diagnosed MDR-PTB patients, the valid withdrawal of the questionnaire was 120 with the withdrawal rate of 100.00%.The treatment compliance and its influencing factors were analyzed by unconditional dichotomous logistic regression analysis of univariate and multivariate. Results Among the 120 cases of newly diagnosed MDR-PTB, 85 cases had good medication adherence and 35 cases had medication adherence. Multivariate regression analysis showed that: poor family economic status (Wald χ ²=5.483, P=0.019, OR=6.27, 95%CI=2.51-13.92), adverse drug reactions (Wald χ ²=7.038, P=0.008,OR=4.73, 95%CI=1.95-10.17), poor awareness of core knowledge on tuberculosis prevention (Wald χ ²=4.621, P=0.032, OR=2.07, 95%CI=1.03-5.65) and self-medication (Wald χ ²=5.925, P=0.010, OR=2.45, 95%CI=1.92-7.01) were the main risk factors for treatment compliance. Conclusion Poor family economic status, adverse drug reactions, self-medication and poor awareness of core knowledge on tuberculosis prevention were the main risk factors for medication adherence, which can be used for reference in exploring and formulating MDR-PTB patients diagnosis and treatment, management policies and measures.