农村地区新涂阳肺结核患者采用家庭成员短程督导化疗依从性的研究

目的探讨家庭成员短程督导化疗对提高新涂阳肺结核患者治疗依从性的效果。方法采用流行病学实验性研究方法, 家庭成员督导组（Ⅰ组）为实验组，村医督导组（Ⅱ组）为对照组。2006年6月—2007年4月,湖北省汉川市、宜都市、咸丰县、秭归县和建始县等5个县（市）登记的新涂阳肺结核病人为研究对象，用SAS软件随机分成2组，分别在家庭督导员或村医督导下实施短程督导化疗, 比较2组治疗依从性和治疗效果；采用EpiData V3.02软件录入数据,EpiData Analysis V2.0.3.129软件汇总分析，SAS 8.0 软件进行χ²分析。 结果5县（市）共登记新涂阳肺结核病人532例,其中Ⅰ组270例, Ⅱ组262例; Ⅰ组2、5、6个月末随访查痰率分别为95.9%,93.0%和92.6%, 村医督导组为95.8%,89.7%和88.9%。Ⅰ组6个月末随访查痰率明显高于Ⅱ组（χ²=6.9350,P<0.05）。Ⅰ组应服药24300次，实际用药23126次,规则服药率为95.2%。Ⅱ组应服药23580次,实际服药22045次,规则服药率为93.5%。Ⅰ组规则服药率明显高于Ⅱ组（χ²=63.1636,P<0.01）；Ⅰ组2个月末痰菌阴转率、治愈率分别为95.6%和92.6%。Ⅱ组2个月末痰菌阴转率、治愈率分别为95.4%和88.9%。2组2个月末痰菌阴转率和治愈率差异无统计学意义。结论在推广全程督导化疗有困难的边远山区和贫困农村，鼓励具有一定文化程度，经过培训的结核病患者家庭成员或志愿者担任家庭督导员，监督病人按时服药及复查，可以弥补医务人员督导治疗在部分农村地区应用的不足，从而提高患者治疗依从性和DOTS实施质量。

Study on compliance of new smear positive pulmonary tuberculosis patients in rural area with directly observed treatment conducted by family member

Objective To explore the effect to improve treatment compliance of new smear positive （NSP） tuberculosis patients with directly observed treatment by family member. Methods The epidemiological, experimental study was utilized. From June 2006 to April 2007, NSP cases registered in Hanchuan, Yidu, Xianfeng, Zigui and Jianshi counties were randomly allo cared to two groups using SAS software. Experimental group （Group 1） received Directly Observed Treatment Short-term （DOTS） conducted by family member and control group （Group2） by village doctor. The treatment compliance and cure rate between 2 groups were evaluated. EpiData V3.02 software, EpiData Analysis V2.0.3. 129 software and SAS 8. 0 software were adopted for data entry, analyzing and ;Х^2 analysis. Results Of tota1532 TB cases registered in five counties, 270 were allocated in group 1 and 262 in group 2. The sputum examination rate after 2, 5,6 months＇ treat allocated in group 1 and 262 in group 2. The sputum examination rate after 2, 5,6 mont ment were 95.9%, 93.0% and 92.6% respectively in group 1, and 95.8%0, 89.7% and group 2. There was significant difference between 2 groups on sputum examination ra months＇ treatment （Х^2=6. 935 0,P〈0.05）; 24 300 does should be taken and 23 126 were taken actually in group 1. 23 580 does should be taken and 22 045 were taken actually in group 2. The drug taking compliance rate in group 1 （95.2%） was significantly higher than that in group 2 （93.5%, Х^2 =63. 163 6, P〈0.01）. The sputum conversion rate after 2 months treatment and cure rate were 95.60/00 and 92.6% in groups 1 and 95.4%, 88.90% in group 2. There was no significant differenee between 2 groups on sputum conversion rate and cure rate. Conclusions It is possible to increase treatment compliance of new smear-positive TB patients and DOTS implement quality by eneouraging educated, trained and responsible family member or volunteer as family supervisor in rural are as.