慢性HBV感染者长期随访队列患者依从性现状及其影响因素

目的 探讨在长期随访队列中慢性HBV感染者的随访依从性现状及其影响因素.方法 前瞻性研究2328例门诊随访的慢性HBV感染者的依从性,每位患者均被要求至少6个月门诊复诊,能达到要求者定义为依从性好,反之为依从性差.收集每位患者入随访时的基本信息(性别、年龄、地址、酗酒史、家族史、是否因肝病住院)及随访过程中的治疗及应答情况,分析影响患者随访依从性的相关因素.结果 随访队列患者的平均随访时间为3.0年.两组在人口学及病史资料方面,性别、居住地、嗜酒史、乙肝家族史、因肝病住院史无差异,但依从性好的组的年龄及有肝癌家族史的比例高于依从性差的组.在基线水平上,入随访肝硬化或肝癌、丙氨酸氨基转移酶(ALT)、天门氨酸氨基转移酶(AST)、血清白蛋白(Alb)、HBeAg阳性率方面有显著差异,而血清总胆红素(TB)、HBV DNA水平无显著差异.在治疗效果及病情进展方面,ALT、AST、Alb、HBV DNA、ALT复常率、DNA转阴率、HBeAg转换率、有无抗病毒以及是否出现耐药方面有显著差异,而表面抗原转阴、新发肝癌、疾病进展、TB、HBeAg阳性率等方面无显著差异.多因素分析提示肝癌家族史、基线DNA水平、HBeAg水平、末次ALT、末次DNA水平以及有无抗病毒为慢性HBV感染者依从性好坏的独立危险因素.结论 有肝癌家族史、基线更高的HBV DNA水平、HBeAg阳性、末次更高的ALT、HBV DNA水平以及无抗病毒治疗是慢性HBV感染者长期随访依从性差的独立危险因素.

The compliance and its affecting factors with treatment guideline recommendations of chronic HBV infection: A long-term follow-up cohort study.

Objective To comprehensively evaluate the compliance and its affecting factors with treatment guide -line recommendations of chronic HBV infection .Methods A prospective analysis was conducted on 2328 outpatients with chronic HBV infection .The personal data of each patient were collected in detail .Each patient was required to return visit every six months as the guideline recommends .Those who could achieve the target were defined as good compliance , and those who couldn′t as poor compliance .Logistic regression analysis was used to screen the risk factors of poor compliance . Results The average follow-up duration was 3.0 years.The demographic characteristics (gender, address, family his-tory of HBV infection, et al.), baseline data (TB, HBV DNA), progression during the therapy and last time data (HB-sAg lost, progression to HCC, TB, HBeAg, et al.) were compared between the 2 groups.The age, family history of HCC, worse baseline data (high level of ALT, AST, HBeAg positive, et al.), better outcome of therapy (low level of ALT, AST, HBV DNA) and have NA ( s) therapy resulted in better compliance .And patients with good compliance showed higher level of ALT normality, complete viral response (CVR), HBeAg seroconversion and viral breakthrough . Multivariate logistic regression analysis showed family history of HCC , baseline HBV DNA level , baseline HBeAg stage , last time ALT level, last time HBV DNA level, and NA(s) therapy were independent risk factors for compliance of chron-ic HBV infection.Conclusion Patients with family history of HCC, high level of baseline HBV DNA, baseline HBeAg positive, high level of last time ALT and HBV DNA and without NA (s) therapy are more likely to have poor compliance to chronic hepatitis B treatment guideline recommendations .