肝移植受者服药依从性现状及其影响因素分析

目的:对肝移植受者服药依从性现状及其影响因素进行观察。方法:组建专人调查小组采用Mofisky-Green测评表对37例接受肝移植手术的患者进行随访调查,并对调查结果与可能的影响因素进行统计分析。结果:37例患者中,依从性不佳者29例(78.38%),依从性良好者8例(21.62%);在肝移植受者服药依从性具有差异性的影响因素中,年龄、文化程度、职业、居住地、术后服药时间、服药次数、对药物了解程度、是否定期复诊为保护因素(OR1),是否担心不良反应为危险因素(OR1)。结论:肝移植受者服药依从性现状不容乐观,应着重开展对肝移植患者关于疾病、药物、不良反应及其应对方法的教育工作,提高受者的自我护理意识,进而达到改善其服药依从性现状的目的。     

Use of Antireflux Medication After Antireflux Surgery

Introduction It is claimed that a substantial number of patients who undergo antireflux surgery use antireflux medication postoperatively. This study was aimed to determine the prevalence and underlying reasons for antireflux medication usage in patients after surgery. Materials and Methods A questionnaire on the usage of antireflux medication was sent to 1,008 patients identified from a prospective database of patients who had undergone a laparoscopic antireflux procedure. Results A total of 844 patients (84%) returned the questionnaire. Mean follow-up was 5.9 years after surgery. A single or combination of medications was being taken by 312 patients (37%): 82% proton pump inhibitors, 9% H₂-blockers and 34% antacids. Fifty-two patients (17%) had never stopped taking medication, whereas 260 patients (83%) restarted medication at a mean of 2.5 years after surgery. Return of the same (31%) or different (49%) symptoms were the commonest reasons for taking medication, whereas 20% were asymptomatic or had other reasons for medication use. Postoperative 24-hour pH studies were abnormal in 16/61 patients (26%) on medication and in 5/78 patients (6%) not taking medication. Conclusions Antireflux medication is frequently taken by many patients for various symptoms after antireflux surgery. Symptomatic patients should be properly investigated before antireflux medications are prescribed.     

影响肾移植术后患者服药依从性的因素调查及护理干预研究

目的调查影响肾移植术后服用免疫抑制剂患者服药依从性的因素,制定针对性的护理干预措施并评定其效果。方法采取向患者和护士分别进行问卷调查的方法找出影响服药依从性的因素,提出针对性的护理干预方法。收集2017年全年肾移植患者100例,分成干预组和对照组。干预组共分为接受单一措施组及接受所有措施组4组。使用修订Morisky服药依从性调查问卷评价干预效果,结果分为依从性好与不好两种。使用卡方检验分析组间差异。结果主要影响服药依从性的因素为:①缺乏按嘱服药的重要性的知识。②服药管理问题。③对患者的出院后的管理不足。经过干预,干预组的合格率为84%,高于对照组的60%(P<0.05)。综合干预组的合格率91.3%,明显高于对照组(P<0.05)。其他各组的两两比较未显示出有统计意义的差异。结论本研究发现了影响肾移植术后服用免疫抑制剂患者服药依从性的几项重要因素。针对性的干预措施能改善服药依从性,综合性的干预措施相对单一干预措施有更为为明确的效果。     

Prevalence and Risk Factors of Non-Adherence with Immunosuppressive Medication in Kidney Transplant Patients

Non-adherence with immunosuppressive regimen is a major risk factor for poor outcome after kidney transplantation. Identifying patients at risk for non-adherence requires understanding the risk factors for non-adherence. This prospective study included a convenience sample of 249 adult kidney transplant patients >1 year post-transplant. Non-adherence was monitored electronically using MEMS(R). Selected socio-economic, therapy-, patient-, condition- and healthcare team-related risk factors for non-adherence were assessed. Period prevalences were expressed as the percent of prescribed doses taken (taking adherence), the percent of correctly dosed days (dosing adherence), the percentage of inter-dose intervals not exceeding 25% of the prescribed interval (timing adherence), and the number of drug holidays per 100 days (no intake for > 48 h if once daily or for > 24 h if twice daily intake). Testing occurred by simple mixed logistic regression analysis. Factors significant after correction for multiple testing were entered into a multiple logistic regression model. Mean taking, dosing, timing adherence, and drug holidays were 98%, 96%, 93%, and 1.1 days, respectively. Non-adherence was associated with lower self-efficacy, higher self-reported non-adherence, no pillbox usage, and male gender. Adherence declined between Monday and Sunday. This study provides a framework for identifying patients at risk for non-adherence and for developing adherence-enhancing interventions.     

Self-Reported Medication Use and Urinary Drug Metabolites in the German Chronic Kidney Disease (GCKD) Study

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肾移植受者应对方式对服药依从性及自我管理的影响

目的探讨肾移植受者疾病应对方式、服药依从性及其自我管理的特点,并分析应对方式对服药依从性和自我管理依从性的影响。 方法采用便利抽样选取2019年3月至5月广州医科大学附属第三医院器官移植随访门诊就诊的肾移植受者作为研究对象。采用一般情况调查表、医学应对问卷、免疫抑制剂依从性Basel评估量表(BAASIS)及肾移植受者自我管理调查量表作为调查工具。所有问卷调查均在肾移植受者门诊随访时进行。采用成组t检验比较肾移植组和慢病常模组面对、回避和屈服因子得分。应用分层回归方程分析肾移植受者应对方式对服药依从性和自我管理的影响。P<0.05为差异有统计学意义。 结果肾移植受者面对因子得分[(19.8±2.9)分]最高。肾移植组和慢病常模组回避因子得分分别为(15.1±2.7)和(14.4±3.0)分,差异有统计学意义(t＝-2.320,P<0.05)。肾移植受者BAASIS得分平均为(22.2±2.6)分,125例受者中53例(42.4%)受者服药依从性好。36例(28.8%)曾在过去1个月中至少漏服1次免疫抑制剂;19例(15.2%)在过去1个月中曾出现至少1次连续漏服状况;63例(50.4%)曾在过去1个月中提前或推迟2 h服药;9例(7.2%)曾不按医嘱剂量服药。肾移植受者自我管理总得分为(91±8)分,其中68例(54.4%)自我管理水平良好,57例(45.6%)自我管理处于中等水平。受者饮食、治疗、躯体活动和社会心理管理得分分别为(29.5±3.0)、(33.4±3.4)、(15.7±2.1)和(12.4±1.6)分。面对、回避和屈服3个变量分别解释服药依从性总变异的8.6%,治疗管理总变异的13.7%,躯体活动管理总变异的7.0%,社会心理管理总变异的25.0%,整体自我管理总变异的15.0%。服药依从性的预测因子为屈服(β＝-0.252,P<0.01),饮食管理的预测因子为面对(β＝0.212,P<0.05),治疗管理的预测因子为面对(β＝0.348,P<0.01),躯体活动管理的预测因子为面对(β＝0.255,P<0.01),社会心理管理的预测因子为面对和屈服(β＝0.394和-0.271,P均<0.01),整体自我管理的预测因子为面对(β＝0.365,P<0.01)。 结论肾移植受者应对方式是服药依从性和自我管理的重要影响因素,应重视其对待疾病的态度和方式,及时转换其消极的应对策略,以提高其服药依从性和自我管理水平。     

普伐他汀对慢性肾脏病患者肾功能及尿蛋白作用的临床研究

目的：研究普伐他汀对慢性肾脏病患者（CKD）肾功能及尿蛋白的影响,探讨其在 CKD 患者中应用的价值。方法：符合入选标准的48例临床诊断 CKD 的患者,在给与 CKD 常规治疗的基础上随机分组为普伐他汀组（n =25）和对照组（n =23）。普伐他汀组加用普伐他汀20 mg 每晚,维持治疗48周。于治疗前、治疗后4周、12周、24周、36周及48周监测患者血肌酐、血脂、尿蛋白等情况,评估肾小球滤过率。结果：普伐他汀组与对照组在年龄、性别、蛋白尿、肾功能等基线水平的差异无统计学意义。治疗后,普伐他汀组血胆固醇、三酰甘油、低密度脂蛋白均较对照组有所下降,36周后组间达到统计学差异（P ﹤0．05）。普伐他汀组24 h 尿蛋白在治疗8周后与对照组差异存在统计学意义（P ﹤0．05）,48周后普伐他汀组尿蛋白较对照组下降52．3%。两组高敏 C 反应蛋白均呈下降趋势,普伐他汀组更为显著。两组估算肾小球率过滤（eGFR）的改变差异无统计学意义。结论：普伐他汀可能可有效改善 CKD 患者的血脂情况,减少蛋白尿,抑制炎症反应,延缓 CKD 进展。     

Diabetic Severity and Risk of Kidney Stone Disease

Background

The prevalence of kidney stone disease is rising along with increasing rates of obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome.

Objective

To investigate the associations among the presence and severity of T2DM, glycemic control, and insulin resistance with kidney stone disease.

Design, setting, and participants

We performed a cross-sectional analysis of all adult participants in the 2007–2010 National Health and Nutrition Examination Survey (NHANES). A history of kidney stone disease was obtained by self-report. T2DM was defined by self-reported history, T2DM-related medication usage, and reported diabetic comorbidity. Insulin resistance was estimated using fasting plasma insulin (FPI) levels and the homeostasis model assessment of insulin resistance (HOMA-IR) definition. We classified glycemic control using glycosylated hemoglobin A₁c (HbA₁c) and fasting plasma-glucose levels (FPG).

Outcome measurements and statistical analysis

Odds ratios (OR) for having kidney stone disease were calculated for each individual measure of T2DM severity. Logistic regression models were fitted adjusting for age, sex, race/ethnicity, smoking history, and the Quételet index (body mass index), as well as laboratory values and components of metabolic syndrome.

Results and limitations

Correlates of kidney stone disease included a self-reported history of T2DM (OR: 2.44; 95% confidence interval [CI], 1.84–3.25) and history of insulin use (OR: 3.31; 95% CI, 2.02–5.45). Persons with FPG levels 100–126 mg/dl and >126 mg/dl had increased odds of having kidney stone disease (OR 1.28; 95% CI, 0.95–1.72; and OR 2.29; 95% CI, 1.68–3.12, respectively). Corresponding results for persons with HbA₁c 5.7–6.4% and ≥6.5% were OR 1.68 (95% CI, 1.17–2.42) and OR 2.82 (95% CI, 1.98–4.02), respectively. When adjusting for patient factors, a history of T2DM, the use of insulin, FPI, and HbA₁c remained significantly associated with kidney stone disease. The cross-sectional design limits causal inference.

Conclusions

Among persons with T2DM, more-severe disease is associated with a heightened risk of kidney stones.