用cox模型对美沙酮维持治疗患者保持情况及影响因素的多因素生存分析

目的分析广东省接受美沙酮维持治疗的患者接受治疗后的保持状况,探讨影响患者治疗保持时间的因素。方法采用系统抽样的方法抽取3个城市治疗点和3个农村地区治疗点,利用国家统一的美沙酮维持治疗信息收集系统所收集的美沙酮维持治疗患者数据资料,包括社会人口学情况、尿检、治疗及随访情况等,采用cox比例风险模型对21个自变量进行单因素分析,对单因素分析有统计学意义的自变量进行多因素分析确定影响接受美沙酮维持治疗的患者维持时间的因素。结果共有2 777名接受美沙酮维持治疗的患者纳入分析,其中男性2 490人,女性287人,2 777名患者平均维持治疗时间为27.8个月（95%CI：24.6～31.0）,累计保持率为54.3%。经cox多因素分析影响治疗保留时间的因素包括：女性性别（RR=0.868）、生活来源（RR=0.178～0.304）、近1个月没有与以前吸毒同伴来往（RR=0.802）等变量是美沙酮维持治疗保持时间的保护因素;而20岁以下（RR=1.591）、21～30岁（RR=1.269）、与家人关系较差（RR=2.257）、治疗前每天吸毒3次以下（RR=1.300）、认为治疗时间不合适（RR=1.379）、每天治疗剂量少于30 mL（RR=1.646）、每天治疗剂量在31～50 mL（RR=1.498）、曾经脱失（RR=1.120）等变量是美沙酮维持治疗保持时间的危险因素（均P〈0.01或P〈0.05）。结论广东省美沙酮维持治疗患者保持率较低,为了提高病人的维持治疗时间,减少脱失,应该综合改进门诊服务质量和治疗水平,应加强家庭和社会的参与和对患者的支持。

Multivariate survival analysis on factors associated with retention in community-based methadone maintenance treatment among drug users with a cox model

Objective To explore the factors associated with retention in community-based methadone maintenance treatment（MMT） among drug users in Guangdong Province,to define the factors associated with duration of retention.Methods Six MMT clinics in rural and urban area were selected by systematic sampling.The data including social demology,testing,treatment and follow-up of the 6 MMT clinics were obtained from the national AIDS information system.Cox regression analysis was employed to define the factors associated with duration of retention,and 21 independent variables were enrolled in mono-analysis,among which 16 significant variables were analyzed by multiple analysis.Results A total of 2 777 patients were analyzed.Of them,2 490（89.7%）are men.The average retention duration is 27.8 months（95%CI：24.6-31.0）,the cumulative retention rate is 54.3%.Multiple cox analysis shows that female（RR=0.868）,living on support from family or friends（RR=0.178）,living on permanent income（RR=0.304）,live on casual income（RR=0.220）,live on social welfare（RR=0.250）,not communicating with former drug user peer（RR=0.802）are protected factors for retention duration;whereas,age younger than 20 years（RR=1.591）,21-30 years（RR=1.269）,not keeping good relationship with family（RR=2.257）,using drug less than 3 times before enrolling in MMT（RR=1.300）,regarding MMT clinic operation time inconvenient（RR=1.379）,daily treatment dose less than 30 mL（RR=1.646）,daily treatment dose between 31-50 mL（RR=1.498）and history of drop off（RR=1.120） are risking factors for MMT retention durance（P 0.01 or P 0.05）.Conclusion MMT retention rate in Guangdong is low.For enhancing retention duration and decreasing withdrawal,treatment skills and quality should be improved,meanwhile,participation of family and society should be encouraged.