肺结核伴药物性肝损伤患者遵医行为及其影响因素研究
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摘要
背景据统计,抗结核药物所致肝损伤发生率约为11.90%,而20%～82%肺结核患者不按医嘱服药,因此探讨肺结核伴药物性肝损伤患者遵医行为及其影响因素具有重要现实意义。目的分析肺结核伴药物性肝损伤患者的遵医行为及其影响因素。方法选取2013年1月—2015年6月在江苏省某三级传染病专科医院诊断为药物性肝损伤的肺结核患者350例,采用自行设计的肺结核患者遵医行为调查表收集其性别、年龄、婚姻状况、文化程度、医疗费用支付方式、耐多药情况及有无合并症等;通过查询患者取药记录计算药物空白时间比例(CMG值)以判断患者遵医行为;肺结核伴药物性肝损伤患者遵医行为的影响因素分析采用非条件多因素Logistic回归分析。结果共发放调查表350份,回收有效调查表318份,有效回收率为90.8%。318例肺结核伴药物性肝损伤患者中男性占72.6%(231/318),年龄为30～59岁者占58.5%(186/318),已婚者占72.3%(230/318),文化程度为高中者占45.0%(143/318),医疗费用支付方式为社会基本医疗保险者占86.8%(276/318),耐多药者占5.0%(16/318),无合并症者占55.3%(176/318),遵医行为较差者占58.5%(186/318)。非条件多因素Logistic回归分析(逐步法)结果显示,婚姻状况〔OR=6.328,95%CI=(3.598,13.374)〕、合并症〔OR=44.801,95%CI=(15.850,126.636)〕是肺结核伴药物性肝损伤患者遵医行为的影响因素(P<0.05)。结论肺结核伴药物性肝损伤患者遵医行为较差,婚姻状况、合并症是肺结核伴药物性肝损伤患者遵医行为的影响因素。
Background According to the statistics,incidence of liver injury caused by antituberculosis drugs is about 11.90%,while 20%～82% patients with pulmonary tuberculosis take medicines against the doctor's advice,thus it is of great realistic significance to explore the treatment compliance and its influencing factors in pulmonary tuberculosis patients accompanied with drug-induced liver injury. Objective To analyze the treatment compliance and its influencing factors in pulmonary tuberculosis patients accompanied with drug-induced liver injury. Methods From January 2013 to June 2015,a total of 350 pulmonary tuberculosis patients accompanied with drug-induced liver injury were selected in a class 3 hospital for infectious disease in Jiangsu Province,self-made Treatment Compliance Questionnaire for Pulmonary Tuberculosis Patients was used to collect related information,including gender,age,marital status,educational level,payment method of medical expenses,multidrug resistance status and with accompanying diseases or not;continuous multiple-interval medication gaps(CMG value)was calculated through querying the record of getting medicines to estimate the treatment compliance;non-conditional multivariate Logistic regression analysis were used to analyze the influencing factors of treatment compliance in pulmonary tuberculosis patients accompanied with drug-induced liver injury. Results The effective response rate of questionnaire was90.8%(318/350). Of the 318 pulmonary tuberculosis patients accompanied with drug-induced liver injury,men accounted for72.6%(231/318),cases from 30 to 59 years old accounted for 58.5%(186/318),married accounted for 72.3%(230/318),cases with education of senior high school accounted for 45.0%(143/318),cases with social basic medical insurance accounted for 86.8%(276/318),cases with multidrug resistance accounted for 5.0%(16/318),cases without accompanying diseases accounted for 55.3%(176/318),cases with poor treatment compliance accounted for 58.5%(186/318).Nonconditional multivariate Logistic regression analysis(step method) results showed that,marital status〔OR=6.328,95%CI=(3.598,13.374)〕and accompanying diseases〔OR=44.801,95%CI=(15.850,126.636)〕were influencing factors of treatment compliance in pulmonary tuberculosis patients accompanied with drug-induced liver injury(P<0.05). Conclusion Treatment compliance is relatively poor in pulmonary tuberculosis patients accompanied with drug-induced liver injury,moreover marital status and accompanying diseases are influencing factors of treatment compliance in pulmonary tuberculosis patients accompanied with drug-induced liver injury.
Background According to the statistics,incidence of liver injury caused by antituberculosis drugs is about 11.90%,while 20%～82% patients with pulmonary tuberculosis take medicines against the doctor's advice,thus it is of great realistic significance to explore the treatment compliance and its influencing factors in pulmonary tuberculosis patients accompanied with drug-induced liver injury. Objective To analyze the treatment compliance and its influencing factors in pulmonary tuberculosis patients accompanied with drug-induced liver injury. Methods From January 2013 to June 2015,a total of 350 pulmonary tuberculosis patients accompanied with drug-induced liver injury were selected in a class 3 hospital for infectious disease in Jiangsu Province,self-made Treatment Compliance Questionnaire for Pulmonary Tuberculosis Patients was used to collect related information,including gender,age,marital status,educational level,payment method of medical expenses,multidrug resistance status and with accompanying diseases or not;continuous multiple-interval medication gaps(CMG value)was calculated through querying the record of getting medicines to estimate the treatment compliance;non-conditional multivariate Logistic regression analysis were used to analyze the influencing factors of treatment compliance in pulmonary tuberculosis patients accompanied with drug-induced liver injury. Results The effective response rate of questionnaire was90.8%(318/350). Of the 318 pulmonary tuberculosis patients accompanied with drug-induced liver injury,men accounted for72.6%(231/318),cases from 30 to 59 years old accounted for 58.5%(186/318),married accounted for 72.3%(230/318),cases with education of senior high school accounted for 45.0%(143/318),cases with social basic medical insurance accounted for 86.8%(276/318),cases with multidrug resistance accounted for 5.0%(16/318),cases without accompanying diseases accounted for 55.3%(176/318),cases with poor treatment compliance accounted for 58.5%(186/318).Nonconditional multivariate Logistic regression analysis(step method) results showed that,marital status〔OR=6.328,95%CI=(3.598,13.374)〕and accompanying diseases〔OR=44.801,95%CI=(15.850,126.636)〕were influencing factors of treatment compliance in pulmonary tuberculosis patients accompanied with drug-induced liver injury(P<0.05). Conclusion Treatment compliance is relatively poor in pulmonary tuberculosis patients accompanied with drug-induced liver injury,moreover marital status and accompanying diseases are influencing factors of treatment compliance in pulmonary tuberculosis patients accompanied with drug-induced liver injury.
引文
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[6]范海淑.肺结核患者化疗全程管理与护理干预对遵医行为的影响[J].河北联合大学学报(医学版),2012,14(2):250-251.DOI:10.3969/j.issn.1008-6633.2012.02.085.
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[9]SHIOTANI R,HENNINK M.Socio-cultural influences on adherence to tuberculosis treatment in rural India[J].Glob Public Health,2014,9(10):1239-1251.DOI:10.1080/17441692.2014.953562.
[10]侯万里,殷晓旭,杨瑞,等.结核病患者遵医行为影响因素分析[J].中国社会医学杂志,2010,27(6):348-350.DOI:10.3969/j.issn.1673-5625.2010.06.011.
[11]RONDAGS A,HIMAWAN A B,METSEMAKERS J F,et al.Factors influencing non-adherence to tuberculosis treatment in Jepara,central Java,Indonesia[J].Southeast Asian J Trop Med Public Health,2014,45(4):859-868.
[12]KISAMBU J,NUWAHA F,SEKANDI J N.Adherence to treatment and supervision for tuberculosis in a DOTS programme among pastoralists in Uganda[J].Int J Tuberc Lung Dis,2014,18(7):799-803.DOI:10.5588/ijtld.13.0753.
[13]MACINTYRE C R,GOEBEL K,BROWN G V,et al.Arandomised controlled clinical trial of the efficacy of family-based direct observation of anti-tuberculosis treatment in an urban,developed-country setting[J].Int J Tuberc Lung Dis,2003,7(9):848-854.
[14]FERNáNDEZVILLAR A,SOPENA B,FERNáNDEZVILLARJ,等.抗结核药物肝毒性反应的危险因素及其影响[J].结核与肺部疾病杂志,2005,8(1):28-34.DOI:10.3969/j.issn.1006-6942.2005.01.005.
[2]BORGDORFF M W,FLOYD K,BROEKMANS J F.Interventions to reduce tuberculosis mortality and transmission in low-and middleincome countries[J].Bull World Health Organ,2002,80(3):217-227.
[3]王陇德.中国结核病控制现状及展望[J].中华结核和呼吸杂志,2006,29(8):505-506.DOI:10.3760/j:issn:1001-0939.2006.08.001.
[4]王盖锵.护理社会学[M].北京:中国科学技术出版社,1993.
[5]张丞,杨卿卿.初治结核患者出院后服药依从性及其影响因素的研究[J].临床肺科杂志,2015,20(12):2166-2168.DOI:10.3969/j.issn.1009-6663.2015.012.010.
[6]范海淑.肺结核患者化疗全程管理与护理干预对遵医行为的影响[J].河北联合大学学报(医学版),2012,14(2):250-251.DOI:10.3969/j.issn.1008-6633.2012.02.085.
[7]FOX G J,LOAN L E P,NHUNG N V,et al.Barriers to adherence with tuberculosis contact investigation in six provinces of Vietnam:a nested case-control study[J].BMC Infect Dis,2015,15:103.DOI:10.1186/s12879-015-0816-0.
[8]中华人民共和国卫生部.肺结核诊断标准(WS 288-2008)[EB/OL].(2008-1-16)[2018-10-26].http://tb.chinacdc.cn/zcfg/dfzcfg/201208/t20120814_66809.htm.
[9]SHIOTANI R,HENNINK M.Socio-cultural influences on adherence to tuberculosis treatment in rural India[J].Glob Public Health,2014,9(10):1239-1251.DOI:10.1080/17441692.2014.953562.
[10]侯万里,殷晓旭,杨瑞,等.结核病患者遵医行为影响因素分析[J].中国社会医学杂志,2010,27(6):348-350.DOI:10.3969/j.issn.1673-5625.2010.06.011.
[11]RONDAGS A,HIMAWAN A B,METSEMAKERS J F,et al.Factors influencing non-adherence to tuberculosis treatment in Jepara,central Java,Indonesia[J].Southeast Asian J Trop Med Public Health,2014,45(4):859-868.
[12]KISAMBU J,NUWAHA F,SEKANDI J N.Adherence to treatment and supervision for tuberculosis in a DOTS programme among pastoralists in Uganda[J].Int J Tuberc Lung Dis,2014,18(7):799-803.DOI:10.5588/ijtld.13.0753.
[13]MACINTYRE C R,GOEBEL K,BROWN G V,et al.Arandomised controlled clinical trial of the efficacy of family-based direct observation of anti-tuberculosis treatment in an urban,developed-country setting[J].Int J Tuberc Lung Dis,2003,7(9):848-854.
[14]FERNáNDEZVILLAR A,SOPENA B,FERNáNDEZVILLARJ,等.抗结核药物肝毒性反应的危险因素及其影响[J].结核与肺部疾病杂志,2005,8(1):28-34.DOI:10.3969/j.issn.1006-6942.2005.01.005.