我国首批1057名社区美沙酮维持治疗病人5年治疗保持率随访研究

Five-year cohort study of the retention rate and its impact factors for 1 057 patients receiving methadone maintenance treatment at the first 8 community-based clinics in China

目的对我国首批8个社区美沙酮维持治疗(MMT)门诊的五年治疗情况,以及保持治疗的影响因素进行分析。方法应用队列研究方法 ,对2004-2009年间符合条件的病人开展为期5年的随访,采用乘积极限法计算不同随访时间的治疗保持率,采用Cox比例风险回归模型,对可能影响治疗时间的人口学特征、治疗剂量、吸毒方式等因素进行分析预测。结果共有1057名病人作为研究对象参加了为期5年的随访,其中初中及以下文化程度840人(79.5%),无业或待业821人(77.7%)。病人开始治疗时平均年龄为(32.3±5.5)岁,吸毒时间为(8.0±3.5)年,采用注射吸毒方式827人(78.2%)。病人5年的中位治疗时间为45.7个月,治疗1年、2年、3年、4年及5年以上的比例分别为73.1%、62.0%、56.4%、48.9%及36.4%。低、中、高三个维持治疗剂量组5年中位治疗保持率,分别为36.6%、47.4%和54.3%(χ2=9.67,P=0.008)。不同门诊间5年治疗保持率中位数差别很大,最高的门诊为60.2%,最低的门诊仅为12.9%(χ2=79.2,P<0.001)。Cox比例风险回归结果显示,高治疗剂量能减少病人治疗期间的脱失风险(HR=0.832,P=0.002),治疗前注射吸毒(HR=1.42,P<0.0001)和共用注射器(HR=1.23,P=0.009)会增加脱失的风险。结论我国首批8个MMT门诊维持治疗病人,5年治疗保持率高于其他国家,但不同门诊间、不同剂量组间差异较大。高治疗剂量(>60mg/d)能降低病人退出治疗的风险;但治疗前注射吸毒及共用注射器行为会增加病人退出治疗的风险。应针对有既往注射吸毒及共用注射器的病人开展重点干预及心理咨询。

Objective To evaluate the retention rate and its impact factors among the drug users who received methadone maintenance treatment （MMT） at the first eight community based clinics in China from 2004 to 2009. Methods A five-year cohort study was conducted among 1057 respondents to assess the retention rates at different periods of MMT. Product-limit method was used to analyze the retention rate at the different periods of MMT and Cox hazard regression model was used to evaluate factors associated with the retention,e.g. demographics,dosage and the routes of drug abuse,etc. Results Of the 1 057 patients 840（79.5%）had junior middle schooling or below and 821（77.7%） were unemployed; the average age of patients entering MMT clinics was 32.3±5.5 years,and the length of their drug abuse was 8.0±3.5 years; 827（78.2%）patients were injecting drug users （IDUs）. The median length of MMT within the 5 years was 45.7 months.The average retention rate for 1,2,3,4 and 5 years of MMT were 73.1%、62.0%、56.4%,48.9% and 36.4%,respectively. The median retention rates among patients treated at low,moderate and high doses of methadone within the 5 years were 36.6%、47.4% and 54.3%（χ2=9.67,P=0.008）,respectively. The median 5-year retention rates in the 8 MMT clinics varied significantly. One clinic recorded the highest retention rate of 60.2%,while the other had the lowest retention rate of 12.9%（χ2=79.2,P0.001）. The results of Cox model indicated that higher dosage reduced the risk to drop-off during MMT （HR=0.832,P=0.002）,and that injecting drugs （HR=1.42,P0.0001） and sharing needles （HR=1.23,P=0.009） before entering MMT clinics might increase the risk to drop-off. Conclusions The five-year retention rate of the 1057 patients in the first eight community based MMT clinics in China is higher than that in other countries. And the retention rates vary significantly among the different clinics and dosage groups. Higher dosage can reduce the risk to drop-off while injecting use and sharing needles before receiving MMT would increase the possibility of subsequent drop-off. Intervention efforts and psychological counseling to reduce drop-off should be focused on those MMT clients who injected drugs or shared needle/syringes.