海洛因成瘾者美沙酮维持治疗脱失原因影响因素的巢式病例对照研究

A nested case-control study on the reason of dropout of methadone maintenance treatment among heroin abusers

目的:探讨美沙酮维持治疗(MMT)脱失的影响因素。方法:采用巢式病例对照研究设计,将镇江市MMT门诊2006年3月～2008年6月收治的309例吸毒者根据治疗随访依从性结果,分成保持组(198例)和脱失组(111例),比较两组基线资料的差异;将是否脱失作为应变量,进行单因素和多因素非条件Logistic回归分析。结果:单因素和多因素非条件Logistic回归分析显示,以与家人/亲属居住为参照,与朋友居住和独自居住均为危险因素,OR值分别为3.523(95%CI:1.242～9.993),3.356(95%CI:1.742～6.464)。以过去1个月没有与吸毒朋友交往为参照,每周1～6次的危险性为2.91(1.50～5.62)倍,与吸毒朋友交往次数平均每天≥1次的危险性为8.33(1.12～100.00)倍。结论:影响镇江市MMT门诊治疗脱失的因素为吸毒者与朋友居住和独自居住、与吸毒朋友交往次数多,应针对性地进行有效干预以提高美沙酮维持治疗的保持率。

Objective： To explore the influential factor of dropout in methadone maintenance treatment（MMT）.Methods：A nested case-control study was conducted from March 2006 to June 2008,and 309 drug abusers accepted MMT were divided into maintenance group（198 cases）and dropout group（111 cases） according the outcome of follow-up,and univariate and multivariate Logistic regression model were used to analyze the factors of dropout.Results：The multivariate Logistic regression analysis showed that inhabitating solely（OR=3.523,95%CI 1.242～9.993） or with friend（OR=3.356,95%CI：1.742～6.464）were the dependent risk factors of dropout regarding inhabitating with family or relatives as reference and the times of contact with drug abuser friends more than one or one per day（OR= 8.33,95%CI：1.12～100.00）or 1-6 times per week（OR=2.91,95%CI：1.50～5.62）increased the risk of dropout significantly.Conclusion：The main reason of dropout in MMT clinic in Zhenjiang is the patients inhabitating solely,residing or contact with drug abuser friends,and measures of intervention should be taken to improve the MMT patients compliance with more pertinence.