Cox模型预测云南省美沙酮维持治疗早期脱失的风险因素分析

The predictors of early dropout in methadone maintenance treatment in Yunnan province

目的:云南省美沙酮维持治疗早期脱失相关因素分析。方法:用队列研究的方法观察2009年3月1日至8月31日期间,218例第一次入组美沙酮门诊的调查对象,并随访到2010年2月28日。美沙酮剂量的记录来自于门诊的数据库。利用Cox回归模型进行数据分析。结果:在第1、2个阶段美沙酮剂量和脱失之间没有关系,而在3个月后高剂量组(>60mg)脱失的可能性较小。脱失还与汉族(HR=1.86,95%CI:1.65-3.26)、到达门诊时间超过30分钟(HR=1.63,95%CI:1.07-2.49)及与药物滥用者住在一起(HR=2.71,95%CI:1.55-4.74)有关。结论:病人早期脱失和民族、门诊可及性、和药物滥用者居住在一起以及美沙酮的剂量有关。推荐使用更高剂量的美沙酮可能对美沙酮维持治疗更有用。

Objective：To identify the predictors of early dropout of patients in methadone maintenance treatment （MMT） clinics in Yunnan province, China. Methods： A cohort study was conducted on 218 patients starting treatment in 5 MMT clinics between March 1, 2009 and August 31, with follow up to February 28, 2010. Attendance at clinic and daily dose were abstracted from the clinic records. Cox regression model was performed to identify factors predicting dropout in the MMT program. Results：There was no relationship between dose and probability of dropout in periods 1 and 2. However, after 3 months higher average daily dose （ 〉 60 mg） was as- sociated with lower probability of dropout. Dropout was more likely among the Han ethnic group （HR = 1.86, 95% CI： 1.65-3.26）, in those who had to spend over 30 minutes to visit the clinic （HR = 1.63, 95% CI： 1.07-2.49） , and in those living with other drug users （HR = 2. 71, 95% CI： 1.55-4. 74 ）. Conclusion：Patients＂ early dropout was related to ethnicity, clinic accessibility, living with drug users and methadone dose. A higher methadone dose as appropriate for maintenance treatment is recommended.