西昌市社区美沙酮维持治疗病人保持治疗影响因素的前瞻性研究

Prospective follow-up study of the retention and its risk factors for the methadone maintenance treatment patients in Xichang,Sichuan Province

目的对四川省西昌市社区美沙酮维持治疗(MMT)病人长期保持治疗的影响因素进行分析。方法应用前瞻性队列研究的方法,对280名2004年入组治疗病人进行为期6年的随访。采用Log-rank法、Cox比例风险模型等方法,对可能影响治疗保持的人口学特征、既往毒品滥用及治疗情况等因素进行分析。结果 280名研究对象随访期间治疗剂量为(56.7±34.6)毫克/天,治疗保持率为39.6%。不同性别、年龄、职业、居住状况、生活来源、家人关系、首次吸毒年龄、毒品滥用时间、是否注射、是否共针及不同居住地的研究对象,在治疗保持方面的差异无统计学意义。低、中、高剂量组保持率分别为9.1%、36.7%和65.7%(P<0.000 1);尿检阳性率10%及以下、11%-20%、20%以上的保持率分别为47.6%、43.9%和6.0%(P<0.000 1);有无家人也接受MMT的保持率分别为59.4%和33.2%(P<0.000 1)。Cox比例风险模型多因素分析结果显示,治疗剂量高(HR=0.15,P=0.002)、有家人接受MMT治疗(HR=0.61,P=0.024)的研究对象,退出治疗的风险低;尿检阳性率高(HR=2.83,P<0.000 1)者更容易退出治疗。结论高治疗剂量、偷吸毒品及有家人一同治疗等治疗特征,对长期治疗情况有较大影响。因此,通过改善MMT服务质量,提高治疗剂量、减少治疗期间偷吸毒品以降低病人退出治疗的风险,应成为MMT门诊的工作重点。

Objective To identify major factors associated with subjects＇ overall retention over the six-year period among the drug users who initially attended the methadone maintenance treatment（MMT） clinics in Xichang in 2004.Methods A six-year prospective follow-up study was conducted among 280 subjects who had been enrolled in the MMT clinic since 2004.Log-rank and Cox Proportional Hazard（Cox PH） multivariate regression models were used to evaluate factors associated with retention,e.g.demographics,drug abuse history and treatment characteristics,etc.Results The average dosage in 280 subjects was（56.7±34.6） mg/day,and the retention rate at the end of follow-up was 39.6%.The differences in gender,age,employment status,dwelling status,source of income,family relationship,age of first drug use,length of drug use,injection,needle sharing,and distance between home and clinic had no statistical significance in regards with the length of retention.The retention rate in subjects receiving low vs median vs high doses was 9.1%,36.7% and 65.7%,respectively（P0.001）;the retention rate in those with urine morphine test ≤10% vs 11-20% vs 20% was 47.6%,43.9% and 6.0%,respectively（P0.001）;the retention rate in those whose family members received or did not receive MMT was 59.4% and 33.2%,respectively（P0.001）.The above differences were statistically significant.Cox PH multivariate regression model revealed that higher daily dosage（60 mg/day）（HR=0.15,P0.000 1） and having family members receiving MMT（HR=0.61,P≤0.024） were associated with lower risk of dropout,whereas higher positive urine morphine test（20%）（HR=2.83,P0.001） was associated with higher risk of dropout over the six-year follow-up.Conclusions Specific interventions to decrease the dropout are needed to focus on patients with certain treatment characteristics when providing the treatment service.Higher daily dosage（60 mg/day） and lower illicit drug use should be emphasized.