Excel联合手机短信随访提高阿德福韦酯个体化治疗慢性乙型肝炎患者依从性

Improving the compliance of patients with chronic hepatitis B treated with individualized adefovir dipivoxil ester by Excel and mobile phone short message

目的探讨Excel联合手机短信随访提高阿德福韦酯（ADV）个体化治疗慢性乙型肝炎患者依从性。方法对575例不同剂量ADV治疗的慢性乙型肝炎患者定期检测HBVDNA，并实时录入Excel。通过插入批注记录检测日期、肝肾功能异常结果，对自行停药或减量出现病毒反弹或停药后肝炎分别用红、黄填充色标注，比较各组依从性、停药或减量相关事件及失访率。结果半量组复查依从性差7．1％，失访率21．4％，总停药35．7％，停药肝炎复发14．2％，停药病毒反弹7．1％；常量组复查依从性差4．7％，失访率18．3％，总停药24．6％，停药肝炎复发8．04％，停药病毒反弹11．3％；1．5～2倍量组依从性好，复查依从性差6．2％～6．0％，失访率21．8％～18％，总停药21．8％～35％，停药肝炎复发6．25％～14％，停药病毒反弹15．6％～O％；联合组复查依从性差12．9％，失访率9．6％，总停药19．3％，停药肝炎复发12．9％，停药病毒反弹6．45％；各组累计停药151例（26．2％），停药后肝炎复发54例（9．39％），重症肝炎2例，停药相关死亡事件2例。结论加倍量组自行停药率比常量组高，加强健康教育与医患联系，提高疾病认知程度并定期检查是保证安全与疗效的关键。Excel联合手机短信随访有四方面优点，可有效提高ADV个体化治疗的依从性。

Objective To explore the compliance of patients with chronic hepatitis B, which was treated with adefovir dipivoxil （ADV）, improved by Excel and message. Methods The level of HBV DNA was tested in 575 patients treated with different doses of ADV and was input in Excel. The date, abnormality of liver and kidney function were recorded by inserting notation. Viral breakthrough, which caused by dose reduction or withdrawal, was highlighted by red or yellow color, respectively. Results In half dosage group, the rate of compliance was reduced by 7.1%, 21.4o/00 of the patients were lost, drug withdrawal was observed in 35.70//oo of the patients, in which 14.2% had hepatitis and 7.1% experience virus breakthrough. In normal dosage group, the rate of compliance was reduced by 4.7%, 18.3% of the patients were lost, drug withdrawal was observed in 24. 6% of the patients, in which 8. 04% had hepatitis and 11.3 % experience virus breakthrough. In the 1.5 times or 2 times dosage groups, the rates of compliance were reduced by 6.2% or 6.0%, 21.8% or18% of the patients were lost, drug withdrawal was observed in 21.8% or 35% of the patients, in which 6.25% or 14% had hepatitis and 15.6% or 20% experience virus breakthrough, respectively. In the group treated with lamivudine and ADV, the rate of compliance was reduced by 12.90//oo, 9.6% of the patients were lost, drug withdrawal was observed in 19. 3% of the patients, in which 12.9% had hepatitis and 6.45% experience virus breakthrough. Totally, 151 patients （26. 2%） discontinued therapy, in which 54 patients （9. 39%） suffered from hepatitis and 2 of them developed severe hepatitis, 2 patients died related to drug withdrawal. Conclusion The rate oftherapy discontinued in double dosage group was higher than that in normal group. The key of therapy benefit is to strengthen the health education, increase the contact of patients and doctors, raise awareness of the disease for the patients and do examination regularly. There are four advantages of Excel and message which could effectively improve the compliance of patients treated with ADV.