美沙酮维持治疗门诊受治者治疗依从性的病例对照研究

A case-control study of outpatients on methadone maintenance treatment

目的分析影响美沙酮维持治疗（MMT）依从性的因素。方法采用病例对照研究方法,以MMT依从性较差者为病例组,依从性较好者为对照组,应用复合性国际诊断访谈问卷（CIDI-3.0）、Beck抑郁问卷（BDI）、社会支持评定量表（SSRS）等,对昆明市9个MMT门诊符合条件的受治者进行调查。结果病例组156人,对照组270人。单因素分析显示,婚姻状况（P〈0.05）、职业情况（P〈0.05）、现住址居住时间（P〈0.05）、偷吸毒品（P〈0.05）为治疗依从性的影响因素。多因素非条件Logistic回归分析显示,无职业[比值比（OR）=2.610,95%可信区间（CI）：1.378-3.983]、偷吸海洛因（OR=3.468,95%CI：2.084-5.769）、重度抑郁终身患病率（OR=4.276,95%CI：1.222-14.961）,自我讨厌感：对自己丧失信心（OR=1.164,95%CI：1.066-2.817）、对自己失望（OR=1.882,95%CI：1.300-3.323）,丧失兴趣：兴趣比以往减少（OR=1.709,95%CI：1.093-2.673）、丧失大部分兴趣（OR=2.895,95%CI：1.448-5.778）为治疗依从性差的危险因素。结论美沙酮维持治疗门诊治疗依从性好的受治者中,有自杀意念的比例较高,无职业、偷吸海洛因、重度抑郁终身患病率、自我讨厌感、丧失兴趣可能为治疗依从性的危险因素。

Objective To investigate factors influencing adherence of methadone maintenance treatment （MMT）. Methods A case-control study was conducted on patients innine methadone maintenance treatment clinics of Kunming city, and they were interviewed with Composite International Diagnostic Interview （CIDI-3.0）, Beck Depression Inventory （BDI） and Social Support Rating Scale （SSRS）. Results There were 156 subjects in case group and 270 subjects in control group. Single factor analysis showed that marital status （P〈0.05）, occupation （P〈0.05）, dwelling time at present place （P〈0.05） and occasionally using heroin （P〈0.05） were risk factors for treatment adherence. Multivariate non-conditional logistic regression analysis showed that unemployment （OR 2. 610,95% CI=1. 378-3. 983）, occasionally using heroin （0R=3. 468,95% CI=2. 084-5. 769）, lifetime major depression （OR=4. 276, 95% CI=1. 222-14. 961）, sense of self hate： loss of confidence in oneself（OR=l. 164, 95% CI=1. 066-2. 817）, disappointed to oneself （OR=1. 882, 95%CI=1. 300-3. 323）, loss of interest： interest declined than before （OR= 1. 709,95%CI= 1. 093-2. 673）, loss of most interest （OR= 2. 895, 95%CI= 1. 448-5. 778） were risk factors of poor treatment adherence. Conclusion Patients with good adherence of methadone maintenance treatment have higher percentage of suicidal ideation, while unemployment, occasionally using heroin, lifetime major depression, sense of self hate, and loss of interest may be risk factors of treatment adherence.