乌鲁木齐市水磨沟区美沙酮门诊患者抗病毒治疗服药依从性对CD4^+T淋巴细胞计数的影响

Effect of medication compliance on CD4^+ T-lymphocytes count in methadone outpatients in Shuimogou District,Urumqi City

目的探讨美沙酮门诊患者抗病毒治疗服药依从性对CD4^+ T淋巴细胞计数的影响。方法对2006年9月-2015年12月乌鲁木齐市水磨沟区美沙酮门诊接受抗病毒治疗的216例AIDS吸毒患者作为研究对象,对患者的抗病毒治疗服药情况进行问卷调查,分析抗病毒治疗依从性对CD4^+ T淋巴细胞计数的影响。结果依从性好的患者占56.94%,依从性差的占43.06%。治疗1年后依从性好的CD4^+ T淋巴细胞计数由治疗前的(294.91±183.56)cells/mm3上升到治疗后的(466.28±215.80)cells/mm^3,差异有统计学意义(P<0.05);依从性不好的CD4^+ T淋巴细胞计数治疗前后差异无统计学意义[306.91±185.481 vs.(293.97±192.83)]cells/mm3,P>0.05);依从性好的组患者在多因素Logistic回归模型分析中,性别、年龄、感染途径与抗病毒治疗CD4^+ T淋巴细胞计数的关系差异无统计学意义(P>0.05)。在多因素Logistic回归模型分析中,抗病毒治疗相关知识(OR=2.369,95%CI:3.624~7.987)、按照要求的次数服药(OR=2.342,95%CI:3.259~6.421)、按照要求的量服药(OR=2.688,95%CI:5.632~8.145)、按要求的时间定时服药(OR=3.256,95%CI:6.014~9.875)、按照要求长期坚持从不间断(OR=4.123,95%CI:6.984~11.251)、家人提醒按时服药(OR=1.987,95%CI:4.709~8.209)是CD4^+ T淋巴细胞计数高低的重要影响因素,差异有统计学意义(P<0.05)。结论 CD4^+ T淋巴细胞计数是反映艾滋病患者依从性高低的较好指标,抗病毒治疗相关知识、按照要求的次数服药、按照要求的量服药、按要求的时间定时服药、按照要求长期坚持从不间断、家人提醒按时服药是影响CD4^+ T淋巴细胞计数的重要影响因素,提高艾滋病患者抗病毒治疗服药依从性,对临床治疗效果具有积极地促进作用。

Objective To explore the effect of compliance with antiretroviral therapy on CD4±T-lymphocyte count in methadone outpatients. Methods Two hundred and sixteen drug addicts who suffered from AIDS and received antiretroviral therapy in methadone clinics in Shuimogou District, Urumqi City from September 2006 to December 2015 served as the research objects, and their compliance to antiretroviral medication was investigated through a questionnaire survey. The effect of adherence to antiretrovi- ral therapy on CD4± T-lymphocyte count was analyzed. Results The patients with good and poor compliance accounted for 56. 94% and 43.06% respectively. After one year of treatment, the CD4± T-lymphocyte count of patients with good compliance in- creased from （ 294.91± 183.56） cells/mm3 before the treatment to （466.28±215.80） cells/mm3 after the treatment, with a statisti- cally significant difference （ P〈0.05 ）. No statistically significant difference was found in the CD4± T-lymphocyte count of patients with poor compliance between before and after the treatment （ （306.91± 185.48）vs. （ 293.97± 192.83） cells/mm3, P〉0.05 ）. The muhivariable logistic regression analysis showed that no statistically significant differences were observed in the correlations between gender, age, route of infection and CD4± T-lymphocyte count after antiretroviral therapy in patients with good compliance （ P〉 0. 05）. The muhivariable logistic regression analysis indicated that the antiretroviral therapy-related knowledge （OR= 2.369,95%CI：3.624-7.987）, taking the medicine for requested times （OR= 2.342, 95%CI： 3.259-6.421 ）, at requested dosage （ OR= 2. 688, 95%CI：5.632-8.145） , and at requested timepoints （OR= 3.256, 95%CI：6.014-9.875） , long-term adherence without intermission as required （OR = 4.123, 95%CI：6.984-11.251 ） and family member＇s reminding of timely taking medicine （OR = 1. 987, 95%CI： 4.709-8.209） were significant factors influencing the CD4＋ T-lymphocyte count （P〈0.05）. Conclusions CD4＋ T-lymphocyte count is a good indicator reflecting AIDS patients＇ compliance. Antiretroviral therapy-related knowledge, tak- ing medicine for requested times, at requested dosage and at requested timepoints, long-term adherence without intermission as re- quired and family member＇ s reminding of timely taking medicine are significant factors influencing the CD4＋ T-lymphocyte count. Improving AIDS patients＇ adherence to antiretroviral therapy plays a positive role in promoting the clinical therapeutic effect.