慢性乙型肝炎患者核苷(酸)类似物抗病毒治疗依从性的影响因素分析

Influencing factors for compliance with antiviral therapy with nucleos(t) ide analogues in patients with chronic hepatitis B

目的分析宁夏医科大学总院慢性乙型肝炎(CHB)患者核苷(酸)类似物(NAs)抗病毒治疗依从性现况。方法选择2017年5月-2017年12月就诊宁夏医科大学总医院感染科(包括门诊、住院部),接受NAs抗病毒治疗的CHB患者。通过对人口学资料、乙型肝炎家族史、医生告知详细否、生活作息、体育锻炼、依从性、乙型肝炎知识知晓情况、健康信念、社会支持等方面内容的问卷调查,分析不同因素对CHB患者NAs治疗依从性的影响。计量资料非正态分布组间比较采用Wilcoxon秩和检验。计数资料组间比较采用χ2检验或Fisher确切概率法。采用多因素logistic回归分析影响CHB患者NAs抗病毒治疗依从性的因素。结果612份调查问卷,回收600份,回收率为98%,有效率为100%。600例CHB患者中NAs抗病毒治疗依从好的有334人(55.67%),而依从性差的266人(44.33%)。依从性差的CHB患者中,不遵从医生建议,自行选择其他药物的有56人(21.05%);有时忘记服药的206人(77.44%);有时不注意服药(时间、剂量、频次)187人(70.30%);症状改善自行减药、停药的135人(50.75%);症状加重或出现其他症状,自行停药的100人(37.59%)。通过单因素分析得出有13个研究指标是影响CHB患者NAs治疗依从性的相关因素(P值均<0.05);将其进行多因素logistic回归分析,得出影响CHB患者NAs治疗依从性的独立因素有:民族[比值比(OR)=0.218,95%可信区间(95%CI):0.076~0.996,P=0.007]、医疗支付方式(OR=0.772,95%CI:0.445~0.919,P<0.001)、体育锻炼(OR=2.55,95%CI:1.472~6.545,P=0.020)、社会支持水平(OR=0.836,95%CI:0.649~0.947,P<0.001)、健康信念中感知不依从后果危害(OR=0.577,95%CI:0.393~0.886,P<0.001)及自我效能(OR=0.094,95%CI:0.074~0.328,P<0.001)。结论慢性乙型肝炎患者对抗病毒治疗的依从性与医疗付费方式、心理状态、自我管理能力密切相关。改善患者医疗费用偿付能力,对患者进行疾病风险认知教育以及减少社会歧视等措施有助于提高患者治疗依从性。

Objective To investigate the current status of compliance with antiviral therapy with nucleos(t)ide analogues (NAs) among chronic hepatitis B (CHB) patients treated in General Hospital of Ningxia Medical University.Methods The CHB patients who received antiviral therapy with NAs at the outpatient and inpatient services of Department of Infectious Diseases,General Hospital of Ningxia Medical University,from May to December,2017 were enrolled.A questionnaire survey was performed for demographics,family history of CHB,detailed doctor's advice,daily routines,physical exercise,compliance,awareness of the knowledge about hepatitis B,health belief,and social support,and the influence of various factors on compliance with NAs treatment was analyzed.The Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups,and the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups.A multivariate logistic regression analysis was used to investigate the influencing factors for compliance with antiviral therapy with NAs among CHB patients.Results A total of 612 questionnaires were distributed,among which 600 were collected,with a questionnaire recovery rate of 98% and a valid rate of 100%.Among the 600 CHB patients,334 (55.67%) had good compliance with the antiviral therapy with NAs and 266 (44.33%) had poor compliance.Among the 266 CHB patients with poor compliance,56 (21.05%) did not follow the doctor's advice and took other drugs,206 (77.44%) sometimes forgot medication,187 (70.30%) sometimes did not pay attention to medication (time,dose,and frequency),135 (50.75%) reduced or stopped drugs after symptoms were improved,and 100 (37.59%) stopped the drugs due to symptom aggravation or appearance of other symptoms.The univariate analysis showed that 13 indices were the influencing factors for compliance with NAs treatment among CHB patients (all P <0.05).A multivariate analysis was performed for these 13 indices and the results showed that race (odds ratio [OR]=0.218,95% confidence interval [CI]: 0.076-0.996,P =0.007),mode of medical payment (OR=0.772,95%CI: 0.445-0.919,P <0.001),physical exercise (OR=2.55,95%CI: 1.472-6.545,P =0.020),level of social support (OR=0.836,95%CI: 0.649-0.947,P <0.001),awareness of the outcome of incompliance (OR=0.577,95%CI: 0.393-0.886,P <0.001),and self-efficacy (OR=0.094,95%CI: 0.074-0.328,P <0.001) were independent influencing factors for compliance with NAs treatment among CHB patients.Conclusion Compliance with antiviral therapy among CHB patients is closely associated with the mode of medical payment,psychological state,and self-management ability.Related measures,such as improvement of patients' ability to pay medical expenses,education on disease risk for patients,and reduction of social discrimination,can help to improve treatment compliance.