结核分枝杆菌/HIV双重感染患者治疗依从不佳的预测模型构建分析

Analysis on predictive modeling constructing of worse compliance in patients with TB/HIV coinfection

目的探讨结核分枝杆菌/HIV双重感染患者治疗依从性的影响因素,构建其治疗依从性预测列线图并验证。方法选取2017年5月至2020年5月于四川大学华西医院就诊的168例结核分枝杆菌/HIV双重感染患者作为研究对象,失访7例,随访结束时采用Morisky服药依从性问卷评价其依从性,根据得分将其分为依从性好组(≥6分,86例)和依从性差组(<6分,75例)。收集两组临床资料,进行单因素分析及多因素logistic回归分析其治疗依从性的影响因素,建立列线图模型并验证。结果依从性差组的农村户口占比、汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分均高于依从性好组,社会支持评定量表(SSRS)评分低于依从性好组,差异均有统计学意义(均P<0.05)。两组文化程度和家庭月收入比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,初中及以下文化程度、家庭月收入<5000元、农村户口、高HAMD评分、高HAMA评分均为结核分枝杆菌/HIV双重感染患者治疗依从性差的独立危险因素(均OR>1,P<0.05),高SSRS评分(OR<1,P<0.05)为其保护因素。列线图预测患者治疗依从性的一致性指数为0.914(95%CI:0.856,0.930)。结论结核分枝杆菌/HIV双重感染患者治疗依从性与文化程度、家庭收入、社会支持等因素有关,列线图可成为预估患者治疗依从性的良好辅助工具。

Objective To explore the influencing factors of treatment compliance in patients with TB/HIV coinfection,and to construct and verify the prediction nomogram of treatment compliance.Methods A total of 168 patients with TB/HIV coinfection admitted to West China Hospital of Sichuan University from May 2017 to May 2020 were selected as the study subjects.Seven patients were lost to follow-up.At the end of follow-up,Morisky medication compliance questionnaire was used to evaluate their compliance.According to their scores,they were divided into good compliance group(≥6 points,86 cases)and poor compliance group(<6 points,75 cases).Clinical data of two groups were collected,univariate analysis and multivariate logistic regression were conducted to analyze the influencing factors of treatment compliance,and a nomogram model was established and verified.Results The rural household registration ratio,Hamilton depression scale(HAMD)score and Hamilton anxiety scale(HAMA)score in the poor compliance group were higher than those in the good compliance group,and the social support rating scale(SSRS)score was lower than that in the good compliance group,with statistical significance(all P<0.05).There were statistically significant differences in education level and monthly family income between the two groups(all P<0.05).The results of multivariate logistic regression analysis showed that education level of junior middle school or below,monthly family income<5000 yuan,rural household registration,high HAMD score and high HAMA score were independent risk factors for poor treatment compliance of patients with TB/HIV coinfection(all OR>1,P<0.05).High SSRS score(OR<1,P<0.05)was the protective factor.The consistency index of nomogram for predicting treatment compliance was 0.914(95%CI:0.856,0.930).Conclusion The treatment compliance of patients with TB/HIV coinfection is related to education,family income,social support and other factors,and the nomogram can be a good auxiliary tool for predicting the treatment compliance of patients.