信息化随访干预措施对HBV感染患者依从性影响分析

An analysis of the influence of informationized follow-up and intervention on the compliance of patients with HBV infection

目的通过信息化随访方式干预慢性乙型病毒性肝炎患者,对比分析其对患者疾病及用药依从性影响。方法收集2014年10月至2017年10月惠州市第六人民医院门诊及住院部诊断为慢性乙型病毒性肝炎、乙肝肝硬化患者,剔除不符合纳入条件患者,共纳入符合条件患者264例,有42例合并肝硬化。对纳入患者采取分层随机抽样方法进行分组,最终微信+电话随访组87例,电话随访组88例,对照组89例。随访并对比三组在2年后肝功能、肝硬化人数及停用恩替卡韦时间等不同差异。结果随访年后三组在失访人数上差异存在统计学意义,其中A组与B组2年后两组在ALT(Z=-3.218,P=0.02)、AST(Z=-2.749,P=0.03)、Alb(Z=1.746,P=0.04)、乙肝病毒DNA(Z=-3.231,P=0.02)指标差异具有统计学意义,而TBil、FIB-4指数、APRI、γ-GT指标差异无统计学意义。A组与C组2年后对比结果显示,两组在ALT(Z=-11.089,P<0.001)、AST(Z=-9.247,P=0.01)、TBil(Z=-7.623,P=0.01)、APRI(Z=-4.834,P=0.01)、γ-GT(Z=-2.867,P=0.03)、Alb(Z=3.187,P=0.02)、乙肝病毒DNA(Z=-10.078,P<0.001)指标差异具有统计学意义,而FIB-4指数指标差异无统计学意义。B组与C组2年后两组对比结果显示,两组在ALT(Z=-1.275,P=0.04)、AST(Z=-2.045,P=0.03)、TBil(Z=-3.762,P=0.02)、APRI(Z=-1.461,P=0.04)、γ-GT(Z=-2.254,P=0.03)、乙肝病毒DNA(Z=-1.782,P=0.04)指标差异具有统计学意义,而Alb、FIB-4指数指标差异无统计学意义。随访2年后A组肝硬化人数为12人,B组为16人,C组为24人。A组与B组(χ^(2)=0.945,P=0.408)、B组与C组肝硬化人数(χ^(2)=2.741,P=0.103)差异无统计学意义,而A、C两组肝硬化人数差异有统计学意义(χ^(2)=6.843,P=0.013)。在2年时间内,A组有15例患者暂停使用恩替卡韦,B组有28例,C组有61例,三组停用恩替卡韦人数差异有统计学意义(χ^(2)=25.061,P<0.001),通过Kaplan-meier分析,结果显示A组使用恩替卡韦时间长于B组(83.0%vs 68.5%,χ^(2)=5.754,P=0.016)及C组(83.0%vs 33.7%,χ^(2)=61.601,P<0.001),而B组使用时间长于C组(63.5%vs 33.7%,χ^(2)=32.451,P<0.001)。结论通过对患者强化信息化干预,可以使患者服用抗乙肝病毒药物依从性提高,降低患者肝功能异常发生及肝硬化发病率。

Objective To compare and analyze the influence of informationized follow-up and intervention on the medication compliances of patients with chronic hepatitis B(CHB).Methods A total of 264 eligible patients were included From October 2014 to October 2017 who were diagnosed as CHB and hepatitis B related cirrhosis in outpatient and inpatient departments of Huizhou Sixth People's Hospital were collected,of which 42 were diagnosed as cirrhosis.The patients were divided into three groups by stratified random sampling method,with 87 cases in WeChat+telephone follow-up group(group A),88 cases in telephone follow-up group(group B)and 89 cases in control group(group C).All patients were followed-up for 2 years and compared for liver functions,the number of patients with liver cirrhosis,and the time of discontinuing anti-viral treatment of enticavir between the groups.Results After follow-up for two years,there was a significant difference in the numbers of lost visitors among these three groups.The levels of ALT(Z=-3.218,P=0.02),AST(Z=-2.749,P=0.03),Alb(Z=1.746,P=0.04),hepatitis B virus DNA(ALB)were statistically different between group A and group B.The levels of ALT(Z=-11.089,P<0.001),AST(Z=-9.247,P=0.01),TBil(Z=-7.623,P=0.01),APRI(Z=-4.81,P=0.02),hepatitis B viral DNA(Z=-10.078,P<0.001)between group A and group C were significantly different,but there was no difference in FIB-4 index.The comparison between group B and group C showed that ALT(Z=-1.275,P=0.04),AST(Z=-2.045,P=0.03),TBil(Z=-3.762,P=0.02),APRI(Z=-1.466,,P=0.04)were statistically different.After 2-years’follow-up,there were 12 cirrhotic patients in group A,16 cirrhotic patients in group B and 24 cirrhotic patients in group C.There is no significant difference between group A and B(χ^(2)=0.945,P=0.408),and group B and C(χ^(2)=2.741,P=0.103),but there is significant difference between group A and group C(χ^(2)=6.843,P=0.013).Within two years,15 patients in group A,28 patients in group B and 61 patients in group C stopped using entecavir.There were significant differences among these three groups(χ^(2)=25.061,P<0.001).The results of Kaplan-meier analysis showed that entecavir use in group A patients was longer than that in group B(83.0%vs 68.5)P=0.016)and group C(83.0%vs 33.7%,χ^(2)=61.601,P<0.001),while group B patients took enticavir longer than that of group C(63.5%vs 33.7%,χ^(2)=32.451,P<0.001).Conclusion Informationized intervention may increase the compliance of CHB patients to antiviral treatment and therefore reduce the incidence of liver function abnormalities and liver cirrhosis.