新型冠状病毒感染疫情期间肾移植受者免疫抑制剂服药依从性研究

Drug compliance of immunosuppressant in kidney transplant recipients during the COVID-19 pandemic

目的对新型冠状病毒感染(COVID-19)疫情期间肾移植受者服药依从性现状进行调查,并分析其影响因素。方法采用方便抽样法选取2021年6月至12月在广州医科大学附属第二医院器官移植科门诊随访中心进行随访的540例肾移植受者作为研究对象。采用一般资料调查表、对COVID-19和新冠疫苗认识程度的调查问卷和免疫抑制剂服药依从性调查问卷进行问卷调查。全部问卷回收后及时进行整理分析,剔除无效问卷。根据免疫抑制剂服药依从性情况将受者分为依从性高组和依从性低组。组间正态分布计量资料采用成组t检验进行比较,计数资料采用χ^(2)检验进行比较。P<0.05为差异有统计学意义。结果本研究共发放调查问卷540份,剔除无效问卷29份,回收有效问卷511份,回收有效率94.6%(511/540)。511例受者中403例(78.9%)表示对COVID-19疫情存在担心,但450例(88.1%)受者表示自己不会发生COVID-19,目前有5例(1.0%)受者发生过COVID-19。260例(50.9%)受者表示愿意接种新冠疫苗,486例(95.1%)会选择接种灭活疫苗;414例(81.0%)受者最担心出现排斥反应。511例受者过去1个月内,忘记服用抗排斥反应药物1次及以上受者203例(39.7%);连续2次或多次忘记服用抗排斥反应药物的受者16例(3.1%);提前或延迟2 h服药的受者213例(41.7%);自行调整抗排斥反应药物剂量的受者12例(2.3%)。225例(44.0%)受者主要因个人因素导致漏服或自行停用抗排斥反应药物,87例(17.0%)表示因工作繁忙而导致错误服药,因疫情导致无法出门购药只有8例(1.6%)。511例受者中247例受者纳入依从性高组,余264例受者纳入依从性低组。两组受者教育状况及最近1次复查血清肌酐水平差异有统计学意义(χ^(2)=117.12,t=-6.48,P均<0.05)。结论肾移植受者术后服药依从性仍有待提高,其服药依从性可能与文化程度有关,应采取相应的干预措施提高受者服药依从性。

Objective To investigate the current status of drug compliance of immunosuppressant and analyze its influencing factors in kidney transplant recipients during the COVID-19 pandemic.Methods 540 renal transplant recipients who were followed up in the outpatient clinic in the Organ Transplantation Center of the Second Affiliated Hospital of Guangzhou Medical University,from June 2021 to December 2021,were selected by the convenience sampling method to do the questionnaire.Surveys on general information,COVID-19 and COVID-19 vaccine,and drug compliance of immunosuppressant were conducted in renal transplant recipients.All the questionnaires were promptly organized and analyzed after collection,and then the invalid questionnaires were excluded.The recipients were divided into high drug compliance group and low drug compliance group according to drug compliance of immunoswppressant.The measurement data of normal distribution between groups were compared by group t test.Chi-squared test was used to compare the counting data.P<0.05 indicates a statistically significant difference.Results A total of 540 survey questionnaires were distributed in this study,with 29 invalid questionnaires excluded.A total of 511 valid questionnaires were collected,with a recovery effectiveness rate of 94.6%(511/540).Among 511 recipients,403 recipients(78.9%)expressed concern about the COVID-19 pandemic,but 450 recipients(88.1%)stated that they would not experience COVID-19.Only 5(1.0%)recipients had experienced COVID-19.260(50.9%)recipients were willing to receive COVID-19 vaccine,and 486 recipients(95.1%)would choose to receive inactivated vaccine,414 recipients(81.0%)were most concerned about acute rejection for vaccination.For 511 recipients in the past month,203 recipients(39.7%)forgot to take immunosuppressive medication once or more;16 recipients(3.1%)forgot to take immunosuppressive medication twice or multiple times;213 recipients(41.7%)received immunosuppressive medication early or delayed for 2 hours;12 recipients(2.3%)adjusted the dosage of immunosuppressive medication on their own.225 recipients(44.0%)forgot or stopped taking the anti-rejection drugs due to personal factors.87 recipients(17.0%)reported taking medication incorrectly due to busy work schedules.Only 8 recipients(1.6%)were unable to go out to purchase medication due to the COVID-19 pandemic.Among 511 recipients,247 recipients were included in high drug compliance group and 264 recipients were included in low drug compliance group.There were significant differences between the two groups in terms of educational level and serum creatinine level for recent time(χ^(2)=117.12,t=-6.48,all P<0.05).Conclusions The drug compliance of kidney transplant recipients remains to be improved,and the education status may be related to the drug compliance of immunosuppressant of kidney transplant recipients.Corresponding intervention measures should be taken to improve the drug compliance.