Analysis of drug compliance and influencing factors of patients with multidrug-resistant pulmonary tuberculosis in Huai’an, Jiangsu Province

doi:10.19982/j.issn.1000-6621.20220214

Abstract

Abstract:

Objective:To investigate the current situation and influencing factors of drug compliance of patients with multidrug-resistant pulmonary tuberculosis (MDR-PTB) in Huai ’an, Jiangsu Province. Methods:A total of 235 MDR-PTB patients diagnosed and treated in the designated tuberculosis hospital in Huai’an, Jiangsu Province from January 2017 to June 2019 were selected, and the Morisky medication adherence scale (MMAS-8) was used for investigation to analyze the current status and influencing factors of drug compliance of MDR-PTB patients. Results:Among the 235 patients, 197 patients (83.8%) had good drug compliance, and 38 patients (16.2%) had poor drug compliance. The results of logistic multivariate analysis showed that male (OR=2.526, 95%CI: 1.217-4.524), aged ≥60 years (OR=1.521, 95%CI: 1.025-2.693), adverse drug reactions (OR=3.892, 95%CI: 1.793-6.822), self-taking medicine (OR=2.635, 95%CI: 1.466-6.107), duration of disease ≥2 years (OR=1.529, 95%CI: 1.112-2.453), floating population (OR=2.868, 95%CI: 1.559-5.234), education background of junior high school or below (OR=1.297, 95%CI: 1.009-1.615), family monthly income <RMB 5000 yuan (OR=1.493, 95%CI: 1.265-5.392) were risk factors of drug compliance. Conclusion:Targeted health education and medication guidance should be carried out for MDR-PTB patients who were male and aged ≥60 years old, with adverse drug reactions and self-administration, and the disease duration ≥2 years, furthermore, those who were floating population, with education background of junior high school or below, and monthly household income <RMB 5000 yuan.

Key words: Tuberculosis,multidrug-resistant, Patient compliance, Factor analysis,statistical

CLC Number:

R521
G479

Wang Chunlei, Jin Tao, Zhao Pengpeng, Ding Shouhua, Zhou Jin, Hu Jinliu. Analysis of drug compliance and influencing factors of patients with multidrug-resistant pulmonary tuberculosis in Huai’an, Jiangsu Province[J]. Chinese Journal of Antituberculosis, 2022, 44(10): 1057-1062. doi: 10.19982/j.issn.1000-6621.20220214

Figures/Tables 3

因素	β值		s $x ¯$ 值		Wald χ²值		P值	OR(95%CI)值
性别
女性								1.000
男性	0.927		0.312		8.821		0.003	2.526(1.217~4.524)
年龄组(岁)
<60								1.000
≥60	0.419		0.205		4.178		0.041	1.521(1.025~2.693)
药物不良反应
无								1.000
有	1.359		0.325		17.485		0.000	3.892(1.793~6.822)
服药监督方式
家人监督服药								1.000
自服药	0.969		0.308		9.898		0.002	2.635(1.466~6.107)
病程(年)
<2								1.000
≥2	0.425		0.159		7.145		0.008	1.529(1.112~2.453)
流动人口
否								1.000
是	1.054		0.436		5.844		0.016	2.868(1.559~5.234)
因素		β值		s $x ¯$ 值		Wald χ²值	P值	OR(95%CI)值
受教育程度
高中及以上								1.000
初中及以下		0.260		0.117		4.938	0.026	1.297(1.009~1.615)
家庭月收入(元)
≥5000								1.000
<5000		0.401		0.185		4.698	0.030	1.493(1.265~5.392)

References 14

[1]	于海娟, 赵梅, 王佳月, 等. 肺结核患者结核杆菌耐药情况及耐多药结核病的危险因素. 中国感染控制杂志, 2020, 19(1):58-62. doi: 10.12138/j.issn.1671-9638.20205260. doi: 10.12138/j.issn.1671-9638.20205260
[2]	赵秀娟, 莫菁莲, 孙涛, 等. 2015-2019年海南省省级结核病定点医疗机构收治的肺结核患者耐药特征及相关因素分析. 中国防痨杂志, 2021, 43(9): 916-923. doi: 10.3969/j.issn.1000-6621.2021.09.011. doi: 10.3969/j.issn.1000-6621.2021.09.011
[3]	杜一琴, 张尊敬, 刘忠达, 等. 丽水地区耐多药肺结核患者用药依从性及影响因素研究. 中国预防医学杂志, 2020, 21(4): 422-427. doi: 10.16506/j.1009-6639.2020.04.015. doi: 10.16506/j.1009-6639.2020.04.015
[4]	World Health Organization. Guidelines for national programs. Geneva: World Health Organization, 2010.
[5]	姜婧, 孙德斌, 刘家起, 等. 沈阳市205例住院肺结核患者就诊延迟及影响因素分析. 结核病与肺部健康杂志, 2020, 9(1):72-78. doi: 10.3969/j.issn.2095-3755.2020.01.016. doi: 10.3969/j.issn.2095-3755.2020.01.016
[6]	杨晓丽, 李宏艳, 王皎磊, 等. 煤工尘肺合并肺结核患者治疗转归及影响因素分析. 结核与肺部疾病杂志, 2022, 3(2):125-130. doi: 10.19983/j.issn.2096-8493.20210160. doi: 10.19983/j.issn.2096-8493.20210160
[7]	连展, 王婷萍, 杜鹃. 武汉市涂阳肺结核患者药物治疗依从性的影响因素分析. 中国防痨杂志, 2018, 40(2): 222-225. doi: 10.3969/j.issn.1000-6621.2018.02.022. doi: 10.3969/j.issn.1000-6621.2018.02.022
[8]	吕春容, 唐晨曦. 2011年-2017年成都市艾滋病合并结核病病人流行病学调查及治疗依从性分析. 护理研究, 2019, 33(9):1508-1513. doi: 10.12102/j.issn.1009-6493.2019.09.011. doi: 10.12102/j.issn.1009-6493.2019.09.011
[9]	王艳, 郑开巧, 魏依亭, 等. 2017-2019年某戒毒所新入所戒毒人员结核感染情况及影响因素分析. 结核病与肺部健康杂志, 2020, 9(1):32-36. doi: 10.3969/j.issn.2095-3755.2020.01.008. doi: 10.3969/j.issn.2095-3755.2020.01.008
[10]	李勇, 路丽苹, 李瑾, 等. 上海市松江区肺结核患者耐药特征及耐多药结核病影响因素分析. 结核与肺部疾病杂志, 2022, 3(2):142-147. doi: 10.19983/j.issn.2096-8493.20210109. doi: 10.19983/j.issn.2096-8493.20210109
[11]	余雅, 廖文平, 刘英, 等. 重庆市贫困区(县)肺结核患者的治疗依从性及其影响因素研究. 疾病监测, 2021, 36(11):1159-1167. doi: 10.3784.jbjc.202105060233. doi: 10.3784.jbjc.202105060233
[12]	蔡俊丽, 景睿, 张文茜, 等. 2016-2020年济南市肺结核患者耐药情况分析. 结核与肺部疾病杂志, 2022, 3(1):27-32. doi: 10.19983/j.issn.2096-8493.20210138. doi: 10.19983/j.issn.2096-8493.20210138
[13]	李媛媛, 苏东栋, 阿尔泰. 159例复治肺结核患者耐药特征及影响因素分析. 结核与肺部疾病杂志, 2021, 2(4):347-351. doi: 10.19983/j.issn.2096-8493.20210063. doi: 10.19983/j.issn.2096-8493.20210063
[14]	余艳艳, 陈振华, 王珏, 等. 痰培养阳性肺结核并发非结核分枝杆菌肺病患者的临床特征及影响因素. 结核与肺部疾病杂志, 2020, 1(3):144-148. doi: 10.3969/j.issn.2096-8493.2020.02.011. doi: 10.3969/j.issn.2096-8493.2020.02.011

分类	依从性良好组(197例)				依从性差组(38例)				χ²值		P值
分类	例数		构成比(%)		例数		构成比(%)		χ²值		P值
年龄组(岁)									3.957		0.047
≥60	56		28.4		17		44.7
<60	141		71.6		21		55.3
性别									8.278		0.004
男性	95		48.2		28		73.7
女性	102		51.8		10		26.3
药物不良反应									5.336		0.021
有	43		21.8		15		39.5
无	154		78.2		23		60.5
服药督导方式									4.691		0.030
家人监督	72		36.5		7		18.4
自服药	125		63.5		31		81.6
婚姻状况									0.370		0.831
未婚	44		22.3		8		21.1
已婚	138		70.1		26		68.4
离异或丧偶	15		7.6		4		10.5
病程(年)									6.887		0.009
≥2	89		45.2		26		68.4
<2	108		54.8		12		31.6
流动人口									5.300		0.021
是	35		17.8		13		34.2
否	162		82.2		25		65.8
受教育程度									5.348		0.021
初中及以下	31		15.7		12		31.6
高中及以上	166		84.3		26		68.4
分类		依从性良好组(197例)				依从性差组(38例)				χ²值	P值
分类		例数		构成比(%)		例数		构成比(%)		χ²值	P值
家庭月收入(元)										4.565	0.033
<5000		29		14.7		11		28.9
≥5000		168		85.3		27		71.1
治疗情况										0.797	0.372
初治		119		60.4		20		52.6
复治		78		39.6		18		47.4
住院时间(d)										0.008	0.930
≥35		30		15.2		6		15.8
<35		167		84.8		32		84.2
出院时病原学情况										0.345	0.558
阳性		58		29.4		13		34.2
阴性或其他		139		70.6		25		65.8

编码	变量	赋值	编码	变量	赋值
Y	服药依从性	0=差,1=良好	X₅	病程	0=<2年,1=≥2年
X₁	性别	0=女性,1=男性	X₆	流动人口	0=否,1=是
X₂	年龄	0=<60岁,1=≥60岁	X₇	受教育程度	0=高中及以上,1=初中及以下
X₃	药物不良反应	0=无,1=有	X₈	家庭月收入	0=≥5000元,1=<5000元
X₄	服药监督方式	0=家人监督服药,1=自服药