乙型肝炎肝硬化患者抗病毒治疗依从性水平及其影响因素

doi:10.3969/j.issn.1004-583X.2018.11.008

临床荟萃

乙型肝炎肝硬化患者抗病毒治疗依从性水平及其影响因素

1.首都医科大学附属北京佑安医院肝衰竭与人工肝治疗研究北京市重点实验室，北京 100069；
2.北京协和医学院基础学院流行病学与卫生统计学系，北京 100005；
3.北京市疾病预防控制中心科研教学管理办公室，北京100013

出版日期:2018-11-05 发布日期:2018-12-10
通讯作者: 通信作者：陈煜，chybeyond@163.com；王丽，liwang@ibms.pumc.edu.cn
基金资助:
国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治”（2012ZX10002004006、2017ZX10203201005、2017ZX10201201、2017ZX10202203006001、2017ZX10302201004002）；国家重点研发计划资助项目（2017YFA0103000）；北京市医院管理局“登峰”人才培养计划基金资助项目（ DFL20151601）；北京市医院管理局临床医学发展专项经费资助项目（ZYLX201806 ）

Factors associated with adherence to antiviral therapy in patients with HBV-related cirrhosis

1.Beijing You' an Hospital of Capital Medical University, Beijing 100069，China; 2.Department of
Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences,
School of Basic Medicine Peking Union Medical College, Beijing 100005； 3.Department of Research
and Education Administration Beijing Centers for Disease Control and Prevention, Beijing 100013, China

Online:2018-11-05 Published:2018-12-10
Contact: Corresponding author: Chen Yu, chybeyond@163.com; Wang Li, liwang@ibms.pumc.edu.cn

摘要/Abstract

摘要： 目的本研究基于真实临床数据评估乙型肝炎肝硬化患者抗病毒治疗依从性及探讨影响抗病毒治疗依从性的因素。方法本研究数据来源于北京佑安医院电子病历数据库，回顾性收集了2008年2月 14日至2012年12月31日期间的乙型肝炎肝硬化患者的门诊及住院信息、取药信息和实验室检查结果及日期。根据患者取药记录，利用药物持有率(medication possession ratio，MPR)评估患者抗病毒治疗依从性水平，并用非条件logistic回归模型分析影响良好依从性的因素。结果研究共纳入北京市应用恩替卡韦(ETV)或阿德福韦(ADV)单药口服抗病毒治疗的患者299例，其中HBeAg阳性患者117例，HBeAg阴性患者182例；大部分入组患者MPR≥80%，约占68%；其中MPR≥95%患者约占45%，MPR≥100%患者约占26.1%，而MPR＜50%的患者仅占12%。单因素分析结果显示基线白蛋白（albumin，ALB）≥35 g/L患者较ALB＜35 g/L患者抗病毒治疗依从性显著增高（OR=2.27，95%CI=1.425~3.618），基线胆碱酯酶（cholinesterase，CHE）≥4 000 U/L患者抗病毒治疗依从性明显高于CHE＜4 000 U/L患者（OR=2.601，95%CI=1.617~4.183）；治疗时间较长的患者抗病毒治疗依从性偏低（OR=0.549，95%CI=0.389~0.757）。在单因素分析中P＜0.15的因素进入多因素校正分析模型，结果显示只有治疗时间对抗病毒治疗依从性有影响（OR=0.021，95%CI=0.005~0.088），其他因素差异均无统计学意义。结论与其他慢性疾病相比，乙型肝炎肝硬化患者的抗病毒治疗依从性水平并不低，影响抗病毒治疗依从性的因素主要是患者的治疗时间，治疗时间越长的患者，依从性越差。

关键词: 肝硬化, 乙型肝炎, 抗病毒药, 服药依从性

Abstract: Objective Based on real clinical data, we firstly evaluated the adherence to antiviral therapy of patients with HBVrelated cirrhosis and explored the factors influencing the adherence of these patients. Methods Demographic characteristics, routine biochemical and virological detection data and antiviral prescription information of patients with HBVrelated cirrhosis who were referred to Beijing You'an Hospital during Feb 14, 2008 and Dec 31, 2012 were collected from the hospital's electronic database. According to the patients' antiviral dispensary records, we used the medication possession rate(MPR) to evaluate the level of adherence to antiviral treatment of patients with HBVrelated cirrhosis. Multivariate logistic regression was used to analyze the factors affecting the good adherence.Results A total of 299 patients treated with ADV or ETV in Beijing area, with 117 patients being HBeAg positive and 182 being HBeAg negative. The male patients accounted for 65.9%. MPR was greater than or equal to 80% in most patients, accounting for 68%; the patients whose MPR greater than or equal to 95% accounted for 45%; the patients whose MPR was equal to 100% accounted for 26.1% and the patients whose MPR < 50% only accounted for 12%.Multivariate logistic regression was used to explore the factors associated with good adherence. Univariate analysis revealed that the medication adherence showed positive correlation with baseline ALB ≥ 35 g/L（OR=2.27，95%CI=1.4253.618）, baseline CHE≥4 000 U/L(OR=2.601, 95%CI=1.6174.183); and negative correlation with the longer treatment time (OR=0.549, 95%CI=0.3890.757). It was showed that only treatment time had significant association with medication adherence (OR=0.021, 95%CI=0.0050.088) through multivariate analysis. Conclusion Compared to other chronic diseases, the level of adherence to antiviral therapy of patients with HBVrelated cirrhosis is not lower. Patients with longer time of treatment tend to show poorer adherence.

Key words: liver cirrhosis, hepatitis B, antiviral agents, medication adherence

徐曼曼1，程凯亮2，邱倩3，赵欣宇2，段钟平1，王丽2，陈煜1. 乙型肝炎肝硬化患者抗病毒治疗依从性水平及其影响因素[J]. 临床荟萃, doi: 10.3969/j.issn.1004-583X.2018.11.008.

Xu Manman1, Cheng Kailiang2, Qiu Qian3, Zhao Xinyu2, Duan Zhongping1, Wang Li2, Chen Yu1. Factors associated with adherence to antiviral therapy in patients with HBV-related cirrhosis[J]. Clinical Focus, doi: 10.3969/j.issn.1004-583X.2018.11.008.

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https://huicui.hebmu.edu.cn/CN/Y2018/V33/I11/950

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乙型肝炎肝硬化患者抗病毒治疗依从性水平及其影响因素

Factors associated with adherence to antiviral therapy in patients with HBV-related cirrhosis

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