系统化干预对小剂量利妥昔单抗治疗视神经脊髓炎谱系疾病患者依从性的影响

王线妮; 任婷婷; 孙唐娜; 郭俊; 朱小宇; 范珊红

doi:10.16766/j.cnki.issn.1674-4152.001717

系统化干预对小剂量利妥昔单抗治疗视神经脊髓炎谱系疾病患者依从性的影响

doi: 10.16766/j.cnki.issn.1674-4152.001717

空军军医大学唐都医院神经内科，陕西西安 710038

基金项目:

陕西省自然科学基金项目 2016JM8033

详细信息

通讯作者:
范珊红，E-mail：123476457@qq.com

中图分类号: R744.52 R741.05
计量
- 文章访问数: 128
- HTML全文浏览量: 30
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2020-01-18
- 网络出版日期: 2022-02-19

Effect of systemic interventions on compliance of patients with neuromyelitis optica spectrum disorder treated with low-dose rituximab

Department of Neurology, Tangdu Hospital, the Air Force Military Medical University, Xi'an, Shaanxi 710038, China

摘要

摘要: 目的探讨系统化干预对小剂量利妥昔单抗治疗视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorder, NMOSD)患者治疗依从性的影响，为降低患者复发率、提高治疗效果提供证据支持。方法选取2014年9月—2019年9月在空军军医大学唐都医院诊治的NMOSD患者89例，将所有患者按简单随机化分为观察组(46例)和对照组(43例)，对照组给予常规治疗和护理，观察组实施系统化干预措施。比较2组患者治疗依从性、年复发率(ARR)和复发人数，并采用临床扩展残疾状况评分量表(EDSS)、日常生活能力量表(ADL)评价患者神经功能改善情况。结果观察组患者的治疗依从性为100.00%，显著高于对照组的81.40%，差异有统计学意义(P=0.002)；观察组患者的年复发率为0.23±0.16，低于对照组的0.56±0.15(P=0.002)；观察组患者诱导期结束1年时的EDSS评分为(1.71±0.69)分, 显著低于对照组[(2.36±1.25)分，P=0.017]；观察组患者诱导期结束1年时ADL评分为(78.25±10.83)分, 显著高于对照组[(71.12±10.12)分，P=0.046]。结论系统化干预能有效提高NMOSD患者对疾病的认知度和治疗依从性，对减少疾病复发、改善神经功能和提高生存质量都具有积极的临床意义。
- 视神经脊髓炎谱系疾病 /
- 利妥昔单抗 /
- 系统化干预 /
- 依从性
Abstract: Objective To investigate the effect of systematic intervention on treatment compliance of patients with neuromyelitis optica spectrum disorder (NMOSD) treated with low-dose rituximab, and to provide evidence to reduce the recurrence rate and improve the treatment effect. Methods Eighty-nine NMOSD patients treated in Tangdu Hospital of Air Force Military Medical University from September 2014 to September 2019 were selected and randomly divided into observation group (46 cases) and control group (43 cases). Routine treatment and nursing were given to the control group, and systematic intervention measures were implemented to the observation group. Treatment compliance, annual recurrence rate (ARR) and number of recurrent patients in the 2 groups were compared. The improved neurological function of the patients was evaluated by the Clinical Extended Disability Scale (EDSS) and the Daily Living Ability Scale (ADL). Results The treatment compliance of patients in the observation group was 100.00%, significantly higher than that of the control group (81.40%), and the difference was statistically significant (P=0.002). The annual recurrence rate in the observation group was 0.23±0.16, lower than that in the control group (0.56±0.15, P=0.002). The EDSS score of the observation group at 1 year after the induction period was (1.71±0.69) points, which was significantly lower than that of the control group [(2.36±1.25) points, P=0.017]. At 1 year after the induction period, the ADL score of patients in the observation group was (78.25±10.83) points, which was significantly higher than that of the control group [(71.12±10.12) points, P=0.046]. Conclusion Systematic intervention can effectively improve the disease awareness and treatment compliance of NMOSD patients, and has positive clinical significance for reducing disease recurrence, improving neurological function and improving quality of life.
- Neuromyelitis optica spectrum disorders /
- Rituximab /
- Systemic intervention /
- Compliance

HTML全文

表 1 2组NMOSD患者治疗依从性比较[例(%)]

组别	例数	完全依从	部分依从	不依从	依从率(%)
观察组	46	43(93.48)	3(6.52)	0(0.00)	100.00(46/46)
对照组	43	28(65.12)	7(16.28)	8(18.60)	81.40(35/43)
注：2组依从性比较，Z=-3.049，P=0.002。

下载: 导出CSV

表 2 2组NMOSD患者EDSS评分比较(x ±s, 分)

组别	例数	治疗前	诱导期结束时	诱导期结束后6个月	诱导期结束1年
观察组	46	3.63±1.03	2.32±0.82	2.21±1.42	1.71±0.69^a
对照组	43	3.47±1.56	2.20±1.21	2.16±0.95	2.36±1.25^a
t值		0.113	-0.423	-2.858	-2.500
P值		0.911	0.675	0.007	0.017
注：与治疗前比较，^aP < 0.05。

下载: 导出CSV

表 3 2组NMOSD患者ADL评分比较(x ±s, 分)

组别	例数	治疗前	诱导期结束时	诱导期结束后6个月	诱导期结束1年
观察组	46	67.29±11.23	68.12±10.05	71.36±10.56	78.25±10.83^a
对照组	43	66.88±10.78	66.68±11.15	70.20±11.23	71.12±10.12^a
t值		-0.015	-1.081	0.577	1.827
P值		0.988	0.286	0.567	0.046
注：与治疗前比较，^aP < 0.05。

下载: 导出CSV

参考文献(24)

[1]	中国免疫学会神经免疫学分会, 中华医学会神经病学分会神经免疫学组, 中国医师协会神经内科分会神经免疫专业委员会. 中国视神经脊髓炎谱系疾病诊断与治疗指南[J]. 中国神经免疫学和神经病学杂志, 2016, 23(3): 155-166. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSMB201603001.htm
[2]	DAMATO V, EVOLI A, IORIO R. Efficacy and safety of rituximab therapy in neuromyelitis optica spectrum disorders: a systematic review and meta-analysis[J]. JAMA Neurol, 2016, 73(11): 1342-1348. doi: 10.1001/jamaneurol.2016.1637
[3]	SHAYGANNEJAD V, FAYYAZI E, BADIHIAN S, et al. Long-term tolerability, safety and efficacy of rituximab in neuromyelitis optica spectrum disorder: a prospective study[J]. J Neurol, 2019, 266(3): 642-650. doi: 10.1007/s00415-019-09180-9
[4]	俞海, 陈向军, 于雪, 等. 减量利妥昔单抗治疗视神经脊髓炎谱系疾病的疗效和安全性观察观察[J]. 中国临床神经科学, 2019, 27(3): 309-312, 320. https://www.cnki.com.cn/Article/CJFDTOTAL-LCSK201903016.htm
[5]	贾晓涛, 顾乃兵, 刘志勤, 等. 小剂量利妥昔单抗序贯治疗视神经脊髓炎谱系疾病的临床疗效观察[J]. 中西医结合心脑血管病杂志, 2018, 16(22): 3256-3258. doi: 10.12102/j.issn.1672-1349.2018.22.005
[6]	LEE K J, CHO S J, KIM B C, et al. Caregiver preference and treatment compliance in patients with mild-to-moderate Alzheimer's disease in South Korea: RECAP study results[J]. Adv Ther, 2017, 34(2): 481-494. doi: 10.1007/s12325-016-0465-8
[7]	钱华, 朱雅芳, 王佳良, 等. 新型药学服务模式对患者用药安全及依从性的干预效果[J]. 中华全科医学, 2019, 17(7): 1218-1221. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201907044.htm
[8]	赖小星, 朱宏伟, 霍晓鹏, 等. 老年多重用药患者用药依从性现状及其以影响因素的研究[J]. 中国护理管理, 2016, 16(12): 1638-1642. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL201612014.htm
[9]	刘玉衡, 金立军. 冠心病患者药物治疗依从性的研究进展[J]. 心血管病学进展, 2019, 40(1): 113-116. https://www.cnki.com.cn/Article/CJFDTOTAL-XXGB201901031.htm
[10]	刘继红, 廖春莲. 应用手机APP提高帕金森患者服药依从性的家庭管理研究[J]. 现代医药卫生, 2019, 35(21): 3278-3280. doi: 10.3969/j.issn.1009-5519.2019.21.011
[11]	HOSSAIN A, MITHILA O. Sleep duration and treatment compliance: a population-based cross-sectional study of hypertensive patients in Bangladesh[J]. BMC Res Notes, 2016, 9(1): 271. doi: 10.1186/s13104-016-2075-6
[12]	CABRE P, MEJDOUBI M, JEANNIN S, et al. Treatment of neuromyelitis optica with rituximab: a 2-year prospective multicenter study[J]. J Neurol, 2018, 265(4): 917-925. doi: 10.1007/s00415-018-8771-5
[13]	GAO F, CHAI B, GU C, et al. Effectiveness of rituximab in neuromyelitis optica: a meta-analysis[J]. BMC Neurol, 2019, 19(1): 36. doi: 10.1186/s12883-019-1261-2
[14]	ZHANG M, ZHANG C, BAI P, et al. Effectiveness of low dose of rituximab compared with azathioprine in Chinese patients withneuromyelitis optica: an over 2-year follow-up study[J]. Acta Neurol Belg, 2017, 117(3): 695-702. doi: 10.1007/s13760-017-0795-6
[15]	谢屿平, 卢娉霞. 视神经脊髓炎免疫学发病机制研究进展[J]. 国际检验医学杂志, 2019, 40(1): 107-111. doi: 10.3969/j.issn.1673-4130.2019.01.028
[16]	张隽, 陈海, 康海娟, 等. 利妥昔单抗治疗5例难治性视神经脊髓炎谱系疾病长期疗效观察[J]. 中国神经免疫学和神经病学杂志, 2016, 23(4): 235-239. doi: 10.3969/j.issn.1006-2963.2016.04.002
[17]	傅拥军, 菅颖, 胡慧群. 急性心肌梗死经PCI术后行延续性护理对患者心理状态和服药依从性的影响[J]. 中华全科医学, 2018, 16(2): 326-329. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201802047.htm
[18]	徐蕾, 金锋, 刘诗盈, 等. 乳腺癌患者内分泌治疗依从性的社会心理学影响因素及行为干预的研究进展[J]. 实用医学杂志, 2018, 34(17): 2974-2977. doi: 10.3969/j.issn.1006-5725.2018.17.037
[19]	王芳, 沈光银, 冯俊, 等. 正念减压疗法对慢性心力衰竭患者自我感受负担及依从性的影响[J]. 安徽医学, 2018, 39(9): 1142-1145. doi: 10.3969/j.issn.1000-0399.2018.09.034
[20]	齐蒙蒙, 蒋玲, 李科, 等. 住院高血压病人治疗依从性现状及其影响因素分析[J]. 全科护理, 2019, 17(28): 3562-3564. doi: 10.12104/j.issn.1674-4748.2019.28.032
[21]	吕曼曼, 吕小林, 陶菁. 全程系统化干预对慢性肾衰竭患者疗效及治疗依从性的影响[J]. 解放军预防医学杂志, 2019, 37(11): 18-19. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYX201911007.htm
[22]	李淑红, 张斌斌, 王波, 等. 健康信念模式主导的护理干预对空巢老年缺血性脑卒中患者治疗依从性及疗效的影响[J]. 中华全科医学, 2017, 15(3): 537-539. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201703054.htm
[23]	李峰, 陶蕾, 徐星, 等. 基于微信平台的延续护理对肿瘤患者居家口服化疗药物依从性的影响[J]. 安徽医学, 2019, 40(4): 456-459. doi: 10.3969/j.issn.1000-0399.2019.04.030
[24]	EKINCI E, NATHOO S, KORATTIL T, et al. Interventions to improve endocrine therapy adherence in breast cancer survivors: what is the evidence?[J]. J Cancer Surviv, 2018, 12(3): 348-356. doi: 10.1007/s11764-017-0674-4