基于倾向性评分法评估耐药肺结核患者疾病感知与服药依从性的相关性

郑珍慧; 江巧敏; 张尊敬

doi:10.16766/j.cnki.issn.1674-4152.003246

基于倾向性评分法评估耐药肺结核患者疾病感知与服药依从性的相关性

doi: 10.16766/j.cnki.issn.1674-4152.003246

丽水市中医院结核病科，浙江丽水 323000

基金项目:

浙江省中医药科技计划项目 2022ZB399

详细信息

通讯作者:
张尊敬，E-mail：lsszyykjk@163.com

中图分类号: R521
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- 文章访问数: 189
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- 被引次数: 0
出版历程
- 收稿日期: 2023-03-31
- 网络出版日期: 2024-01-13

Evaluation of the association between disease perception and medication adherence in patients with drug-resistant pulmonary tuberculosis using the propensity score method

Tuberculosis Department, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang 323000, China

摘要

摘要: 目的耐药肺结核(MDR-TB)患者的服药依从性问题已引起高度重视，本研究采用倾向性评分法(PSM)探讨疾病感知与服药依从性的相关性。方法选取2019年6月—2022年10月丽水市中医院结核病科收治的172例MDR-TB患者，依据Morisky服药依从性量表(MMAS-8)分成依从性良好组(103例)和依从性较差组(69例)。比较组间相关资料和简易疾病感知问卷(BIPQ)量表评分，采用logistic回归分析研究MDR-TB患者服药依从性的影响因素。PSM法按照1∶1的比例进行组间均衡匹配，比较PSM匹配后组间资料。分析PSM匹配前后MDR-TB患者MMAS-8、BIPQ量表评分的相关性。结果 PSM匹配前，依从性良好组年龄＜60岁、病程＜2年、高中及以上文化水平、家庭月收入≥6 000元、家人督导服药的比例高于依从性较差组(均P＜0.05)，医疗自费、有药物不良反应的比例和BIPQ量表评分低于依从性较差组(均P＜0.05)。年龄、病程、文化水平、家庭经济水平、医疗支付方式、药物不良反应、BIPQ量表评分是MDR-TB患者服药依从性的独立影响因素(均P＜0.05)。PSM匹配48对，依从性良好组BIPQ量表评分低于依从性较差组[(35.17±5.78)分vs. (43.22±6.25)分，t=6.551，P＜0.05]。PSM匹配前后BIPQ、MMAS-8量表评分均呈负相关关系(r=-0.674、-0.574，均P＜0.05)。结论 MDR-TB患者服药依从性的影响因素较多，其疾病感知水平与服药依从性呈负相关。
- 耐药肺结核 /
- 倾向性评分法 /
- 疾病感知 /
- 服药依从性 /
- 相关性
Abstract: Objective The issue of medication adherence in patients with multi drug-resistance tuberculosis (MDR-TB) has received much attention. This study used propensity score matching (PSM) to explore the relationship between disease perception and medication adherence. Methods From June 2019 to October 2022, 172 patients with MDR-TB admitted to the tuberculosis department of Lishui Hospital of Traditional Chinese Medicine, and were divided into a good compliance group (n=103) and a poor compliance group (n=69) according to the Morisky medication adherence scale (MMAS-8). The relevant data between groups and the scores of the brief illness perception questionnaire (BIPQ) were compared, and the factors influencing MDR-TB patients' medication adherence were analyzed logistically. The PSM method performs balanced 1∶1 matching between groups and compares data between groups after PSM matching. To analyze the correlation between MMAS-8 and BIPQ scores in MDR-TB patients before and after PSM matching. Results Before PSM matching, the proportion of the good compliance group with age < 60 years, disease duration < 2 years, education level of high school or above, family monthly income ≥6 000 yuan, and family supervised medication use was higher than that of the poor compliance group (all P < 0.05); the proportion of medical expenses, adverse drug reactions, and BIPQ score were lower in the poor compliance group (all P < 0.05). Age, disease course, level of education, family economic level, method of medical payment, adverse drug reactions and BIPQ scale scores were independent predictors of drug adherence in MDR-TB patients (all P < 0.05). After 48 pairs of PSM were successfully matched, the BIPQ of the good compliance group was still significantly lower than that of the poor compliance group [(35.17±5.78) points vs. (43.22±6.25) points, t=6.551, P < 0.05]. There was a moderate negative correlation between BIPQ and MMAS-8 scores in MDR-TB patients before and after PSM matching (r=-0.674, -0.574, all P < 0.05). Conclusion There are many factors influencing drug adherence in MDR-TB patients, and their level of disease perception is strongly negatively correlated with drug adherence.
- Drug-resistant pulmonary tuberculosis /
- Propensity score matching /
- Disease perception /
- Medication adherence /
- Relevance

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表 1 PSM匹配前2组MDR-TB患者相关资料比较

Table 1. Comparison of relevant data between two groups of MDR-TB patients before PSM matching

项目	依从性良好组(n=103)	依从性较差组(n=69)	统计量	P值
性别[例(%)]			1.057^a	0.304
男性	53(51.46)	41(59.42)
女性	50(48.54)	28(40.58)
年龄[例(%)]			4.703^a	0.030
＜60岁	65(63.11)	32(46.38)
≥60岁	38(36.89)	37(53.62)
病程[例(%)]			5.162^a	0.023
＜2年	70(67.96)	35(50.72)
≥2年	33(32.04)	34(49.28)
文化水平[例(%)]			4.090^a	0.043
初中及以下	45(43.69)	41(59.42)
高中及以上	58(56.31)	28(40.58)
婚姻状况[例(%)]			0.325^a	0.850
已婚	80(77.67)	51(73.91)
未婚	13(12.62)	10(14.49)
离婚/丧偶	10(9.71)	8(11.59)
居住地[例(%)]			1.837^a	0.175
城镇	63(61.17)	35(50.72)
农村	40(38.83)	34(49.28)
家庭经济水平[例(%)]			4.641^a	0.031
月收入＜6 000元	41(39.81)	39(56.52)
月收入≥6 000元	62(60.19)	30(43.48)
医疗支付方式[例(%)]			4.897^a	0.027
自费	42(40.78)	40(57.97)
医保	61(59.22)	29(42.03)
服药方式[例(%)]			4.090^a	0.043
自行服药	45(43.69)	41(59.42)
家人督导服药	58(56.31)	28(40.58)
药物不良反应[例(%)]			4.325^a	0.038
有	25(24.27)	27(39.13)
无	78(75.73)	42(60.87)
BIPQ量表评分(x±s, 分)	35.24±6.05	43.27±7.10	7.953^b	＜0.001
注：^a为χ²值，^b为t值。

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表 2 PSM匹配前MDR-TB患者服药依从性的多因素logistic分析

Table 2. Multivariate logistic analysis of medication compliance of MDR-TB patients before PSM matching

项目	B	SE	Wald χ²	P值	OR值	95% CI
年龄	0.377	0.157	5.766	0. 005	1.458	1.203~4.278
病程	0.410	0.201	4.161	0.013	1.506	1.141~2.583
文化水平	-0.669	0.214	6.087	0.027	0.512	0.317~0.974
家庭经济水平	-0.562	0.209	8.715	0.003	0.570	0.335~0.983
医疗支付方式	-0.467	0.319	12.481	0.002	0.627	0.401~0.904
家人督导服药	-0.540	0.212	6.488	0.018	0.583	0.301~0.799
药物不良反应	0.186	0.084	4.903	0.028	1.204	1.032~1.837
BIPQ量表评分	0.380	0.127	8.953	0.015	1.462	1.187~5.625

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表 3 PSM匹配后2组MDR-TB患者相关资料比较

Table 3. Comparison of relevant data between two groups of MDR-TB patients after PSM matching

项目	依从性良好组(n=48)	依从性较差组(n=48)	统计量	P值
性别[例(%)]			0.169^a	0.681
男性	28(58.33)	26(54.17)
女性	20(41.67)	22(45.83)
年龄[例(%)]			0.377^a	0.539
＜60岁	27(56.25)	24(50.00)
≥60岁	21(43.75)	24(50.00)
病程[例(%)]			0.375^a	0.540
＜2年	25(52.08)	22(45.83)
≥2年	23(47.92)	26(54.17)
文化水平[例(%)]			0.379^a	0.538
初中及以下	20(41.67)	23(47.92)
高中及以上	28(58.33)	25(52.08)
婚姻状况[例(%)]			0.272^a	0.873
已婚	37(77.08)	39(81.25)
未婚	7(14.58)	6(12.50)
离婚/丧偶	4(8.33)	3(6.25)
居住地[例(%)]			0.389^a	0.533
城镇	30(62.50)	27(56.25)
农村	18(37.50)	21(43.75)
家庭经济水平[例(%)]			0.396^a	0.529
月收入＜6 000元	17(35.42)	20(41.67)
月收入≥6 000元	31(64.58)	28(58.33)
医疗支付方式[例(%)]			0.697^a	0.404
自费	17(35.42)	21(43.75)
医保	31(64.58)	27(56.25)
服药方式[例(%)]			0.383^a	0.536
自行服药	19(39.58)	22(45.83)
督导服药	29(60.42)	26(54.17)
药物不良反应[例(%)]			0.515^a	0.473
有	10(20.83)	13(27.08)
无	38(79.17)	35(72.92)
BIPQ量表评分(x±s, 分)	35.17±5.78	43.22±6.25	6.551^b	＜0.001
注：^a为χ²值，^b为t值。

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