【摘要】：背景結核病是當前全球最重要的傳染性疾病之一,中國目前是世界上22個結核病高負擔國家之一,居第二位,貴州省肺結核疫情遠高于全國平均水平。發(fā)現(xiàn)和治愈患者是我國現(xiàn)階段防控結核的主要措施,而患者的治療依從性是治愈肺結核的關鍵。目的分析貴州省肺結核病患者治療依從性現(xiàn)狀及影響因素,評價肺結核患者依從性量表(ARS量表)對依從性評價的效果,研發(fā)提高肺結核患者治療依從性的干預措施。研究結果有助于優(yōu)化貴州省有限的結核病防治資源,達到節(jié)約社會疾病控制成本與進一步提高我省總體治療依從率的雙重目的,具有重要的公共衛(wèi)生學意義。方法在貴州省88個縣中隨機抽取10個縣,選取這10個縣6個月期間的活動性肺結核患者作為研究對象,運用現(xiàn)況調(diào)查分析貴州省肺結核病患者治療依從性現(xiàn)狀;運用隊列研究評價ARS量表對依從性評價的效果;運用隨機對照試驗研究評價依從性干預措施的效果。研究結果1、本次調(diào)查的1749例肺結核患者,在復查、取藥過程中至少出現(xiàn)過1次不依從的1001例,占57.2%。出現(xiàn)過2次不依從占17.2%;出現(xiàn)過3次不依從占5.1%。在1001例出現(xiàn)不依從患者中,延遲2~9天的占50%左右;延遲天數(shù)大于30天的,在療程結束時更是高達19.8%;患者診斷結果、患者初復治情況與總體依從情況有顯著性差異(P0.05)�；颊咴\斷結果、初復治情況同時為患者治療總體依從性的影響因素(P0.05)。2、ARS量表評分結果與實際依從性結果有一定的吻合度(Kappa系數(shù)=0.403,P0.001),靈敏度為71.1%,特異度為70.2%,正確指數(shù)為0.41。在眾多影響因素中ARS評分和初復治情況均是患者實際依從性的主要影響因素,P0.05。經(jīng)多因素分析,ARS評分OR=5.649,表明在初復治情況相同的前提下,ARS評分為依從者的復查依從性是評分為不依從者的5.649倍。3、干預組5月末和6(8)月末治療依從性顯著高于對照組;在出現(xiàn)延遲的患者中,干預組5月末和6(8)月末平均延遲天數(shù)顯著低于對照組;經(jīng)多因素分析,提示“是否干預”是患者治療依從性的重要影響因素。研究結論1、貴州省肺結核患者規(guī)范治療比例非常低;貴州省肺結核患者延遲程度還比較輕;總體依從性涂陽患者較涂陰患者好,初治患者較復治患者好。2、ARS量表能較準確地前瞻性評估患者治療依從性,但是需要進一步改進。3、開發(fā)的開展適當健康教育和縣級強化督導的干預措施有效,能提高患者治療依從性。
[Abstract]:Background Tuberculosis is one of the most important infectious diseases in the world. At present, China is one of the 22 countries with high TB burden in the world, ranking the second place. The epidemic situation of tuberculosis in Guizhou Province is much higher than the national average. Finding and curing patients is the main measure to prevent and control tuberculosis in our country at present, and the treatment compliance of patients is the key to cure tuberculosis. Objective to analyze the status quo and influencing factors of pulmonary tuberculosis compliance in Guizhou province, to evaluate the effect of pulmonary tuberculosis compliance scale (ARS), and to develop intervention measures to improve pulmonary tuberculosis compliance. The results are helpful to optimize the limited resources of tuberculosis prevention and control in Guizhou province, to save the cost of social disease control and to further improve the compliance rate of general treatment in Guizhou Province, which has important public health significance. Methods A total of 10 counties were randomly selected from 88 counties of Guizhou Province. The patients with active pulmonary tuberculosis in these 10 counties were selected as research objects. The current status of compliance of pulmonary tuberculosis patients in Guizhou Province was analyzed. Cohort study was used to evaluate the effectiveness of ARS scale for compliance evaluation, and randomized controlled trial was used to evaluate the effectiveness of compliance intervention. Results 1. 1001 cases (57.2%) of the 1749 pulmonary tuberculosis patients in this study who had failed to comply at least once in the course of reexamination and withdrawal. There have been two disobedience accounts for 17.2 and three disobedience for 5.1. Of the 1001 patients who did not comply, 50% had a delay of 2 or 9 days, and those with a delay of more than 30 days were as high as 19. 8% at the end of the course of treatment. There was significant difference between the initial relapse and the overall compliance of the patients (P0.05). The initial relapse was also the influencing factor of the patients' overall compliance (P0.05). 2There was a certain degree of agreement between the scores of ARS and the actual compliance (Kappa coefficient = 0.403 P0.001). The sensitivity was 71.1, the specificity was 70.2, and the correct index was 0.41. Among the many influencing factors, ARS score and initial relapse were the main influencing factors of patients' actual compliance (P0.05). By multivariate analysis, ARS score OR=5.649, showed that the reexamination compliance of those with ARS score was 5.649 times higher than that of those who did not. The therapeutic compliance of the intervention group was significantly higher than that of the control group at the end of May and the end of 6 (8). The average delay days in the intervention group at the end of May and at the end of 6 (August) were significantly lower than those in the control group. Conclusion 1, the proportion of standardized treatment for pulmonary tuberculosis patients in Guizhou Province is very low, the delay degree of pulmonary tuberculosis patients in Guizhou Province is still relatively light; The overall compliance of smear positive patients is better than that of smear negative patients, and that of newly treated patients is better than that of re-treated patients. 2 the ARS scale can accurately and prospectively evaluate the patients' compliance with treatment, but further improvement is needed. The developed intervention measures of appropriate health education and intensive supervision at county level are effective and can improve the compliance of patients with treatment.
【學位授予單位】：第三軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R521

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