【摘要】：背景結(jié)核病是當(dāng)前全球最重要的傳染性疾病之一,中國(guó)目前是世界上22個(gè)結(jié)核病高負(fù)擔(dān)國(guó)家之一,居第二位,貴州省肺結(jié)核疫情遠(yuǎn)高于全國(guó)平均水平。發(fā)現(xiàn)和治愈患者是我國(guó)現(xiàn)階段防控結(jié)核的主要措施,而患者的治療依從性是治愈肺結(jié)核的關(guān)鍵。目的分析貴州省肺結(jié)核病患者治療依從性現(xiàn)狀及影響因素,評(píng)價(jià)肺結(jié)核患者依從性量表(ARS量表)對(duì)依從性評(píng)價(jià)的效果,研發(fā)提高肺結(jié)核患者治療依從性的干預(yù)措施。研究結(jié)果有助于優(yōu)化貴州省有限的結(jié)核病防治資源,達(dá)到節(jié)約社會(huì)疾病控制成本與進(jìn)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(xué)意義。方法在貴州省88個(gè)縣中隨機(jī)抽取10個(gè)縣,選取這10個(gè)縣6個(gè)月期間的活動(dòng)性肺結(jié)核患者作為研究對(duì)象,運(yùn)用現(xiàn)況調(diào)查分析貴州省肺結(jié)核病患者治療依從性現(xiàn)狀;運(yùn)用隊(duì)列研究評(píng)價(jià)ARS量表對(duì)依從性評(píng)價(jià)的效果;運(yùn)用隨機(jī)對(duì)照試驗(yàn)研究評(píng)價(jià)依從性干預(yù)措施的效果。研究結(jié)果1、本次調(diào)查的1749例肺結(jié)核患者,在復(fù)查、取藥過(guò)程中至少出現(xiàn)過(guò)1次不依從的1001例,占57.2%。出現(xiàn)過(guò)2次不依從占17.2%;出現(xiàn)過(guò)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(jié)束時(shí)更是高達(dá)19.8%;患者診斷結(jié)果、患者初復(fù)治情況與總體依從情況有顯著性差異(P0.05)�；颊咴\斷結(jié)果、初復(fù)治情況同時(shí)為患者治療總體依從性的影響因素(P0.05)。2、ARS量表評(píng)分結(jié)果與實(shí)際依從性結(jié)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(píng)分和初復(fù)治情況均是患者實(shí)際依從性的主要影響因素,P0.05。經(jīng)多因素分析,ARS評(píng)分OR=5.649,表明在初復(fù)治情況相同的前提下,ARS評(píng)分為依從者的復(fù)查依從性是評(píng)分為不依從者的5.649倍。3、干預(yù)組5月末和6(8)月末治療依從性顯著高于對(duì)照組;在出現(xiàn)延遲的患者中,干預(yù)組5月末和6(8)月末平均延遲天數(shù)顯著低于對(duì)照組;經(jīng)多因素分析,提示“是否干預(yù)”是患者治療依從性的重要影響因素。研究結(jié)論1、貴州省肺結(jié)核患者規(guī)范治療比例非常低;貴州省肺結(jié)核患者延遲程度還比較輕;總體依從性涂陽(yáng)患者較涂陰患者好,初治患者較復(fù)治患者好。2、ARS量表能較準(zhǔn)確地前瞻性評(píng)估患者治療依從性,但是需要進(jìn)一步改進(jìn)。3、開(kāi)發(fā)的開(kāi)展適當(dāng)健康教育和縣級(jí)強(qiáng)化督導(dǎo)的干預(yù)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(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R521

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