美沙酮维持治疗患者脱失情况影响因素的Logistic分析  

Logistic regression analysis of factors associated with drop out of drug users receiving community-based methadone maintenance treatment in Guangdong

作　　者：杨放[1] 林鹏[1] 何群[1] 李艳[1] 龙其穗[1] 罗玉兰[1] 

机构地区：[1]广东省疾病预防控制中心艾滋病防治所,广州510300

出　　处：《中国艾滋病性病》2011年第5期543-546,共4页Chinese Journal of Aids & STD

基　　金：广东省医学科研基金项目(A2008079)~~

摘　　要：目的分析广东省接受美沙酮维持治疗的患者接受治疗后的脱失情况,探讨影响患者治疗脱失率的影响因素。方法采用系统抽样的方法抽取3个城市治疗点和3个农村地区治疗点,利用国家统一的美沙酮维持治疗信息收集系统所收集的美沙酮维持治疗患者数据资料,包括社会人口学情况、尿检、治疗及随访情况等,采用Lo-gistic模型对21个自变量进行单因素分析,对单因素分析有统计学意义的自变量进行多因素分析,以确定影响接受美沙酮维持治疗的患者脱失的因素。结果共有2 728名接受美沙酮维持治疗的病患者纳入分析,其中男性2 448人,女性280人,2 728名患者维持治疗时间中位数为12.52个月(25%、75%位数分别为3.88、25.10月),累计脱失率为77.7%。经非条件Logistic多因素分析影响脱失率的因素包括:女性(OR=0.66)、有各种生活来源(OR=0.34～0.71)、尿吗啡检测阴性(OR=0.52)、没有被抓捕过(OR=0.49)、无脱失史(OR=0.36)等变量是美沙酮维持治疗脱失率的保护因素;而初中以下(OR=2.64)、高中或中专(OR=2.29)、认为治疗费用偏高(OR=4.09)、与家人关系较差(OR=1.68)、每天治疗剂量较低(少于30mg OR=1.61;31～50mg OR=1.34)、对治疗不满意(OR=1.71)、参加治疗时间较短(少于1年OR=1.96;1-2年OR=1.72)等变量是美沙酮维持治疗脱失的危险因素(均P<0.01或P<0.05)。结论广东省美沙酮维持治疗患者脱失率较高,为了提高病人的维持率,减少脱失应该改进门诊服务质量和治疗水平,应加强家庭和社会的参与和对病人的支持。Objective To explore the factors associated with drop out of drug users receiving community-based methadone maintenance treatment（MMT） in Guangdong province,Methods Six MMT clinics in rural and urban area were selected by systematic sampling,and the data including sociodemographic,testing,treatment and follow-up in the 6 MMT clinics were obtained from the national AIDS information system.Logistic regression analysis was employed to define the factors associated with duration of retention;21 independent variables were included for mono-analysis,among which 19 significant variables were analyzed by multiple analysis.Results A total of 2 728 patients were analyzed,among whom 2 448（89.7%）were males and 280 were females.The average retention duration was 12.52 months（the 25% and 75% percentile was 3.88,25 and 10 months,respectively）.and the cumulative drop out rate was 77.7%.Multiple Logistic analysis showed that female（OR=0.66）,having living support（OR =0.34～0.71）,negative urine morphine test（OR =0.52）,history of never being arrested（OR =0.49）or not being re-enrolled（0.36） were protective factor for reducing drop out;whereas education below primary schooling（OR=2.64）,high schooling and middle technical schooling（OR=2.29）,feeling too expensive MMT（OR=4.09）,keeping bad relationship with family（OR =1.68）,daily treatment dose less than 30 ml（OR =1.61） or between 31-50 ml（OR =1.34）,being unsatisfied with treatment（OR =1.71）,duration of MMT treatment less than 1 year（OR =1.96） or between 1 and 2 years（OR =1.72） were risk factors for MMT drop out,All the above P values were less than 0.01 or 0.05.Conclusion The cumulative MMT drop out rate in Guangdong is relatively high and to decrease drop out rate and raise the retention rate,the quality and skill of MMT should be improved,and supports from either family or society should be strengthened.

关 键 词：海洛因成瘾者 美沙酮维持治疗 脱失率 LOGISTIC回归分析 

分 类 号：R512.91[医药卫生—内科学]