2018-2019年云南省某医院肝癌高危人群肝癌监测依从性变化及影响因素分析  

Changes in adherence to hepatocellular carcinoma surveillance among high-risk population in a hospital in Yunnan and the related influencing factors

作　　者：刘畅 戴静毅 赵军[1] LIU Chang;DAI Jing-yi;ZHAO Jun(School of Public Health,Hubei University of Medicine,Shiyan,Hubei 442000,China;不详)

机构地区：[1]湖北医药学院公共卫生与健康学院,湖北十堰442000 [2]云南省昆明市第三人民医院公共实验室暨新发传染病研究部

出　　处：《中国预防医学杂志》2023年第2期122-128,共7页Chinese Preventive Medicine

基　　金：“十四五”湖北省高等学校优势特色学科群项目(2022PHXK01);湖北省教育厅人文社会科学研究项目(21Y168);湖北医药学院研究生科技创新项目(YC2021048)。

摘　　要：目的 评估2018—2019年云南省某医院肝癌高危人群的肝癌监测依从性,探索两个监测周期肝癌监测依从性的变化及其影响因素。方法 2018年5月—2019年1月共招募380例具有肝癌风险的患者入组,进行基础问卷调查,并在入组后6个月和12个月分别进行电话随访,记录肝癌监测时间、检查项目等。以未监测、不定期监测、定期监测为有序结果变量,建立有序logistic回归模型分析肝癌高危人群肝癌监测依从性的影响因素。以入组后前6个月为第1个监测周期,后6个月为第2个监测周期,探索两个监测周期肝癌监测依从性的变化。结果 入组后第1个监测周期成功随访301例,第二个周期成功随访241例。完成两个周期监测的患者仅有45例(18.67%)。有序logistic回归分析结果显示,因慢性肝病的年就医频率、肝病病因是肝癌监测依从性独立的影响因素。因慢性肝病的年就医次数≥3次(OR=2.68, 95%CI:1.23~5.95)、肝硬化(OR=3.50, 95%CI:1.47~8.47)、乙肝(OR=2.50, 95%CI:1.21~5.25)的患者肝癌监测依从性更好。二分类logistic回归分析结果显示,在第1个监测周期中,肝硬化(OR=4.32, 95%CI:1.82~10.65)、乙肝(OR=2.71, 95%CI:1.29~5.87)、因慢性肝病年就医次数≥3次(OR=4.91,95%CI:2.12~12.38)的患者肝癌监测依从性更好;在第2个监测周期中,少数民族的患者(OR=0.37,95%CI:0.15~0.84)监测依从性较差,月收入800~6 000元的患者(OR=2.52,95%CI:1.22~5.43)监测依从性更好。结论 肝癌高危人群对于肝癌监测的总体依从性较差;就医频率高、肝硬化和乙肝的患者肝癌监测的整体依从性更好;收入低的患者和少数民族患者更容易在长期的监测中产生“监测疲劳”。Objective To understand the adherence to hepatocellular carcinoma surveillance in high-risk population in a hospital in Yunnan, and to discuss the changes and related influencing factors of adherence to hepatocellular carcinoma surveillance during two surveillance periods after enrollment in 2018—2019.Methods A total of 380 patients with high risk of hepatocellular carcinoma were recruited from May 2018 to January 2019 in a hospital. A basic questionnaire survey was conducted at enrollment, and two telephone followups were performed at 6 and 12 months after enrollment to record the surveillance time and types of examination.Regular surveillance, irregular surveillance and surveillance failure were defined if patients received surveillance tests for liver cancer every six months during a one-year follow-up. once or twice but both in the first or last six months and no surveillance tests. With no surveillance, irregular surveillance and regular surveillance as outcome variables, an ordinal logistic regression model was constructed to analyze the influencing factors of hepatocellular carcinoma surveillance adherence in high-risk population. Changes in the adherence to hepatocellular carcinoma surveillance from the first period(the first 6 months) to the second period(the last 6 month) were analyzed. Results 301 patients were successfully followed up in the first surveillance period and 241 in the second period after enrollment. Only 45 patients(18. 67%) completed both surveillance periods. Ordinal logistic regression analysis showed that annual frequency of hospital visits for chronic liver diseases and causes of liver diseases were independent influencing factors for adherence to hepatocellular carcinoma surveillance. Patients with ≥3 times annual hospital visits due to chronic liver diseases(OR = 2. 68, 95%CI: 1. 23-5. 95) or with liver cirrhosis(OR = 3. 50, 95%CI: 1. 47-8. 47) or hepatitis B(OR = 2. 50, 95%CI: 1. 21-5. 25) had better compliance with hepatocellular carcinoma surveillance. Binary logistic regre

关 键 词：肝癌 高危人群 监测 依从性 影响因素 

分 类 号：R735.7[医药卫生—肿瘤]