棕榈酸帕利哌酮注射液治疗稳定期精神分裂症患者中断的影响因素分析及预测模型构建  

Influencing factors and construction of predictive model for discontinuation of paliperidone palmitate injection in patients with stable schizophrenia

作　　者：王贤 徐韦云[1] 熊金霞[1] 蔡军[2] 汪作为[1] 施征宇 WANG Xian;XU Weiyun;XIONG Jinxia(Hongkou Mental Health Center,Shanghai 200083,China)

机构地区：[1]上海市虹口区精神卫生中心,上海市200083 [2]上海交通大学医学院附属精神卫生中心

出　　处：《精神医学杂志》2024年第5期465-469,共5页Journal of Psychiatry

基　　金：2023年上海市虹口区卫生健康委员会医学科研课题立项建设项目(编号:虹卫2303-16);上海市虹口区“公共卫生优秀青年人才培养计划”(编号:HKGWYQ2024-09);上海市虹口区精神卫生中心优秀人才培养计划(编号:2023YXQNRC01);2022年上海市虹口区科学技术委员会医学课题(编号:虹卫2201-04)。

摘　　要：目的研究每月注射一次的棕榈酸帕利哌酮注射液(PP1M)治疗稳定期精神分裂症患者中断的影响因素,并构建预测模型。方法选取使用PP1M治疗的稳定期精神分裂症患者122例,收集患者基本信息、疾病特征及治疗情况、康复支持等资料,随访一年,观察患者使用PP1M治疗的依从性,分析中断治疗的影响因素,并构建中断的预测模型。通过拟合优度检验评价模型拟合优度,再通过绘制工作特征(ROC)曲线,得到曲线下面积(AUC),评价模型预测价值。结果为期一年随访中,1例失访,有效随访121例,其中36例患者PP1M治疗中断,85例患者治疗依从,治疗中断率为29.75%。单因素分析显示工作情况、病程、不良反应、监护人年龄、监护人文化程度、家庭人均月收入、参加个案管理是影响治疗中断的相关因素(P<0.05)。回归分析结果显示,病程、不良反应、监护人文化程度、参加个案管理是PP1M治疗稳定期精神分裂症患者治疗中断的独立影响因素(P<0.01)。Hosmer-Lemeshow拟合优度检验显示,χ^(2)=2.811,P=0.941,受试者ROC曲线分析显示,治疗中断的预测模型AUC为0.826,95%CI为0.749~0.902,灵敏度为72.2%,特异度为76.5%。结论长病程、出现不良反应可能是稳定期精神分裂症患者PP1M治疗中断的危险因素,监护人文化程度高及患者参加个案管理是保护因素,依据上述因素构建的回归预测模型预测效能良好。Objective To explore the determinants of treatment interruption with once-monthly paliperidone palmitate(PP1M)injections in patients with stabilized schizophrenia and to develop a predictive model for such discontinuations.Methods A total of 122 patients diagnosed with stable schizophrenia who received PP1M treatment were selected and their demographic data,illness details,treatment histories,and rehabilitation assistance were collected,to conduct a one-year follow-up to monitor their adherence to PP1M therapy,and to analyze the influencing factors of discontinuation of treatment,and construct a prediction model of the interruption.The model’s goodness of fit was evaluated and its predictive value was analyzed through area under receiver operating characteristic(ROC)curve(AUC).Results During one-year follow-up,1 case was lost to follow-up,and 121 cases were effective follow-up,36 cases of PP1M treatment discontinuation,85 cases of treatment compliance,with treatment discontinuation rate of 29.75%.Univariate analysis showed that job status,course of disease,side effects,age of the guardian,educational level of the guardian,family income per month,and participation in case management were the related factors affecting treatment interruption(P<0.05).Binary logistic regression analysis showed that course of disease,side effects,educational level of the guardian,and participation in case management were the independent influencing factors of treatment discontinuation in patients with stable schizophrenia treated with PP1M(P<0.01).Hosmer-Lemeshow fit test showedχ^(2)=2.811,P=0.941,and ROC curves revealed that the AUC of the predictive model for treatment interruption was 0.826,95%CI:0.749~0.902,with a sensitivity of 72.2%and a specificity of 76.5%.Conclusion The long course of disease and side effects may be the risk factors of PP1M treatment discontinuation in stable schizophrenics.The high educational level of the guardians and the patients’participation in case management are the protective factors,and the regr

关 键 词：棕榈酸帕利哌酮 稳定期 精神分裂症 中断 影响因素 预测模型 

分 类 号：R749.3[医药卫生—神经病学与精神病学]