肺结核患者治疗不依从影响因素分析及风险预测模型的构建研究  

Analysis of factors influencing treatment non-adherence in pulmonary tuberculosis patients and construction of a risk prediction model

作　　者：阮淑金 陈敬芳 王秀芬[3] 张丹丹[3] 李孟君 孟婷 Ruan Shujin;Chen Jingfang;Wang Xiufen;Zhang Dandan;Li Mengjun;Meng Ting(School of Nursing,University of South China,Hengyang 421001,China;Scientific Research and Teaching Department,Shenzhen Third People’s Hospital,Shenzhen 518112,China;Department of Pulmonary Medicine,Shenzhen Third People’s Hospital,Shenzhen 518112,China)

机构地区：[1]南华大学护理学院,衡阳421001 [2]深圳市第三人民医院科研教学部,深圳518112 [3]深圳市第三人民医院肺病医学部,深圳518112

出　　处：《结核与肺部疾病杂志》2025年第2期183-190,共8页Journal of Tuberculosis and Lung Disease

基　　金：深圳市自然科学基金(JCYJ20220530163403008);深圳市第三人民医院院级课题(G001366)。

摘　　要：目的:分析肺结核患者治疗不依从性的现状及影响因素,并构建治疗不依从风险预测模型,为筛选高风险人群提供参考。方法:采用便利抽样法,从2024年6—8月国家感染性疾病临床医学研究中心抽取就诊的年龄≥18岁确诊并进行抗结核药物治疗的肺结核患者为研究对象,通过问卷调查的方式收集符合入组标准患者的一般人口学资料和临床资料。按照7∶3的比例将纳入的患者随机分为训练集和验证集,根据是否依从治疗将训练集患者分为“治疗依从”和“治疗不依从”两组,采用二元logistic回归模型分析影响患者治疗不依从的因素并建立预测模型,再采用受试者工作特征曲线下面积(AUC)评估模型的预测性能和验证集的验证准确性。结果:参照入组标准,研究共纳入300例肺结核患者,发放300份问卷,有效回收率为98.33%(295/300)。295例纳入患者中,治疗依从者240例(81.36%),不依从者55例(18.64%);训练集207例,包括治疗依从者167例和不依从者40例;验证集88例,包括治疗依从者73例和不依从者15例。多因素logistic回归分析显示,复治、年龄校正Charlson共病指数(ACCI)评分>4分和中药治疗均是治疗不依从的危险因素[OR(95%CI)=8.207(2.393~28.146);OR(95%CI)=4.262(1.305~13.917);OR(95%CI)=16.276(2.564~103.306)],而高社会支持水平是治疗不依从的保护因素[OR(95%CI)=0.038(0.012~0.117)]。基于上述4个因素构建的风险预测模型的AUC(95%CI)值为0.927(0.880~0.974),敏感度为92.50%(37/40),特异度为82.04%(137/167),约登指数为0.75,此时对应的模型预测概率值为0.126。88例验证集模型的AUC(95%CI)值为0.841(0.753~0.985),敏感度为80.00%(12/15),特异度为84.93%(62/73),准确率为84.09%(74/88)。结论:本医疗机构就诊的肺结核患者治疗不依从率较低,复治、低社会支持水平、ACCI评分>4分和使用中药治疗均是影响患者治疗依从性的危险因素,以此构建的风险预测模型具有较Objective:To explore the current status and risk factors of treatment non-adherence in patients with pulmonary tuberculosis(PTB),and to establish a risk prediction model,providing a reference for screening high-risk groups.Methods:Using convenience sampling,PTB patients aged≥18 years who were diagnosed and receiving anti-TB medication at the National Clinical Research Center for Infectious Diseases from June to August 2024 were selected as study subjects.General demographic and clinical data of patients meeting the inclusion criteria were collected through questionnaire survey.Patients were randomly divided into training set and validation set at a ratio of 7∶3.Patients in the training set were further categorized into“treatment adherence”and“treatment non-adherence”groups based on their adherence status.Binary logistic regression was used to analyze factors influencing treatment non-adherence,and construct a prediction model.Finally,we used area under the curve(AUC)to evaluate prediction performance of the model and accuracy of the validation set.Results:According to the inclusion criteria,300 PTB patients were enrolled,and 300 pieces of questionnaire were distributed,with a valid response rate of 98.33%(295/300).Thus,295 patients were ultimately included.Among them,240 patients(81.36%)were treatment-adherent,and 55 patients(18.64%)were non-adherent.The training set included 207 patients(167 adherent and 40 non-adherent),and the validation set included 88 patients(73 adherent and 15 non-adherent).Multivariable logistic regression analysis showed that re-treatment,Age-adjusted Charlson comorbidity index(ACCI)score>4,and traditional Chinese medicine treatment were risk factors for treatment non-adherence(OR(95%CI)=8.207(2.393-28.146);OR(95%CI)=4.262(1.305-13.917);OR(95%CI)=16.276(2.564-103.306)),while high social support was a protective factor(OR(95%CI)=0.038(0.012-0.117)).The risk prediction model constructed based on these four factors had an AUC(95%CI)of 0.927(0.880-0.974),with a sensitivity of 92.

关 键 词：结核 肺 病例管理 危险因素 因素分析 统计学 预测 模型 统计学 

分 类 号：R521[医药卫生—内科学] R181.2[医药卫生—临床医学]