文章摘要
阳凯,吴茜,汤恒,蒋洪林,李丽娜,王棠.湖北省美沙酮维持治疗者退出状况及影响因素分析[J].中华流行病学杂志,2022,43(10):1645-1650
湖北省美沙酮维持治疗者退出状况及影响因素分析
Analysis of withdrawal status and influencing factors in patients receiving methadone maintenance treatment in Hubei province
收稿日期:2022-05-13  出版日期:2022-10-18
DOI:10.3760/cma.j.cn112338-20220513-00411
中文关键词: 美沙酮维持治疗  退出  影响因素
英文关键词: Methadone maintenance treatment  Withdrawal  Influencing factor
基金项目:
作者单位E-mail
阳凯 湖北省疾病预防控制中心艾滋病预防控制中心, 武汉 430079  
吴茜 湖北省疾病预防控制中心艾滋病预防控制中心, 武汉 430079  
汤恒 湖北省疾病预防控制中心艾滋病预防控制中心, 武汉 430079  
蒋洪林 湖北省疾病预防控制中心艾滋病预防控制中心, 武汉 430079  
李丽娜 湖北省疾病预防控制中心艾滋病预防控制中心, 武汉 430079 343617358@qq.com 
王棠 湖北省卫生健康委员会疾病预防控制处, 武汉 430079 1328133546@qq.com 
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中文摘要:
      目的 分析湖北省美沙酮维持治疗(MMT)者退出状况及影响因素。方法 选取2006年6月至2021年12月在湖北省MMT门诊入组接受MMT者,收集社会人口学资料、吸毒史、MMT等信息,对其MMT的生存资料采用Kaplan-Meier法进行单因素分析,多因素分析采用Cox比例风险回归模型。结果 本研究共纳入26 716例MMT者,男女性别比为3.34∶1(20 557∶6 159);保持治疗时间为0.01~15.72年,中位时间为2.21(95%CI:2.16~2.26)年。截至随访终点,退出治疗比例为86.75%(23 175/26 716)。MMT者入组0~、2~、4~、9~和14~年累积保持治疗概率分别为67.61%、40.24%、30.03%、15.49%和6.56%。Cox比例风险回归模型分析结果显示,退出治疗风险较高的因素包括少数民族(HR=1.66,95%CI:1.52~1.82)、有职业(HR=1.05,95%CI:1.01~1.08)、无强制隔离戒毒史者(HR=1.04,95%CI:1.01~1.09)、入组治疗年份为2016-2021年者(HR=1.46,95%CI:1.35~1.58);退出治疗风险较低的因素包括入组时年龄≥60岁者(HR=0.56,95%CI:0.42~0.75)、大专及以上文化程度(HR=0.83,95%CI:0.75~0.91)、其他城市门诊(HR=0.90,95%CI:0.87~0.93)、吸毒年限≥20年(HR=0.72,95%CI:0.66~0.80)、日服药剂量≥90 mg(HR=0.73,95%CI:0.69~0.78)和入组治疗年份为2011-2015年者(HR=0.93,95%CI:0.89~0.97)。结论 湖北省MMT者退出治疗比例较高。退出治疗的影响因素较为复杂,MMT者的日服药剂量是在安全情况下可加以干预的因素,应在一定程度上适当维持在较高服药剂量。
英文摘要:
      Objective To analyze the withdrawal in patients receiving methadone maintenance treatment (MMT) and its related influencing factors in Hubei province.Methods The patients receiving MMT in clinics in Hubei province were selected from June 2006 to December 2021. The general demographic data, drug abuse history, and MMT information were collected. The survival data of patients with MMT were analyzed by the Kaplan-Meier method, and the Cox proportional hazards model was used for multivariate analysis.Results A total of 26 716 patients receiving MMT were included in this study, and the gender ratio between men and women was 3.34:1(20 557:6 159). The duration of MMT was 0.01-15.72 years, and the median duration was 2.21 (95%CI:2.16-2.26) years. At the end of the follow-up, the withdrawal proportion was 86.75% (23 175/26 716). MMT's 0-year, 2-year, 4-year, 9-year and 14-year cumulative probabilities appeared as 67.61%, 40.24%, 30.03%, 15.49% and 6.56%, respectively. Results from the Cox proportional hazards regression model showed that the factors of the withdrawal risk were higher in patients receiving MMT, including minority nationality (HR=1.66, 95%CI:1.52-1.82), having jobs (HR=1.05, 95%CI:1.01-1.08), no history of compulsory isolation or detoxification (HR=1.04, 95%CI:1.01-1.09) and the enrollment in 2016-2021 (HR=1.46, 95%CI:1.35-1.58). The factors of the withdrawal risk were lower in patients receiving MMT, including 60-year-olds or above (HR=0.56, 95%CI:0.42-0.75), college degree or above education level (HR=0.83, 95%CI:0.75-0.91), outpatient services of other cities (HR=0.90, 95%CI:0.87-0.93), drug use for 20 years or more (HR=0.72, 95%CI:0.66-0.80), 90 mg or more per daily dosage (HR=0.73, 95%CI:0.69-0.78) and the enrollment in 2011-2015 (HR=0.93, 95%CI:0.89-0.97).Conclusions The withdrawal proportions of patients receiving MMT were high in Hubei province. The withdrawal influencing factors were complex. The daily dose was an essential factor that can be intervened under the safe MMT condition, and a higher dose should be appropriately prescribed.
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