北京市社区美沙酮维持治疗者治疗保持情况及其影响因素的随访研究

刘国武; 王娟; 卢红艳

Abstract

刘国武,王娟,卢红艳.北京市社区美沙酮维持治疗者治疗保持情况及其影响因素的随访研究[J].Chinese journal of Epidemiology,2012,33(12):1248-1251

北京市社区美沙酮维持治疗者治疗保持情况及其影响因素的随访研究

Rate of retention and related factors on patients under methadone maintenance treatment in Beijing: a prospective cohort study

Received:June 18, 2012 Revised:June 18, 2012

DOI：10.3760/cma.j.issn.0254-6450.2012.12.011

KeyWord: 美沙酮维持治疗吸毒人员危险因素

English Key Word: Methadone maintenance treatment Drug users Risk factor

FundProject:安徽省科技攻关计划资助项目(06013058A)

Author Name	Affiliation	E-mail
LlU Guo-wu	Beijing Municipal Center for Disease Control and Prevention, beijing l000l3, China
WU Juan	Beijing Municipal Center for Disease Control and Prevention, beijing l000l3, China
LU Hong-yan	Beijing Municipal Center for Disease Control and Prevention, beijing l000l3, China	hongyan_lu@sina.com

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Abstract:

目的了解北京市社区美沙酮维持治疗(MMT)者的长期治疗情况及其影响因素.方法采用前瞻性队列研究设计,对2004-2006年参加MMT的548名治疗者进行随访研究.采用Log-rank法及Cox比例风险模型对长期治疗情况及其影响因素进行分析.结果 548名研究对象中男性(79.6%)、汉族(94.0%)、无业或待业(80.8%)为主,平均年龄(37.3±6.7)岁,吸毒时间为(9.1±4.0)年,参加治疗前6个月以注射吸毒为主(81.9%).MMT治疗时间中位数为2.1年,随访终点时保持率为41.2%.不同剂量组(Log-rank x2＝10.527,P＝0.005)、实际治疗比例(Log-rank x2＝ 19.027,P＜0.001)及尿吗啡检测阳性率(Log-rank x2＝159.485,P＜0.001)的治疗保持率间差异有统计学意义. Cox比例风险模型多因素分析结果显示,高中及以上文化程度(HR＝ 0.76,P＝0.021)、治疗剂量不低于60 mg/d(HR＝0.64,P＝0.002)、尿吗啡检测阳性率在1% ～ 9%(HR＝0.32,P＜0.001)等因素有助于研究对象长期参加治疗,而尿吗啡检测阳性率≥20%时(HR＝2.92,P＜0.001)研究对象很容易退出治疗.结论高治疗剂量(≥60 mg/d)有助于治疗者长期保持治疗,而治疗期间偷吸毒品(≥20%)则增加治疗者退出治疗的风险.

English Abstract:

Objective To study the rates of retention and associated factors on patients undermethadone maintenance treatment (MMT) in Beijing.Methods A prospective cohort wasconducted among 548 patients who enrolled in MMT clinics during 2004-2006 in Beijing.Log-rankmethod and Cox PH regression models were used to study related factors associated with long-termretention.Results Of the 548 patients,463 (79.6%) were males,with 515 (94.0%) under Hanethnicity.443 (80.8%) of them were unemployed with 449 (81.9%) as injecting drug users at the timeof enrollment.The average age and duration of drug abuse at enrollment were 37.3± 6.7 and 9.1 ± 4.0years,respectively.The median length of treatment was 2.1 years with five-year retention rate as41.2%.The long-term retention rates between different dosages (Log-rank x2＝ 10.527,P＝0.005),treatment ratio (Log-rank x2＝ 19.027,P＜0.001) and illicit drug use (Log-rank x2＝159.485,P＜0.001) showed significant differences,statistically.Factors as having high education level (HR ＝ 0.76,P＝ 0.021),with daily dosage 60 mg/day or more (HR＝ 0.64,P＝0.002),having 1%-9% times urine morphine positive result (HR＝0.32,P＜0.001) seemed to be able to predict the lower risk of dropout during the follow-up period.However,frequent illicit drug use (＞20%)(HR＝2.92,P＜0.001) could increase the risk of dropout.Conclusion Treatment with higher dosage (≥60 mg/day) of methadone seemed to have decreased the possibility of dropout during the follow-up period,whereas frequent illicit drug use (≥20%) was important risk factor causing long-term retention.

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