湖北省美沙酮维持治疗者退出状况及影响因素分析

阳凯; 吴茜; 汤恒; 蒋洪林; 李丽娜; 王棠

Abstract

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].Chinese journal of Epidemiology,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

Received:May 13, 2022

DOI：10.3760/cma.j.cn112338-20220513-00411

KeyWord: 美沙酮维持治疗退出影响因素

English Key Word: Methadone maintenance treatment Withdrawal Influencing factor

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Author Name	Affiliation	E-mail
Yang Kai	Center of HIV/AIDS Control and Prevention, Hubei Provincial Center for Disease Control and Prevention, Wuhan 430079, China
Wu Xi	Center of HIV/AIDS Control and Prevention, Hubei Provincial Center for Disease Control and Prevention, Wuhan 430079, China
Tang Heng	Center of HIV/AIDS Control and Prevention, Hubei Provincial Center for Disease Control and Prevention, Wuhan 430079, China
Jiang Honglin	Center of HIV/AIDS Control and Prevention, Hubei Provincial Center for Disease Control and Prevention, Wuhan 430079, China
Li Lina	Center of HIV/AIDS Control and Prevention, Hubei Provincial Center for Disease Control and Prevention, Wuhan 430079, China	343617358@qq.com
Wang Tang	Department of Disease Control and Prevention, Hubei Provincial Health Commission, Wuhan 430079, China	1328133546@qq.com

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Abstract:

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。

English Abstract:

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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