慢性乙型肝炎患者肝细胞癌监测依从性的影响因素分析
DOI: 10.3969/j.issn.1001-5256.2023.09.010
Influencing factors for compliance with hepatocellular carcinoma surveillance in patients with chronic hepatitis B
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摘要:
目的 分析慢性乙型肝炎(CHB)患者肝细胞癌(HCC)监测依从性的影响因素。 方法 选取2012年6月—2016年12月参加湖北省中医院临床研究且结束临床研究时间>4年的CHB患者,于2020年9月—2021年12月对其进行问卷随访调查,以至少每隔6个月进行1次HCC早期筛查作为定期监测,分析HCC高危人群近4年定期监测的依从性及其影响因素。非正态分布计量资料两组间比较采用Wilcoxon秩和检验。计数资料组间比较采用χ2检验。采用多因素Logistic回归分析CHB患者HCC定期监测依从性的影响因素。 结果 共纳入CHB患者223例,定期进行HCC监测CHB患者占30.94%(69/223)。单因素分析结果显示:年龄(χ2=11.940,P=0.003)、长期接受健康宣传教育(χ2=32.066,P<0.001)、抗病毒药物服用情况(χ2=10.004,P=0.002)、HBV DNA(χ2=12.365,P<0.001)与患者定期HCC监测依从性有关。多因素Logistic回归分析结果显示:年龄≥60岁(OR=0.197,95%CI:0.050~0.777,P=0.020)和长期接受健康宣传教育(OR=4.810,95%CI:2.219~10.429,P<0.001)是CHB患者HCC监测依从性的独立影响因素。 结论 CHB患者HCC定期监测总体依从性较差。其中,年龄≥60岁的CHB患者HCC定期监测依从性较其他年龄段较差,长期接受健康教育的患者HCC定期监测依从性较好。 Abstract:Objective To investigate the influencing factors for compliance with hepatocellular carcinoma (HCC) surveillance in patients with chronic hepatitis B (CHB). Methods The CHB patients who participated in the clinical study of Hubei Provincial Hospital of Traditional Chinese Medicine from June 2012 to December 2016 and had an interval of >4 years from the end of the clinical study were enrolled, and a questionnaire follow-up survey was conducted from September 2020 to December 2021. Early screening for HCC was conducted at least every 6 months as regular surveillance, and compliance with 4-year regular surveillance and related influencing factors were analyzed in the population at a high risk of HCC. The Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups, and the chi-square test was used for comparison of categorical data between groups. A multivariate Logistic regression analysis was used to investigate the influencing factors for regular HCC surveillance in CHB patients. Results A total of 223 CHB patients were enrolled, and 30.94% (69/223) of these CHB patients underwent regular HCC surveillance. The univariate analysis showed that age (χ2=11.940, P=0.003), long-term health education (χ2=32.066, P<0.001), use of antiviral drugs (χ2=10.004, P=0.002), and HBV DNA (χ2=12.365, P<0.001) were associated with the compliance with regular HCC surveillance in patients. The multivariate Logistic regression analysis showed that age ≥60 years (odds ratio [OR]=0.197, 95% confidence interval [CI]: 0.050-0.777, P=0.020) and long-term health education (OR=4.810, 95% CI: 2.219-10.429, P<0.001) were independent influencing factors for compliance with HCC surveillance in CHB patients. Conclusion There is poor overall compliance with regular HCC surveillance in CHB patients. CHB patients aged ≥60 years had poorer compliance with regular HCC surveillance than the other age groups, and patients receiving long-term health education tend to have good compliance with regular HCC surveillance. -
Key words:
- Hepatitis B, Chronic /
- Carcinoma, Hepatocellular /
- Patient Compliance
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表 1 CHB患者肝癌定期监测依从性影响因素的单因素分析
Table 1. Univariate analysis of factors influencing regular monitoring of hepatocellular carcinoma in CHB patients
项目 合计 肝癌定期监测依从性 统计值 P值 是 否 性别[例(%)] χ2=0.001 0.975 男 171(76.7) 53(31.0) 118(69.0) 女 52(23.3) 16(30.8) 36(69.2) 年龄[例(%)] χ2=11.940 0.003 <45岁 71(31.8) 17(23.9) 54(76.1) 45~60岁 123(55.2) 49(39.8) 74(60.2) ≥60岁 29(13.0) 3(10.3) 26(89.7) 婚姻状态[例(%)] χ2=0.000 >0.05 已婚 212(95.1) 66(31.1) 146(68.9) 未婚 11(4.9) 3(27.3) 8(72.7) BMI[例(%)] χ2=2.106 0.349 ≤18.5 kg/m2 9(4.0) 1(11.1) 8(88.9) 18.5~24.0 kg/m2 111(49.8) 36(32.4) 75(67.6) >24.0 kg/m2 103(46.2) 32(31.1) 71(68.9) 教育程度[例(%)] χ2=0.143 0.931 小学 13(5.8) 4(30.8) 9(69.2) 中学 135(60.5) 43(31.9) 92(68.1) 大专及以上 75(33.6) 22(29.3) 53(70.7) 月收入[例(%)] χ2=1.034 0.793 <3 000元 51(22.9) 18(35.3) 33(64.7) 3 000~<5 000元 84(37.7) 26(31.0) 58(69.0) 5 000~<10 000元 63(28.3) 19(30.2) 44(69.8) ≥10 000元 25(11.2) 6(24.0) 19(76.0) 长期接受健康宣传教育[例(%)] χ2=32.066 <0.001 是 105(47.1) 52(49.5) 53(50.5) 否 118(52.9) 17(14.4) 101(85.6) 疾病严重程度[例(%)] χ2=0.013 0.911 CHB 180(80.7) 56(31.1) 124(68.9) 代偿期肝硬化 43(19.3) 13(30.2) 30(69.8) 乙型肝炎家族史[例(%)] χ2=1.040 0.308 有 131(58.7) 44(33.6) 87(66.4) 无 92(41.3) 25(27.2) 67(72.8) 肝癌家族史[例(%)] χ2=2.774 0.096 有 61(27.4) 24(39.3) 37(60.7) 无 162(72.6) 45(27.8) 117(72.2) 合并非酒精性脂肪性肝病[例(%)] χ2=0.220 0.639 是 60(26.9) 20(33.3) 40(66.7) 否 163(73.1) 49(30.1) 114(69.9) 抗病毒过程中出现耐药[例(%)] χ2=0.095 0.758 是 16(7.2) 6(37.5) 10(62.5) 否 207(92.8) 63(30.4) 144(69.6) 抗病毒药物服用情况[例(%)] χ2=10.004 0.002 已停用 40(17.9) 4(10.0) 36(90.0) 持续服用 183(82.1) 65(35.5) 118(64.5) HBV DNA[例(%)] χ2=12.365 <0.001 阳性 35(15.7) 2(5.7) 33(94.3) 阴性 188(84.3) 67(35.6) 121(64.4) 病程(年) 20.0(11.1~28.0) 22.0(13.5~29.5) 19.0(10.0~28.0) Z=1.660 0.097 中医证候评分(分) 10.0(5.0~14.0) 10.0(4.0~14.0) 9.0(6.0~14.0) Z=0.674 0.500 表 2 CHB患者肝癌监测依从性影响因素的Logistic回归分析变量赋值表
Table 2. Variable assignment table for Logistic regression analysis of factors influencing hepatocellular carcinoma monitoring compliance in CHB patients
变量 赋值 性别 男=0,女=1 年龄 45~60岁=0,<45岁=1,≥60岁=2 长期接受健康宣传教育 是=1,否=0 肝癌家族史 有=1,无=0 抗病毒药物服用情况 停止服用=1,持续服用=0 HBV DNA 阳性=1,阴性=0 表 3 CHB患者肝癌监测依从性的影响因素分析
Table 3. Logistic regression analysis of influencing factors of compliance for hepatocellular carcinoma monitoring in patients with CHB
项目 B值 SE Wald χ2值 P值 OR 95%CI 常量 -1.430 0.581 6.050 0.014 0.239 性别 -0.682 0.432 2.486 0.115 0.506 0.217~1.180 年龄 <45岁 vs 45~60岁 -0.586 0.369 2.515 0.113 0.557 0.270~1.148 ≥60岁 vs 45~60岁 -1.627 0.702 5.377 0.020 0.197 0.050~0.777 长期接受健康教育 1.571 0.395 15.826 <0.001 4.810 2.219~10.429 肝癌家族史 0.249 0.370 0.451 0.502 1.282 0.620~2.651 抗病毒药物服用情况 -0.096 0.674 0.020 0.887 0.909 0.243~3.402 HBV DNA -1.545 0.810 3.639 0.056 0.213 0.044~1.043 病程 0.033 0.017 3.660 0.056 1.034 0.999~1.070 -
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