传染病信息

目的 调查潜伏结核感染患者预防性抗结核治疗依从性现状及相关因素，并制定干预策略。方法 采取基线调查+随机对照干预的混合研究设计，纳入2021年1月至2024年12月中国人民解放军西部战区总医院收治的180例潜伏结核感染患者进行研究，入组1周后完成基线调查，采用Morisky用药依从性量表（MMAS-8）调查患者治疗依从性，并据此将其分为依从组（MMAS-8评分≥6分，n=76）与非依从组（Morisky medication adherence scale,MMAS）-8评分<6分，n=104）。比较两组患者一般资料、中国居民传染病健康素养量表及社会支持量表（social support rating scale, SSRS）评分，采用多因素Logistic回归分析模型分析依从性差的影响因素。将非依从组随机分为干预组（n=52，采取基于影响因素调查而制定的干预措施）、对照组（n=52，采取常规治疗依从性干预），比较两组干预效果。结果180例患者完全依从率为42.22%(76/180)。非依从组中年龄≥60岁、采用6个月异烟肼单药治疗、合并≥2种基础疾病患者的比例均高于依从组，而中国居民传染病健康素养量表得分、SSRS得分均低于依从组，差异有统计学意义（均P<0.05）。多因素Logistic回归分析显示，年龄≥60岁（OR=3.852,95%CI:1.986～7.472）、合并≥2种基础疾病（OR=3.528,95%CI:1.816～6.852）、采用6个月异烟肼单药治疗（OR=4.215,95%CI:2.236～7.948）、低健康素养（OR=3.126,95%CI:1.624～6.012）及低社会支持（OR=3.987,95%CI:2.054～7.736）是潜伏结核感染患者预防性抗结核治疗依从性差的独立危险因素。干预后，干预组的完全依从率、治疗完成率及MMAS-8评分均高于对照组，药物不良反应发生率低于对照组，差异有统计学意义（均P<0.05）。结论 潜伏结核感染患者预防性治疗的整体依从性处于中等偏下水平，年龄、长疗程单药方案、多病共存、健康素养不足及社会支持匮乏是其独立影响因素。据此为基础构建的多维干预策略可显著提升此类患者短期预防性抗结核治疗的依从性，并降低药物不良反应发生率。

Objective To investigate the current status of adherence to tuberculosis preventive treatment and its associated factors among patients with latent tuberculosis infection(LTBI), and to formulate intervention strategies. Methods A mixed-method design combining a baseline survey and a randomized controlled intervention was adopted. A total of 180 patients with LTBI enrolled from January 2021 to December 2024. A baseline survey was completed one week after enrollment and treatment adherence was assessed using the Morisky Medication Adherence Scale(MMAS-8). Patients were accordingly divided into an adherence group(MMAS-8 score ≥ 6, n=76) and a non-adherence group(MMAS-8 score < 6, n=104). The general characteristics, scores on the Chinese Residents' Infectious Disease Health Literacy Scale, and the Social Support Rating Scale(SSRS) scores were compared between the two groups. Multivariable Logistic regression analysis was performed to identify the influencing factors of poor adherence. The non-compliance group was then randomly divided into an intervention group(n=52, receiving intervention measures formulated based on the identified influencing factors) and a control group(n=52, receiving routine adherence intervention), and the intervention effects were compared between the two groups. Results The rate of full adherence among the 180 patients was 42.22%(76/180). In the non-compliance group, the proportions of patients aged ≥ 60 years, those receiving 6-month isoniazid monotherapy, and those with ≥ 2 comorbidities were all significantly higher than those in the adherence group, whereas the scores on the Chinese Residents' Infectious Disease Health Literacy Scale and the SSRS were significantly lower than those in the adherence group(all P < 0.05). Multivariable logistic regression analysis showed that age ≥ 60 years(OR=3.852, 95%CI: 1.986–7.472), ≥ 2 comorbidities(OR=3.528, 95%CI: 1.816–6.852), 6-month isoniazid monotherapy(OR=4.215, 95%CI: 2.236–7.948), low health literacy(OR=3.126, 95%CI: 1.624–6.012), and low social support(OR=3.987, 95%CI: 2.054–7.736) were independent risk factors for poor adherence to tuberculosis preventive treatment among patients with LTBI. After intervention, the full adherence rate, treatment completion rate, and MMAS-8 score in the intervention group were all significantly higher than those in the control group, while the incidence of adverse drug reactions was significantly lower than that in the control group(all P<0.05). Conclusion The overall adherence to tuberculosis preventive treatment among patients with LTBI is at a below-moderate level. Advanced age, long-duration monotherapy regimens, multimorbidity, insufficient health literacy, and inadequate social support are independent influencing factors. The multidimensional intervention strategy constructed based on these factors can significantly improve short-term adherence to preventive anti-tuberculosis treatment and reduce the incidence of adverse drug reactions in this patient population.