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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 342 -348. doi: 10.3877/cma.j.issn.1674-0807.2020.06.004

所属专题： 文献；

论著

luminal型乳腺癌患者戈舍瑞林用药依从性现状及影响因素分析
陈霞1, 罗凤2,†(), 孔令泉2   
  1. 1. 400016　重庆医科大学附属第一医院内分泌乳腺外科；611731　成都市妇女儿童中心医院护理部
    2. 400016　重庆医科大学附属第一医院内分泌乳腺外科
  • 收稿日期:2020-03-08 出版日期:2020-12-01
  • 通信作者: 罗凤

Medication compliance with goserelin and influencing factors in patients with luminal breast cancer

Xia Chen1, Feng Luo2,†(), Lingquan Kong2   

  1. 1. Department of Endocrine and Breast Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; Department of Nursing, Chengdu Women’s and Children’s Central Hospital, Chengdu 610073, China
    2. Department of Endocrine and Breast Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
  • Received:2020-03-08 Published:2020-12-01
  • Corresponding author: Feng Luo
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引用本文：

陈霞, 罗凤, 孔令泉. luminal型乳腺癌患者戈舍瑞林用药依从性现状及影响因素分析[J]. 中华乳腺病杂志(电子版), 2020, 14(06): 342-348.

Xia Chen, Feng Luo, Lingquan Kong. Medication compliance with goserelin and influencing factors in patients with luminal breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2020, 14(06): 342-348.

目的

了解luminal型乳腺癌患者戈舍瑞林用药依从性情况，分析影响其依从性的相关因素。

方法

根据纳入及排除标准，收集2015年1月至2017年12月重庆医科大学附属第一医院内分泌乳腺外科使用戈舍瑞林治疗的luminal型乳腺癌女性患者174例进行回顾性分析。中位随访时间16个月(范围：1～54个月)，完成随访154例，失访20例，失访率为11.5%(20/174)。采用问卷调查评价其用药依从性，使用χ2检验和Mann-Whitney U检验比较不同特征患者依从性的差异；用Logistic回归分析影响患者依从性的相关因素。将患者分为≤40岁(103例)和>40岁(51例)2个亚组，进行亚组分析。

结果

在完成随访的154例患者中，依从性好82例(53.2%，82/154)，依从性差72例(46.8%，72/154)。≤40岁组患者中，55.3%(57/103)依从性好，而>40岁组患者中仅49.0%(25/51)依从性好。全部患者中，文化程度、医保类型、不良反应和是否了解疗程时间均与乳腺癌患者戈舍瑞林用药依从性有关(χ2＝13.586、13.042、7.880、14.251，P均<0.050)；Logistic回归分析结果显示：高中及以下学历、居民医保和不了解戈舍瑞林的疗程时间为影响依从性的危险因素(OR＝2.772，95%CI：1.243～6.183，P＝0.013；OR＝5.188，95%CI：1.383～19.465，P＝0.015; OR＝3.363，95%CI：1.645～6.878，P＝0.001)。亚组分析显示：文化程度、职业、医保类型和是否了解疗程时间是≤40岁患者戈舍瑞林用药依从性的影响因素(χ2＝15.992、5.978、7.701、10.376，P均<0.050)；不良反应及医保类型是>40岁患者用药依从性的影响因素(χ2＝4.763、7.471，P均<0.050)。Logistic回归分析表明：高中及以下文化程度和不了解疗程时间是≤40岁患者用药依从性的危险因素(OR＝5.126，95%CI：2.086～12.598，P<0.001; OR＝3.631, 95%CI：1.500～8.792，P＝0.004)；居民医保是>40岁患者用药依从性的危险因素(OR＝64.315，95%CI：2.513～1 646.042，P＝0.012)，不良反应是>40岁患者用药依从性的保护因素OR＝0.189，95%CI＝0.047～0.759，P＝0.019)。

结论

luminal型乳腺癌患者戈舍瑞林用药依从性较差，文化程度、医保类型及是否了解疗程时间都可能影响患者的依从性。≤40岁组和>40岁组患者依从性有差异，且影响因素不同，建议对不同年龄患者用药采用不同的干预措施。

关键词: 乳腺肿瘤, 药物治疗依从性, 戈舍瑞林
Objective

To investigate the medication compliance with goserelin in patients with luminal breast cancer and analyze influencing factors.

Methods

According to the inclusion and exclusion criteria, 174 female patients with luminal breast cancer treated with goserelin in the Department of Endocrinology and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University from January 2015 to December 2017 were enrolled for a retrospective analysis. The median follow-up time was 16 months (range: 1 to 54 months). Totally 154 patients completed follow-up and 20 were lost to follow-up. The loss to follow-up rate was 11.5%(20/174). A questionnaire survey was conducted to evaluate the compliance. The χ2 test and the Mann-Whitney U test were used to compare the drug compliance in patients with different characteristics. Logistic regression was used to analyze related factors affecting the compliance. The patients were divided into two subgroups: ≤40 years (103 cases) and >40 years (51 cases) for subgroup analysis.

Results

Among all 154 patients who completed the follow-up, 82 patients had good compliance (53.2%, 82/154) and 72 patients had poor compliance (46.8%, 72/154). Among patients ≤40 years, 55.3% (57/103) had good compliance, while only 49.0% (25/51) of patients >40 years had good compliance. In all patients, education level, type of medical insurance, adverse reactions and whether to understand the course of treatment were all related to the compliance of breast cancer patients (χ2=13.586, 13.042, 7.880, 14.251, all P<0.050 ); Logistic regression analysis showed that poor education (high school and below), resident medical insurance, and ignorance of goserelin treatment course were risk factors affecting compliance (OR=2.772, 95%CI: 1.243-6.183, P=0.013; OR=5.188, 95%CI: 1.383-19.465, P=0.015; OR=3.363, 95%CI: 1.645-6.878, P=0.001). Subgroup analysis showed that education level, occupation, type of medical insurance and whether to understand the course of treatment were the influencing factors of goserelin compliance in patients≤40 years (χ2=15.992, 5.978, 7.701, 10.376, all P<0.050); adverse reactions and type of medical insurance were the influencing factors of compliance in patients >40 years old (χ2=4.763, 7.471, both P<0.050). Logistic regression analysis showed that poor education (high school and below) and ignorance of treatment course were risk factors for goserelin compliance in patients ≤40 years old (OR=5.126, 95%CI: 2.086-12.598, P<0.001; OR=3.631, 95%CI: 1.500-8.792, P=0.004); Resident medical insurance was a risk factor in patients >40 years (OR=64.315, 95%CI: 2.513-1 646.042, P=0.012), but adverse reaction was a protective factor in patients >40 years (OR=0.189, 95%CI: 0.047-0.759, P=0.019).

Conclusion

Patients with luminal breast cancer have poor medication compliance with goserelin. Education level, medical insurance type and understanding of treatment course may affect the compliance of patients. The compliance and its influencing factors present significant difference between patients ≤40 years and patients>40 years, so and the influencing factors are different. It is recommended that different intervention measures be given to the patients of different ages.

Key words: Breast neoplasms, Drug therapy compliance, Goserelin
表1 luminal型乳腺癌患者戈舍瑞林用药依从性影响因素Logistic回归分析变量赋值表
变量 变量名 赋值
文化程度 X1 大专及以上＝0，高中及以下＝1
医保类型 X2 其他＝0，职工医保＝1，居民医保＝2
不良反应 X3 无＝0，有＝1
是否了解戈舍瑞林的疗程时间 X4 了解＝0，不了解＝1
用药依从性 Y 依从性好＝0，依从性差＝1
图1 luminal型乳腺癌患者戈舍瑞林用药依从性差的常见原因
表2 luminal型乳腺癌患者戈舍瑞林用药依从性的单因素分析[例(%)]
变量 依从性好(n＝82) 依从性差(n＝72) 检验值 P值
年龄        
  ≤40岁 57(69.5) 46(63.9) χ2＝0.547 0.459
  >40岁 25(30.5) 26(36.1)
民族        
  汉族 79(96.3) 70(97.2) χ2＝0.095 0.758
  少数民族 3(3.7) 2(2.8)
家族史        
  无 77(93.9) 67(93.1) χ2＝0.045 0.831
  有 5(6.1) 5(6.9)
婚姻状况        
  未婚 11(13.4) 5(6.9) χ2＝2.307 0.315
  已婚 67(81.7) 65(90.3)
  离异 4(4.9) 2(2.8)
生育史        
  未育 20(24.4) 10(13.9) χ2＝2.695 0.101
  已育 62(75.6) 62(86.1)
文化程度        
  高中及以下 28(34.1) 46(63.9) χ2＝13.586 <0.001
  大专及以上 54(65.9) 26(36.1)
经济情况        
  较差 26(31.7) 26(36.1) χ2＝0.332 0.564
  良好 56(68.3) 46(63.9)
职业        
  无业 20(24.4) 28(38.9) χ2＝3.756 0.053
  在职 62(75.6) 44(61.1)
医保类型        
  职工医保 63(76.8) 40(55.6) χ2＝13.042 0.001
  居民医保 6(7.3) 21(29.1)
  其他 13(15.9) 11(15.3)
居住地类型        
  主城 55(67.1) 40(55.6) χ2＝2.152 0.142
  郊县 27(32.9) 32(44.4)
既往史        
  无 65(79.3) 58(80.6) χ2＝0.040 0.842
  有 17(20.7) 14(19.4)
组织学分期        
  1期 1(1.2) 1(1.4) Z＝-0.027 0.978
  2期 71(86.6) 62(86.1)
  3期 10(12.2) 9(12.5)
不良反应        
  无 25(30.5) 38(52.8) χ2＝7.880 0.005
  有 57(69.5) 34(47.2)
用药目的        
  不了解 29(35.4) 31(43.1) χ2＝0.953 0.329
  了解 53(64.6) 41(56.9)
疗程时间        
  不了解 32(39.0) 50(69.4) χ2＝14.251 0.001
  了解 50(61.0) 22(30.6)
表3 luminal型乳腺癌患者戈舍瑞林用药依从性的Logistic回归分析结果
变量 回归系数 标准误 P值 OR值 95%置信区间
文化程度          
  大专及以上 参考值        
  高中及以下 1.020 0.409 0.013 2.772 1.243～6.183
医保类型          
  其他 参考值        
  职工医保 0.507 0.565 0.369 1.661 0.549～5.024
  居民医保 1.646 0.675 0.015 5.188 1.383～19.465
疗程时间          
  了解 参考值        
  不了解 1.213 0.365 0.001 3.363 1.645～6.878
表4 不同年龄组乳腺癌患者戈舍瑞林用药依从性的单因素分析[例(%)]
变量 ≤40岁组 χ2值 P值 >40岁组 χ2值 P值
依从性好(n＝57) 依从性差(n＝46) 依从性好(n＝25) 依从性差(n＝26)
文化程度                
  高中及以下 13(22.8) 28(60.9) 15.392 <0.001 15(60.0) 18(69.2) 0.476 0.490
  大专及以上 44(77.2) 18(39.1) 10(40.0) 8(30.8)
职业                
  无业 12(21.1) 20(43.5) 5.978 0.014 8(32.0) 8(30.8) 0.009 0.925
  在职 45(78.9) 26(56.5) 17(68.0) 18(69.2)
医保类型                
  职工医保 44(77.2) 25(54.3) 7.701 0.021 20(80.0) 17(65.4) 7.471 0.024
  居民医保 5(8.8) 13(28.3) 1(4.0) 8(30.8)
  其他 8(14.0) 8(17.4)     4(16.0) 1(3.8)    
不良反应                
  无 19(33.3) 24(52.2) 3.716 0.054 6(24.0) 14(53.8) 4.763 0.029
  有 38(66.7) 22(47.8) 19(76.0) 12(46.2)
疗程时间                
  不了解 19(33.3) 30(65.2) 10.376 0.001 13(52.0) 20(76.9) 3.467 0.063
  了解 38(66.7) 16(34.8) 12(48.0) 6(23.1)
表5 ≤40岁组患者戈舍瑞林用药依从性Logistic回归分析结果
变量 回归系数 标准误 P值 OR值 95%置信区间
文化程度          
  大专及以上 参考值        
  高中及以下 1.634 0.459 <0.001 5.126 2.086～12.598
疗程时间          
  了解 参考值        
  不了解 1.290 0.451 0.004 3.631 1.500～8.792
表6 >40岁组患者用药依从性Logistic回归分析结果
变量 回归系数 标准误 P值 OR值 95%置信区间
医保类型          
  其他 参考值        
  职工医保 1.831 1.261 0.146 6.241 0.527～73.918
  居民医保 4.164 1.654 0.012 64.315 2.513～1 646.042
不良反应          
  无 参考值        
  有 -1.666 0.709 0.019 0.189 0.047～0.759
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