慢性乙型肝炎患者抗病毒治疗依从性分析.docVIP

慢性乙型肝炎患者抗病毒治疗依从性分析 　　[摘要] 目的 探讨和分析使用核苷类药物抗病毒治疗出现病毒学突破但未耐药的慢性乙型肝炎患者的依从性。 方法 采用回顾性分析的方法收集自2012年1～12月宁夏医科大学总医院感染疾病科口服核苷和核苷酸类药物抗病毒治疗后出现病毒学突破但未耐药的慢性乙型肝炎患者，对入选患者进行特定的临床调查分析问卷。 结果 ①47.8%（33/69）的患者对NAs抗病毒作用的认识方面有一项以上的认识不足，其中包括不了解NAs分类23例；不清楚NAs的作用和副作用11例；不知道慢性乙型肝炎需要长期抗病毒治疗2例；不知道自己所服用的NAs副反应5例。②100%（69/69）的患者在服用NAs过程中用药依从性下降，自行停药3例；漏服药物69例；减量服药4例；没有按要求服用药物9例；服药时间不固定3例；与其他药物经常混合服用现象30例。③21.7%（15/69）在药品质量和药品储存方面存在问题，其中同一药品经常更换生产厂家者7例；药品储存没有按规定要求储存在适宜温度条件下14例。 结论 在慢性乙型肝炎的抗病毒治疗过程中，临床医生应积极指导和督导患者规律、规范化服药，提高依从性。如果出现应答不佳或病毒学突破，应积极分析应答不佳或病毒学突破的原因，尽早对治疗方案进行优化调整，对早期发现的耐药患者及时采取挽救性治疗，为患者获得最大受益提供保证。 　　[关键词] 抗病毒治疗；病毒学突破；未耐药；慢性乙型肝炎；依从性 　　[中图分类号] R512.62 [文献标识码] B [文章编号] 1673-9701（2016）10-0092-04 　　[Abstract] Objective To discuss and analyze the compliance of the chronic hepatitis B patients who use nucleoside drugs as anti-viral treatment and have virological breakthrough but no drug resistance. Methods The chronic hepatitis B patients who had virological breakthrough but no drug resistance after orally taking nucleoside and nucleotide drugs as anti-viral treatment in the Infectious Diseases Department of General Hospital of Ningxia University from January 2012 to December 2012 were analyzed retrospectively and the included patients were given specific clinical survey questionnaire. Results （1） 47.83% （33/69） of patients had insufficient understanding of NAs antiviral effects in at least one aspect， including 23 patients not familiar with NAs classification， 11 patients not knowing NAs effects and side effects， 2 patients unaware of the need of long-term antiviral treatment for chronic hepatitis B and 5 patients ignorant of NAs side reactions. （2） 100% （69/69） of patients had reduced medication compliance during the administration of NAs， including 3 patients withdrawing drugs voluntarily， 69 patients having missed doses， 4 patients taking reduced dosage， 9 patients neglecting medication requirement， 3 patients having flexible medication time and 30 patients mixing this drug with othe