临泉地区县域肺结核接受正规治疗意愿及影响因素研究

doi:10.12183/j.scjpm.2026.0144

摘要/Abstract

摘要： 目的分析临泉地区县域肺结核患者接受正规治疗意愿情况,并探讨其影响因素。方法选取2021年8月至2025年8月临泉县启动肺结核正规治疗的270例患者,通过面对面访谈收集资料。于治疗启动（T0）、中期（T1,治疗1个月）、结束时（T2）调查患者药片计数、微信打卡情况,记录服药依从性以评估接受正规治疗意愿。对比接受意愿高与接受意愿低患者资料,通过Lasso回归筛选可能影响肺结核患者接受正规治疗意愿的因素,并通过多因素logistic回归模型分析明确最终的影响因素。结果 270例患者中,共68例患者持续服药率≤90%,不接受正规治疗意愿患者占比为25.19%。经Lasso回归及多因素logistic回归分析显示,文化程度为初中以下（OR=3.358）、不知晓治愈率情况（OR=3.264）、家庭月收入<5 000元（OR=4.646）、督导管理方式为自我管理（OR=4.547）、药物不良反应为重度副作用（OR=3.945）均为肺结核患者接受正规治疗意愿的相关因素（均P<0.05）。结论针对肺结核患者接受正规治疗意愿的改善,应重点关注文化程度低、不知晓治愈率情况、家庭月收入低、督导管理方式为自我管理、药物不良反应为重度副作用的患者的健康教育力度,加强监督和治疗指导,通过多方面综合干预措施,提高县域肺结核患者接受正规治疗的意愿。

关键词: 肺结核, 治疗意愿, 影响因素, 服药依从性

Abstract: Objective To investigate the willingness of patients with pulmonary tuberculosis in Linquan County to adhere to standard treatment and to identify its associated determinants. Methods A cohort of 270 patients initiating standard treatment for pulmonary tuberculosis in the county between August 2021 and August 2025 were enrolled in this study. Data were collected through face-to-face interviews. Willingness to undergo standard treatment was operationalized as medication adherence, which was evaluated at treatment initiation (T0), the one-month follow-up (T1), and at the completion of therapy (T2) using pill counts and WeChat-based check-in records. A comparative analysis was conducted between patients with high and low treatment willingness. Lasso regression was employed to screen for potential predictors of treatment willingness, followed by a multivariate logistic regression analysis to identify the definitive influencing factors. Results Among the 270 participants, 68 (25.19%) exhibited a medication adherence rate of ≤90%, and were thus classified as having a low willingness to accept standard treatment. The Lasso and subsequent multivariate logistic regression analyses revealed that a junior high school education or lower (OR=3.358), unawareness of tuberculosis cure rates (OR=3.264), a monthly family income below 5 000 RMB (OR=4.646), a self-administered supervision model (OR=4.547), and the presence of severe adverse drug reactions (OR=3.945) were significant factors associated with a lower willingness to accept standard treatment (all P<0.05). Conclusion To enhance adherence to standard treatment for pulmonary tuberculosis, health education initiatives should be prioritized for patients with lower educational attainment, those unaware of treatment efficacy, individuals from low-income households, patients on self-administered therapy, and those experiencing severe adverse drug reactions. Strengthening supervision and therapeutic guidance through multifaceted, comprehensive interventions is critical for improving treatment willingness among pulmonary tuberculosis patients at the county level.

Key words: Pulmonary tuberculosis, Treatment willingness, Influencing factors, Medication adherence

中图分类号:

郭秀云, 武常峰, 马前坡. 临泉地区县域肺结核接受正规治疗意愿及影响因素研究[J]. 华南预防医学, 2026, 52(2): 144-148.

Guo Xiuyun, Wu Changfeng, Ma Qianpo. Willingness to accept standard treatment for pulmonary tuberculosis and associated factors in Linquan County[J]. South China Journal of Preventive Medicine, 2026, 52(2): 144-148.

参考文献

[1] 庞艳, 吴成果, 汪清雅, 等. 2019—2023年重庆市医务人员肺结核登记情况及流行病学特征[J]. 中国感染控制杂志, 2025, 24(7): 898-905.
[2] 余雅, 廖文平, 刘英, 等. 重庆市贫困区(县)肺结核患者的治疗依从性及其影响因素研究[J]. 疾病监测, 2021, 36(11): 1159-1167.
[3] 玛依沙·达肯, 陈阳贵, 李德洋, 等. 2021—2022年乌鲁木齐市肺结核家庭密切接触者预防性治疗意愿的影响因素分析[J]. 预防医学情报杂志, 2023, 39(8): 918-925.
[4] 李果, 徐华, 敬明燕, 等. 某县结核潜伏感染者拒绝预防性治疗的原因分析和对策评价[J]. 临床肺科杂志, 2022, 27(9): 1415-1420.
[5] 王展, 李忠奇, 丁晓艳, 等. 江苏省学生结核潜伏感染者预防性治疗意愿现状及其影响因素[J]. 中国热带医学, 2024, 24(3): 244-251.
[6] 梁智萍, 樊立锋. 陕西某县2018—2020年肺结核发病影响因素及防控效果研究[J]. 山西医药杂志, 2022, 51(7): 812-814.
[7] 夏岚, 陈闯, 张佩如, 等. 2011—2020年四川省结核病防治工作成就与展望[J]. 预防医学情报杂志, 2025, 41(3): 285-292.
[8] 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 肺结核基层诊疗指南(2018年)[J]. 中华全科医师杂志, 2019, 18(8): 709-717.
[9] 尤媛媛, 张国龙, 陈裕. 120例初治耐多药肺结核患者治疗依从性的影响因素分析[J]. 中国防痨杂志, 2020, 42(3): 249-254.
[10] Chang KC, Yew WW.Management of difficult multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis: Update 2012[J]. Respirology, 2013, 18(1): 8-21.
[11] Cupido G, Günther G.Post tuberculosis lung disease and tuberculosis sequelae: A narrative review[J]. Indian J Tuberc, 2024, 71(1): 64-72.
[12] 陈晓蝶, 买吾拉江·依马木, 常敏丽, 等. 2019—2021年喀什地区莎车县肺结核时空流行特征分析[J]. 安徽医科大学学报, 2025, 60(5): 937-944.
[13] 李本春, 王应军, 曹晓玉. 肺结核患者服药依从性预测模型的建立[J]. 现代医学, 2022, 50(5): 529-535.
[14] Guardia Zuñiga RC, Abad de Vite BV, Azañero Suarez A, et al. Educational level mediates the relationship between knowledge and preventive practices in multidrug-resistant tuberculosis patients[J]. Epidemiologia (Basel), 2025, 6(4): 75.
[15] 左杨斌, 李津, 林添钰, 等. 结核分枝杆菌多重耐药的流行病学特征及患者治疗依从性的影响因素分析[J]. 中国医药导刊, 2025, 27(9): 982-986.
[16] Fenta MD, Ogundijo OA, Warsame AAA, et al.Facilitators and barriers to tuberculosis active case findings in low-and middle-income countries: A systematic review of qualitative research[J]. BMC Infect Dis, 2023, 23(1): 515.
[17] Pedersen OS, Holmgaard FB, Mikkelsen MKD, et al.Global treatment outcomes of extensively drug-resistant tuberculosis in adults: A systematic review and meta-analysis[J]. J Infect, 2023, 87(3): 177-189.
[18] 殷伟彩, 徐晓曼, 王东昕. 影响肺结核患者服药依从性的相关危险因素[J]. 医学临床研究, 2025, 42(4): 586-589.
[19] 康益敏, 闫娟娟, 赫超硕, 等. 肺结核病人健康素养对服药依从性的影响[J]. 护理研究, 2025, 39(11): 1880-1886.
[20] Ridolfi F, Amorim G, Peetluk LS, et al.Prediction models for adverse drug reactions during tuberculosis treatment in Brazil[J]. J Infect Dis, 2024, 229(3): 813-823.