Kraus M R, Schäfer A, Csef H, Faller H, Mörk H, Scheurlen M
Medizinische Poliklinik, University of Würzburg, Germany.
Dig Dis Sci. 2001 Oct;46(10):2060-5. doi: 10.1023/a:1011973823032.
Tolerance of interferon-a therapy for hepatitis C is often poor and medication is expensive. Compliance with diagnostic procedures and, even more important, with medical treatment is obviously critical to minimize the rate of dropouts and to maximize cost efficiency. Moreover, a good concordance with scheduled follow-ups is important for early recognition and treatment of interferon-associated side effects. Therefore, we investigated psychiatric symptoms, interpersonal problems, different modes of acquisition, and sociodemographic factors in HCV-infected patients as possible predictor variables of good versus poor compliance. In a longitudinal study, 74 patients with chronic hepatitis C (CHC) who fulfilled the criteria for treatment with interferon (IFN)-alpha-2b with or without ribavirin were investigated prospectively to identify those at risk for poor compliance during IFN medication. To assess predictive factors, we used both IIP-C (Inventory of Interpersonal Problems) and SCL-90-R (Symptom Check List 90 Items Revised) as psychometric instruments. Sociodemographic and somatic variables as well as compliance during IFN therapy were also evaluated. Poor compliance before or during medication was demonstrated by 23% (N = 17) of HCV patients. Sociodemographic factors and mode of acquisition, particularly former intravenous drug (IVD) abuse were not significantly linked with compliance. Logistic regression analysis demonstrated that the subgroup of patients with compliance problems was best identified by both pretherapeutic psychiatric symptoms and interpersonal problems. Predictive value was best and significant for anger-hostility (P = 0.009), intrusive (P = 0.014), depression (P = 0.015), and phobic anxiety (P = 0.049). Adopting this statistical prediction model, sensitivity was 47.1%, but specificity reached 98.3%. In total, 86.5% of cases were classified correctly. In situations of unclear indication for IFN therapy, psychological variables assessment of before the beginning of treatment may represent an additional decision-making factor.
丙型肝炎干扰素-α治疗的耐受性通常较差，且药物费用昂贵。遵守诊断程序，更重要的是遵守医学治疗，显然对于将脱落率降至最低并使成本效益最大化至关重要。此外，与预定随访的良好一致性对于早期识别和治疗干扰素相关的副作用很重要。因此，我们调查了丙型肝炎病毒（HCV）感染患者的精神症状、人际关系问题、不同感染途径以及社会人口统计学因素，将其作为依从性良好或较差的可能预测变量。在一项纵向研究中，对74例符合使用干扰素（IFN）-α-2b联合或不联合利巴韦林治疗标准的慢性丙型肝炎（CHC）患者进行了前瞻性调查，以确定那些在IFN治疗期间存在依从性差风险的患者。为了评估预测因素，我们使用人际问题清单（IIP-C）和症状自评量表90项修订版（SCL-90-R）作为心理测量工具。还评估了社会人口统计学和躯体变量以及IFN治疗期间的依从性。23%（N = 17）的HCV患者在用药前或用药期间表现出依从性差。社会人口统计学因素和感染途径，特别是既往静脉注射毒品（IVD）滥用与依从性无显著关联。逻辑回归分析表明，通过治疗前的精神症状和人际关系问题最能识别出存在依从性问题的患者亚组。对愤怒-敌意（P = 0.009）、强迫观念（P = 0.014）、抑郁（P = 0.015）和恐惧焦虑（P = 0.049）的预测价值最佳且具有显著性。采用这种统计预测模型，敏感性为47.1%，但特异性达到98.3%。总体而言，86.5%的病例分类正确。在IFN治疗指征不明确的情况下，治疗开始前的心理变量评估可能是一个额外的决策因素。
