Zhu Yichen, Zhou Yifan, Zhang Lei, Zhang Jian, Lin Jun
Department of Urology, Capital Medical University Beijing Friendship Hospital, Beijing, China.
Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing, China.
J Investig Med. 2017 Oct;65(7):1049-1056. doi: 10.1136/jim-2016-000265. Epub 2017 May 8.
Immunosuppressive treatment regimens are complex and require ongoing self-management. Medication adherence can be difficult to achieve for several reasons. The current meta-analysis and systematic review investigated whether adherence interventions improved immunosuppressive treatment adherence in kidney transplant recipients. Medline, Cochrane, EMBASE, and Google Scholar were searched until October 17, 2016 using the following search terms: kidney transplantation, compliance, adherence, and immunosuppressive therapy. Randomized controlled trials and two-arm prospective, retrospective, and cohort studies were included. The primary outcomes were adherence rate and adherence score. Eight studies were included with a total for 546 patients. Among participants receiving intervention, the adherence rate was significantly higher than the control group (pooled OR=2.366, 95% CI 1.222 to 4.578, p=0.011). Participants in the intervention group had greater adherence scores than those in the control group (pooled standardized difference in means =1.706, 95% CI 0.346 to 3.065, p=0.014). Sensitivity analysis indicated that findings for adherence rate were robust. However, for adherence score, the significance of the association disappeared after removing one of the studies indicating the findings may have been overly influenced by this one study. Intervention programs designed to increase immunosuppressive adherence in patients with kidney transplant improve treatment adherence.
免疫抑制治疗方案复杂，需要持续的自我管理。由于多种原因，药物依从性很难实现。当前的荟萃分析和系统评价调查了依从性干预措施是否能提高肾移植受者对免疫抑制治疗的依从性。截至2016年10月17日，使用以下检索词在Medline、Cochrane、EMBASE和谷歌学术上进行检索：肾移植、依从性、坚持性和免疫抑制治疗。纳入随机对照试验以及双臂前瞻性、回顾性和队列研究。主要结局为依从率和依从性评分。纳入八项研究，共546例患者。在接受干预的参与者中，依从率显著高于对照组（合并比值比=2.366，95%置信区间1.222至4.578，p=0.011）。干预组参与者的依从性评分高于对照组（合并标准化均值差异=1.706，95%置信区间0.346至3.065，p=0.014）。敏感性分析表明，依从率的研究结果可靠。然而，对于依从性评分，在剔除其中一项研究后，关联的显著性消失，这表明研究结果可能受到该单一研究的过度影响。旨在提高肾移植患者免疫抑制依从性的干预项目可改善治疗依从性。
