与儿童和青少年相比，镰状细胞病的年轻成年人具有更高的羟基脲依从性。
Higher hydroxyurea adherence among young adults with sickle cell disease compared to children and adolescents.
机构信息
Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
出版信息
Ann Med. 2022 Dec;54(1):683-693. doi: 10.1080/07853890.2022.2044509.
BACKGROUND
Sickle cell disease (SCD) results in severe complications, such as anaemia and pain episodes. Hydroxyurea (HU) is efficacious in SCD, yet adherence remains low.
OBJECTIVE
To assess the relationship of HU adherence to health care utilization and patients' characteristics.
METHODS
This is a 5-year retrospective chart review. Patients' demographics and medical history were collected from the electronic medical record (EMR). HU adherence was evaluated using foetal haemoglobin "HbF%", mean corpuscular volume "MCV", and absolute neutrophil count "ANC". Age groups included children (<12 years), adolescents (12-17 years), and young adults (≥18 years).
RESULTS
A total of 113 SCD patients on HU were included (median age 14 years, IQR 10-20; 50% female; 88% HbSS). Young adults had significantly higher HU adherence compared to adolescents and children, including higher median HbF% (24.2 . 12.4 . 8.6, = .003), MCV (fl) (106.4 . 96.2 . 95.4, = .01) and lower ANC (10/ml) (3.25 . 4.9 . 4.2, = .01), respectively. Patients with chronic pain had lower HU adherence (HbF% 15.3 . 10.7, = .04; ANC 3.6 . 6.3, = .002; MCV 102.3 . 93.1, = .1). Patients with higher HbF or MCV and lower ANC had significantly less frequent emergency room visits (r=-0.26, = .01; r=-0.23, = .01; r=0.24, = .01) and hospitalizations (r=-0.27, = .01; r=-0.31, = .01; r=0.21, = .02) as well as shorter length of stays (r=-0.27, = .0045; r=-.34, = 0.004; r=0.23, = .02), respectively. Similar trends in HU adherence and health care utilization were seen in subgroup analysis of only HbSS patients. There was no significant association of HU adherence to patients' sex, socio-economic status, distance from hospital, and HU duration.
CONCLUSIONS
Young adults with SCD had significantly higher HU adherence compared to children and adolescents. Patients with lower HU adherence and/or chronic pain had increased health care utilization. Future studies examining barriers to adherence and evaluating interventions to optimize HU adherence in SCD are warranted.KEY MESSAGESYoung adults with SCD had significantly higher HU adherence, as reflected in their laboratory markers, compared to children and adolescents.Patients with higher HU adherence and/or those without chronic pain had lower or less frequent health care utilization.No significant association of HU adherence to patients' sex, socio-economic status and distance from hospital.
背景
镰状细胞病（SCD）会导致严重的并发症，如贫血和疼痛发作。羟基脲（HU）在 SCD 中有效，但依从性仍然较低。
目的
评估 HU 依从性与医疗保健利用和患者特征的关系。
方法
这是一项为期 5 年的回顾性图表审查。从电子病历（EMR）中收集患者的人口统计学和病史。HU 依从性通过胎儿血红蛋白“HbF%”、平均红细胞体积“MCV”和绝对中性粒细胞计数“ANC”进行评估。年龄组包括儿童（<12 岁）、青少年（12-17 岁）和年轻人（≥18 岁）。
结果
共纳入 113 名接受 HU 治疗的 SCD 患者（中位年龄 14 岁，IQR 10-20；50%为女性；88%为 HbSS）。与青少年和儿童相比，年轻人的 HU 依从性显著更高，包括更高的中位 HbF%（24.2. 12.4. 8.6， = .003）、MCV（fl）（106.4. 96.2. 95.4， = .01）和更低的 ANC（10/ml）（3.25. 4.9. 4.2， = .01）。慢性疼痛患者的 HU 依从性较低（HbF% 15.3. 10.7， = .04；ANC 3.6. 6.3， = .002；MCV 102.3. 93.1， = .1）。HbF 或 MCV 较高且 ANC 较低的患者急诊就诊（r=-0.26， = .01；r=-0.23， = .01；r=0.24， = .01）和住院（r=-0.27， = .01；r=-0.31， = .01；r=0.21， = .02）以及住院时间（r=-0.27， = .0045；r=-0.34， = .004；r=0.23， = .02）均显著减少。仅 HbSS 患者亚组分析中也观察到 HU 依从性和医疗保健利用的相似趋势。HU 依从性与患者性别、社会经济地位、距医院的距离无显著相关性。
结论
与儿童和青少年相比，SCD 年轻患者的 HU 依从性明显更高，反映在他们的实验室指标上。HU 依从性较低和/或患有慢性疼痛的患者医疗保健利用率更高。未来需要研究阻碍依从性的因素，并评估优化 SCD 中 HU 依从性的干预措施。
主要信息
与儿童和青少年相比，SCD 年轻患者的 HU 依从性明显更高，反映在他们的实验室指标上。
较高 HU 依从性和/或无慢性疼痛的患者的医疗保健利用率较低或较少。
HU 依从性与患者性别、社会经济地位和距医院的距离无显著相关性。
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