成人癫痫患者服药依从性个体化预测模型的建立与验证

Establishment and validation of an individualized predictive model for medication compliance in epilepsy adult patients

  • 摘要:
    目的 建立成人癫痫患者服药依从性的个体化预测模型并验证其预测效果。
    方法 选取192例癫痫患者作为研究对象,采用Morisky用药依从性量表(MMAS)评估患者服药依从性,根据依从性情况将患者分成依从组(MMAS评分6~8分)和对照组(MMAS评分 < 6分)。收集2组患者一般资料、疾病资料、用药资料及社会支持情况开展单因素分析,通过多因素Logistic回归分析明确患者服药依从性的影响因素,应用R软件中的rms程序包建立预测服药依从性的列线图模型,通过受试者工作特征(ROC)曲线的曲线下面积(AUC)、校准曲线对模型的区分度、精准度进行检验。
    结果 192例患者中,服药依从性良好者119例(61.98%),服药依从性差者73例(38.02%);学历、服用抗癫痫药物种数、药物副作用、接受用药知识教育次数、社会支持度是癫痫患者服药依从性的影响因素(P < 0.05);基于5项预测指标建立癫痫患者服药依从性的列线图模型,检验结果显示AUC为0.830(95%CI:0.772~0.888),校准曲线与理想曲线趋势相近,Hosmer-Lemeshow拟合优度检验示χ2=9.970,P=0.267,表明该模型的区分度、精准度均较高。
    结论 基于学历、服用抗癫痫药物种数、药物副作用、接受用药知识教育次数、社会支持度建立的列线图模型对癫痫患者服药依从性具有良好的预测价值。

     

    Abstract:
    Objective To establish an individualized prediction model for medication compliance in epilepsy adult patients and verify its predictive effect.
    Methods A total of 192 epilepsy patients were selected as study objects, the Morisky Medication Adherence Scale (MMAS) was applied to assess patients' medication compliance, and patients were divided into compliance group (MMAS score of 6 to 8 points) and control group (MMAS score < 6 points) based on their compliance status. The general information, disease information, medication information, and social support of patients were analyzed. Multiple Logistic regression analysis was applied to analyze the influencing factors of patients' medication compliance, the rms program package in R software was applied to establish a column chart model for predicting medication adherence, and the area (AUC) under the receiver operating characteristic (ROC) curve and the calibration curve were used to test its discrimination and accuracy.
    Results Among the 192 patients, 119(61.98%) had good medication adherence and 73(38.02%) had poor medication adherence. The main influencing factors of medication compliance in epilepsy patients included educational background, antiepileptic drug medication type, side effects of drugs, frequency of medication knowledge education, and social support (P < 0.05); a column chart model for medication compliance in epilepsy patients was constructed based on five predictive indicators, the results showed that the AUC was 0.830 (95%CI, 0.772 to 0.888), and the calibration curve and ideal curve trends were similar, the goodness of fit Hosmer-Lemeshow test showed that thechi-square value was 9.970 and P value was 0.267, indicating that the model had high discrimination and accuracy.
    Conclusion The nomogram established based on educational background, administration of antiepileptic drug type, side effects of drugs, frequency of medication knowledge education, and social support has a good predictive value in medication compliance in epilepsy patients.

     

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