Social support and treatment compliance of patients with pulmonary arterial hypertension in Shandong province
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摘要: 目的 探究肺动脉高压(PAH)患者社会支持度和相关影响因素，以及社会支持度对患者诊疗依从性的影响，为提高PAH患者社会支持、改善患者治疗现状提供参考。方法 课题组自编PAH患者社会经济现况调查表，对2019年9月—2020年9月于山东大学齐鲁医院就诊，经右心导管检查确诊且同意接受问卷调查的PAH患者通过问卷星平台进行问卷调查。结果 共纳入PAH患者239例，来自山东省16个县市，年龄15~78岁，其中女性患者198例(82.8%)。主要病因为先天性心脏病相关PAH，共109例(45.6%)。社会支持总得分(21.09±4.71)分，主观支持分(10.14±2.97)分，客观支持分(4.8±1.39)分，支持利用度(6.15±1.92)分。社会支持评定量表(SSRS)得分与患者家庭年收入密切相关，其主观支持得分(t=2.420，P=0.016)、客观支持得分(t=3.518，P=0.001)和社会支持总得分(t=2.481，P=0.014)在不同年收入组差异均具有统计学意义；社会支持得分与患者诊疗依从性因素非医嘱停药(χ2=10.649，P=0.001)、规律复诊(χ2=5.080，P=0.024)密切相关。居住地农村组(χ2=8.025，P=0.005)、SSRS低分组(χ2=5.080，P=0.024)患者复诊依从性更差。主观支持得分(OR=1.093，P=0.005)与居住地(OR=0.417，P=0.005)是患者复诊依从性的独立影响因素，SSRS主观得分高的患者以及城市患者复诊依从性更好。结论 PAH患者社会支持受到患者社会经济现状制约，并对患者复诊依从性造成直接影响。改善患者社会经济情况有助于提高患者社会支持度、提高患者规律复诊的主动性，进而改善预后。Abstract: Objective To investigate the social support and related influencing factors of patients with pulmonary hypertension(PAH), as well as the influence of social support on patients' treatment compliance, so as to provide a reference for improving the social support and treatment status.Methods A questionnaire on the social and economic status of PAH patients was designed by the research group. Patients who were diagnosed by right cardiac catheterization and agreed to accept the questionnaire from September 2019 to September 2020 in Qilu Hospital of Shandong University were investigated through the Questionnaire Star Platform.Results A total of 239 patients with PAH aged 15-78 years from 16 cities in Shandong Province were included in the study, including 198 female patients (82.8%), and 109 cases (45.6%) were mainly due to congenital heart disease. The total social support score was (21.09±4.71), the subjective support score was (10.14±2.97), the objective support score was (4.8±1.39), and the utilization of support was (6.15±1.92). SSRS scores were closely related to the annual family income. There were statistically significant differences in subjective support score (t=2.420,P=0.016), objective support score (t=3.518,P=0.001), and total social support score (t=2.481,P=0.014) among groups with different annual income. The social support score affected medication compliance (χ2=10.649,P=0.001) and regular follow-up (χ2=5.080,P=0.024). Patients in the rural group (χ2=8.025,P=0.005) and the low SSRS score group (χ2=5.080,P=0.024) had worse follow-up compliance. The subjective support score (OR=1.093,P=0.005) and residence (OR=0.417,P=0.005) were independent influencing factors for follow-up compliance. Patients with high SSRS subjective scores and patients in city had better follow-up compliance.Conclusion The social support for patients with PAH in Shandong Province is restricted by the social-economic status of patients and has a direct impact on patients' active follow-up. Improving patients' social-economic situation is helpful to improve patients' social support degree and initiative of regular follow-up.
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表 1 PAH患者人口学特征与病因分布
Table 1. Demographic characteristics and etiological distribution of PAH patients
例(%) 项目 数值 性别 男 41(17.2) 女 198(82.8) 年龄 ≤18岁 4(1.7) 19~59岁 226(94.6) ≥60岁 9(3.8) 民族 汉 238(99.6) 少数民族 1(0.4) 居住地 城市 91(38.1) 乡村 148(61.9) 病因 先心病相关 109(45.6) 未矫治 61(25.5) 矫治术后 48(20.1) 特发性 81(33.9) 结缔组织病相关 35(14.6) 肺动脉阻塞性疾病相关 11(4.6) 家族可遗传性 3(1.3) 
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表 2 社会支持得分影响因素
Table 2. Influencing factors of social support scores
X±S 项目 主观支持分 客观支持分 支持利用度 总得分 性别 男(41例) 10.07±2.93 4.56±1.67 6.12±2.30 20.76±5.25 女(198例) 10.15±2.98 4.85±1.32 6.15±1.84 21.16±4.61 t值/F值 0.145 1.228 0.09 0.494 P值 0.878 0.221 0.929 0.621 居住地 农村(148例) 10.06±3.00 4.70±1.45 6.07±1.93 20.82±4.77 城市(91例) 10.26±2.92 4.98±1.28 6.27±1.91 21.52±4.62 t值/F值 0.513 1.528 0.81 1.103 P值 0.608 0.128 0.419 0.271 文化程度 初中及以下(124例) 9.92±3.21 4.65±1.47 6.03±1.91 20.60±5.06 高中及以上(115例) 10.37±2.67 4.97±1.28 6.27±1.93 21.620±4.27 t值/F值 1.185 1.836 0.955 1.679 P值 0.237 0.068 0.34 0.094 家庭年收入 ≤3万(134例) 9.73±3.07 4.53±1.43 6.16±2.03 20.43±4.94 >3万(105例) 10.66±2.76 5.15±1.25 6.12±1.77 21.93±4.29 t值/F值 2.420 3.518 0.161 2.481 P值 0.016 0.001 0.872 0.014 个人经济能力 无收入(154例) 9.75±2.94 4.80±1.31 6.13±1.86 20.68±4.65 有收入(85例) 10.84±2.91 4.81±1.53 6.18±2.03 21.82±4.77 t值/F值 2.737 0.069 0.179 1.801 P值 0.007 0.945 0.858 0.073 PAH类型 先心病相关(109例) 9.55±2.78 4.69±1.46 5.93±1.97 20.17±4.70 特发性(81例) 10.81±3.05 4.94±1.33 6.37±1.95 22.12±4.80 结缔组织病相关(35例) 9.91±3.14 4.54±1.40 6.57±1.74 21.03±4.50 t值/F值 4.361 1.216 2.062 4.024 P值 0.014 0.298 0.13 0.019
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表 3 社会支持总得分对患者诊疗依从性的影响
Table 3. The effect of total social support score on patients' treatment compliance
例(%) 项目 高分组(108例) 低分组(131例) t/χ2值 P值 专科就诊 86(79.6) 97(74.0) 1.029 0.310 联合用药 62(57.4) 67(51.1) 0.177 0.674 非医嘱停药(是否因经济原因停药) 70(64.8) 109(83.2) 10.649 0.001 规律复诊 83(76.9) 83(63.4) 5.080 0.024 基因检测 62(57.4) 73(55.7) 0.068 0.794
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表 4 复诊影响因素
Table 4. Influencing factors of reexamination
例(%), X±S 项目 规律复诊组(166例) 不能规律复诊组(73例) t/F值 P值 年龄/岁 35.68±9.542 35.93±10.96 0.164 0.870 女性 138(83.1) 60(82.2) 0.032 0.859 农村 93(56.0) 55(75.3) 8.025 0.005 初中及以下文化程度 80(48.2) 44(60.3) 2.964 0.085 年家庭收入≤3万 88(53.0) 46(63.0) 2.059 1.151 个人无收入 108(65.1) 46(63.0) 0.093 0.761 SSRS低分组 83(50.0) 48(65.8) 5.080 0.024 PAH类型 154例 71例 4.278 0.118 先心病相关 70(45.5) 39(54.9) 特发性 55(35.7) 26(36.6) 结缔组织病相关 29(18.8) 6(8.5)
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表 5 以复查情况为因变量的二元logistic回归分析
Table 5. Binary logistic regression analysis with follow-up as the dependent variable
因素 B SE Wald P值 OR(95%CI) 主观支持分 0.089 0.032 7.812 0.005 1.093(1.027~1.164) 居住地区 -0.875 0.313 7.794 0.005 0.417(0.226~0.771)
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