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    炎症性肠病患儿服药依从性影响因素及其风险预测模型的构建

    Influencing Factors and Risk Prediction Model Construction of Medication Adherence in Pediatric Patients with Inflammatory Bowel Disease

      摘要
    • 摘要:
      目的 分析炎症性肠病(inflammatory bowel disease，IBD)患儿服药依从性影响因素，并构建风险预测模型，探索其预测价值。
      方法 纳入2022年1月—2024年1月来浙江大学医学院附属儿童医院就诊的IBD患儿为研究对象，通过问卷调查的形式收集相关数据，根据药物依从性量表得分将患儿分为服药依从性不良组(≤16分)和服药依从性良好组(≥17分)，比较2组人口社会学资料和临床资料，多因素Logistic回归分析确定依从性的独立影响因素，据此构建IBD患儿服药依从性不良的风险预测列线图模型。
      结果 共152例患儿，服药依从性不良者69例(45.4%)。多因素二元Logistic回归分析显示，患儿年龄(OR=1.13，95%CI 1.02~1.25，P=0.024)、服药频率(OR=2.00，95%CI 1.22~3.27，P=0.006)、母亲文化教育程度(OR=0.59，95%CI 0.38~0.92，P=0.020)以及父母的克罗恩病与溃疡性结肠炎知识问卷(Crohn’s and Colitis Knowledge Score，CCKNOW)得分(OR=0.90，95%CI 0.83~0.99，P=0.023)是患儿服药依从性的显著影响因素。基于此4项预测指标构建患儿服药依从性不良风险预测列线图模型：Logit(P)=0.117×年龄+0.692×服药频率−0.533×母亲文化教育程度−0.102×父母CCKONW得分。受试者工作特征曲线显示，曲线下面积为0.759(95%CI0.683~0.835)。经Hosmer-Lemeshow拟合度检验结果显示，χ2=5.983，P=0.650，模型拟合的准确度较好；校准曲线结果显示，预测概率与实际概率接近，提示该模型具有良好的区分、校准和预测能力。
      结论 IBD患儿服药依从性不良的影响因素主要有患儿年龄、服药频率、患儿母亲文化教育程度以及父母疾病相关知识素养，相关的列线图模型预测价值良好，有助于早期识别服药依从性不良高风险人群。

       

      Abstract:
      OBJECTIVE To analyze the influencing factors of medication adherence in pediatric patients with inflammatory bowel disease(IBD), and to construct a risk prediction model to explore its predictive value.
      METHODS  Children with IBD who admitted to Children's Hospital, Zhejiang University School of Medicine from January 2022 to January 2024 were selected as the research object, and the relevant data were collected through questionnaire survey. According to the medication adherence score, the pediatric patients were divided into the non-adherence group(score≤16) and the adherence group(score≥17). Then the demographic and clinical characteristics between the 2 groups were compared, the influencing factors of medication adherence were confirmed by multivariate binary Logistic regression analysis, which were used to construct a risk nomogram prediction model for poor medication adherence in pediatric patients with IBD.
      RESULTS A total of the 152 pediatric patients, 69 cases(45.4%) had poor adherence. Multivariate binary Logistic regression analysis showed that pediatric patients’s age(OR=1.13, 95%CI 1.02−1.25, P=0.024), frequency of administration(OR=2.00, 95%CI 1.22−3.27, P=0.006), mother’s educational level(OR=0.59, 95%CI 0.38−0.92, P=0.020) and parents’ score of Crohn’s and Colitis Knowledge Score(CCKNOW)(OR=0.90, 95%CI 0.83−0.99, P=0.023) were significant influencing factors of medication adherence in pediatric patients with IBD. The nomogram prediction model of medication adherence was constructed based on this 4 indicators: Logit(P)=0.117×age+0.692×frequency of administration−0.533×mother’s educational level−0.102×parents’ CCKONW score. The receiver operating characteristic curve showed that the area under the curve of the nomogram prediction model was 0.759(95%CI 0.683−0.835). The Hosmer-Lemeshow fitting test showed that a good accuracy of model fitting(χ2=5.983, P=0.650). The calibration curve showed that the predicted probability was close to the actual probability, indicating good distinguishing, calibration and forecasting ability of this model.
      CONCLUSION The influencing factors including pediatric patients’s age, frequency of administration, mother’s educational level and parents’ disease-related knowledge level. The relevant nomogram model had good predictive value, and is helpful for early identification of high-risk populations with poor medication adherence.

       

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