慢性C型肝炎患者接受干擾素合併Ribavirin治療遵從行為及其相關因素探討-縱貫性研究

Abstract

本研究目的在探討慢性C型肝炎患者接受干擾素合併Ribavirin治療相關因素。自2004年7月至2005年4月以立意取樣方式，於台北市某醫學中心門診選取33位18歲以上罹患慢性C型肝炎患者作為研究樣本，並採結構式問卷量表進行調查。研究工具內容包括：生活品質量表、自我效能量表、治療遵從行為量表、社會支持量表、身體症狀量表、情緒狀態量表及個人基本資料。患者一共接受五次問卷填答 (治療前T0、治療後兩週T1、一個月T2、兩個月T3、三個月T4)。研究資料以SPSS 12.0視窗套裝軟體進行描述性統計、重複測量單因子變異數分析、克-瓦單因子變異數分析、皮爾遜積差相關等統計方法分析。 本研究對象女性17人，男性16人，平均年齡50歲，C型肝炎病毒基因型以1b居多，肝纖維化程度以F2居多。研究發現，大部分慢性C型肝炎患者能按照醫師指定的時間及劑量使用藥物，但也會因為某些原因自行調整使用藥物的時間。在治療前三個月，計算Ribavirin平均口服劑量遵從率為93.99%，干擾素平均注射劑量遵從率達95.86%、接受治療時間的遵從率則為99.53%，回診率達100%，大部分的慢性C型肝炎患者均有較高的治療遵從行為。 慢性C型肝炎患者在接受干擾素合併Ribavirin治療前三個月時，實驗室檢查值除Seg在治療第二週先下降再緩慢增加外，其他項目ALT、AST、Total bilirubin、Cr、TSH及Free T4各數值均呈現逐漸下降情形。身體症狀在治療前三個月，常見類似感冒症狀，如：疲累、肌肉酸痛、失眠、頭痛、頭暈、關節痛等。情緒狀態在治療前三個月中疲憊-懶散之情緒次量表平均得分在治療前與治療後均排名第一，為負向情緒中最常出現症狀。 慢性C型肝炎患者接受干擾素合併Ribavirin治療在前三個月有中等程度以上的生活品質。社會關係範疇與環境範疇在治療前後較無明顯差異，心理範疇在治療前三個月一直為得分最低。社會支持在治療前三個月以情緒性支持最強，實質性支持最弱。支持來源部分以家人親戚朋友及配偶所獲得支持最多，從病友團體獲得支持最少。自我效能在治療前三個月時不因藥物副作用造成身體及情緒的不適，其自我效能平均得分仍高。 本研究結果有助於護理人員瞭解慢性C型肝炎患者接受干擾素合併Ribavirin治療情形及影響治療之相關因素，可作為提供整體性護理照顧的參考。

The major purpose of this research was to examine the relationship between prescription adherence and its related factors among chronic hepatitis C patients who received regimen of interferon and ribavirin. Thirty-three chronic hepatitis C patients aged over 18 years were recruited through purposive sampling from one teaching hospital which is located in a metropolitan area of north Taiwan between July 2004 to April 2005. The structured instruments were applied and the participants were asked to complete Physical Symptoms Scale, Mood States Scale, Self-efficacy Scale, Social Support Scale, Quality of Life Scale, Treatment Adherence Scale and the Demographic Profile. All participants who completed the questionnaire at baseline (T0) were interviewed again at two weeks (T1) one month (T2), two months (T3), and three months (T4) after baseline (T0). Data entry and analyses were performed in SPSS 12.0. Descriptive statistics, repeated measure ANOVA, Kruskal-wallis test, Pearson’s product-moment correlation were used for the data analyses. The research sample in the study included 17 females and 16 males with an average age of 50 years. The majority of the genotype of hepatitis C virus is 1b and the degree of liver fibrosis is F2. The research found that the majority of chronic hepatitis C patients were able to take medication according to the timing and dosage prescribed by doctors. However, some patients changed the medication time for themselves due to personal reasons. In the first three months of the medication, the adherence rate of average oral dosage of ribavirin was calculated to be 93.99%, the adherence rate of average interferon injection dosage to be 95.86%, the adherence rate of medication timing to be 99.53%, clinic follow-up rate to be 100%, and most of chronic hepatitis C patients have relatively high medication adherence rate. In the first three months of the medication of chronic hepatitis C with interferon and ribavirin, the experimental values, except for Seg values which displayed an initial decrease and a subsequent increase during the second week of the medication, including ALT, AST, total bilirubin, Cr, TSH and Free T4, all values showed gradual decrease. Flu-like symptoms for example, fatigue, muscular pain, insomnia, headache, dizziness, and joint pain, were commonly seen during the first three months. Fatigue was the most common negative mood symptom in this sample. The average intensity scores of fatigue-inertia subscale of the Mood States Scale were highly ranked in the first one both before and after the medication. Chronic hepatitis C patients receiving medication of interferon and ribavirin reported fair quality of life in the first three months of medication. There was no significant difference in scores of the social relationships domain and the environment domain between before and after the medication. The psychological domain remained the lowest score during the first three months of the medication. According to results from the Social Support Scale, patients reported the highest scores on emotional support and the lowest scores on the tangible support (social support subscale- emotional support, informational support, appraisal support, and tangible support). The majority of the support sources came from family members, relatives, friends and spouse, while the least came from patient group. Although mild physical and emotional symptoms resulting from the adverse effect of the medicine made patients feel distress, the scores of the self-efficacy on treatment adherence remained high during the three months of the medication. Findings from this research can help health professionals and contribute significantly to the literature on the prescription adherence and its related factors among chronic hepatitis C patients who receive medication of Interferon and Ribavirin. This research provides abundant information which can serve as a reference for holistic nursing care.