探讨儿童肝移植受者出院后服药依从性的现状及影响因素。

选取2010年1月至2020年1月在上海交通大学医学院附属仁济医院行肝移植手术、并保持门诊随访的1 177例儿童受者及家属，调查儿童受者一般人口学资料和临床诊疗资料，采用Basel免疫抑制药物依从性评估量表评估服药依从性情况，分析影响其服药依从性的相关因素。计数资料采用构成比(%)表示，组间比较采用卡方检验或Fisher确切概率法。单因素分析采用logistic回归，将P<0.10的因素纳入多因素分析，P<0.05为差异有统计学意义。

本研究共发出研究问卷1 177份，回收有效问卷1 127份，有效回收率95.8%。1 127例儿童受者中，共有637例(56.5%)保持良好的服药依从性。移植后0~2、3~4、5~10和>10年的受者分别为668、290、159和10例，总体依从性良好的受者比例分别为63.9%(427/668)、50.3%(146/290)、39.0%(62/159)和20.0%(2/10)，差异有统计学意义(χ²＝44.695，P<0.05)。提示服药不依从的各条目中，过去1个月提前或推迟2 h及以上服药的发生率最高(30.0%)，其次是过去1个月漏服1次(15.9%)，过去1个月不按医嘱剂量服药发生率最低(4.0%)。多因素logistic回归分析结果显示，年龄≥6岁(OR＝0.665，95%CI：0.477~0.928)、术后时间≥3年(OR＝0.542，95%CI：0.417~0.704)、未定期复诊(OR＝0.460，95%CI：0.216~0.979)的儿童肝移植受者免疫抑制剂服药依从性更差，主要照顾者受教育程度大专及本科或以上的儿童肝移植受者免疫抑制剂服药依从性更好(OR＝1.444，95%CI：1.122~1.859)。

儿童肝移植受者服药依从性随着术后时间的延长有逐渐下降的趋势，可能与受者年龄、家属对于疾病的认识和药物的了解等多种因素相关，应提升家属认知水平，加强对儿童受者行为的管理，降低术后服药不依从的发生率。

To investigate the current situation and influencing factors of medication compliance in pediatric liver transplant recipients after discharge.

From January 2010 to January 2020, 1177 pediatric recipients who underwent liver transplantation in Renji Hospital, Shanghai Jiao Tong University School of Medicine and maintained outpatient follow-up were selected to investigate. The general demographic statistics, clinical diagnosis and treatment data were investigated, and Basel immunosuppressive drug compliance assessment scale was used to assess medication compliance, and the related factors affecting medication compliance were statistically analyzed. Enumeration data were expressed as constituent ratio (%), and Chi-square test or Fisher′s exact test was used for comparison between groups.Univariate analysis was performed using logistic regression, and factors with P<0.10 were included in multivariate analysis, and P<0.05 was considered statistically significant.

A total of 1 177 questionnaires were sent out and 1 127 were returned, with an effective recovery rate of 95.8%. A total of 637 cases (56.5%) maintained good medication compliance. Among pediatric recipients who had been transplanted for 0 to 2, 3 to 4, 5 to 10, and >10 years, 63.9% (427/668), 50.3% (146/290), 39.0% (62/159), and 20.0% (2/10) had good overall compliance, respectively, and the difference was statistically significant (χ²=44.695, P<0.05). Among the items indicating non-compliance, the incidence of taking medicine 2 h or more earlier or delayed in the past month was the highest (30.0%), followed by missed one dose in the past month (15.9%), and the incidence of not taking the drug according to the prescribed dose in the past month was the lowest (4.0%). Multivariate logistic regression analysis showed that immunosuppressant medication compliance was worse in pediatric liver transplant recipients aged ≥6 years (OR=0.665, 95% CI: 0.477-0.928), with postoperative time ≥3 years (OR=0.542, 95% CI: 0.417-0.704), and without regular return visits (OR=0.460, 95% CI: 0.216-0.979), and immunosuppressant medication compliance was better in pediatric liver transplant recipients with college education and undergraduate or above major caregivers (OR=1.444, 95% CI: 1.122-1.859).

The medication compliance of pediatric liver transplant recipients decreases gradually with the prolongation of postoperative time, which may be related to recipient age, family members′ understanding of the disease and drugs and other factors. It is necessary to improve the cognitive level of family members, strengthen the management of pediatric recipients′ behavior and reduce the occurrence of postoperative medication noncompliance.