摘要
目的探讨基于知信行(KAP)理论的延续性干预对高危人类乳头瘤病毒(HPV)持续感染合并宫颈上皮内瘤样变Ⅰ(CINⅠ)患者艾拉光动力治疗(ALA-PDT)效果的影响。方法采用便利抽样法选取2022年7月1日至2023年6月30日于首都医科大学附属北京地坛医院皮肤性病门诊接受诊治的高危HPV持续感染合并CINⅠ的患者共120例,随机数字表法分为对照组(60例)和观察组(60例)。两组患者均接受艾拉光动力治疗,对照组采用常规治疗,观察组在常规治疗基础上实施基于KAP理论的延续性干预。采用独立样本t检验比较两组患者在干预前、6次光动力术后、术后3个月和术后6个月的自我效能(GSES评分)和生活质量(SF-36评分)指标;应用卡方检验比较两组患者术后3个月和6个月的HPV分型和阴道镜复查结果。结果治疗前对照组和观察组患者GSES和SF-36评分差异无统计学意义(t=0.852、P=0.398,t=0.012、P=0.991)。6次光动力术后、术后3个月和6个月,观察组患者GSES评分分别为(25.63±4.34)、(30.09±4.34)和(34.21±4.56),显著高于对照组[(22.23±4.05)、(25.78±4.57)和(29.56±5.13)](t=3.137、3.746、3.711,P=0.003、<0.001、<0.001);SF-36评分分别为(72.73±3.58)、(80.25±4.20)和(89.34±4.65),高于对照组(64.59±3.47)、(72.78±3.96)和(78.79±4.11)(t=8.547、7.088、9.311,P均<0.001),差异均有统计学意义。光动力术后3个月和6个月,观察组患者HPV分型转阴率分别为73.3%(44/60)和70.0%(42/60),高于对照组的65%(39/60)和61.7%(37/60),差异均有统计学意义(χ^(2)=15.98、13.76,P均<0.001);术后6个月,观察组病变逆转率为80.0%(48/60),高于对照组(68.3%、41/60),差异均有统计学意义(χ^(2)=16.89、P<0.001),提示观察组疗效优于对照组。结论基于KAP理论的延续性干预可显著提升高危HPV持续感染并发CINⅠ患者的自我效能和生活质量,优化患者的临床结局。
Objective To investigate the effect of continuity care intervention based on the knowledge,attitude and practice(KAP)theory on the clinical outcomes of patients with high-risk human papillomavirus(HR-HPV)persistent infection complicated with cervical intraepithelial neoplasia gradeⅠ(CINⅠ)undergoing aminolevulinic acid photodynamic therapy(ALA-PDT).Methods Total of 120 patients with HR-HPV persistent infection and CINⅠdiagnosed at the Dermatovenereology Outpatient Department of Beijing Ditan Hospital,Capital Medical University,from July 1st 2022 to June 30th 2023 were selected by convenience sampling method.Patients were randomly divided into control group(60 cases)and observation group(60 cases)by random number table method.Both groups received ALA-PDT treatment.Patients in control group received routine care,while observation group underwent additional continuity care intervention based on KAP theory.Indexes of generalized self-efficacy scale(GSES scores)and short form health survey(SF-36 scores)were compared between the two groups at baseline,after 6 times of ALA-PDT,3-month and 6-month after ALA-PDT by independent samples t-test.HPV genotyping results and colposcopy reexamine findings were evaluated at 3 months and 6 months after ALA-PDT by Chi-square test.Results GSES and SF-36 scores between control group and observation group before treatment were not significantly different(t=0.852,P=0.398;t=0.012,P=0.991).After 6 times of ALA-PDT,3-month and 6-month after ALA-PDT,the GSES scores of patients in observation group were(25.63±4.34),(30.09±4.34)and(34.21±4.56),significantly higher than those of the control group[(22.23±4.05),(25.78±4.57)and(29.56±5.13)],with significant differences(t=3.137,3.746,3.711;P=0.003,<0.001,<0.001);while the SF-36 scores of patients in observation group were(72.73±3.58),(80.25±4.20)and(89.34±4.65),significantly higher than those of the control group[(64.59±3.47),(72.78±3.96)and(78.79±4.11)],with significant differences(t=8.547,7.088,9.311;all P<0.001).At 3 and 6 months after ALA-PDT,the HPV-negative conversion rates of patients in observation group were 73.3%(44/60)and 70.4%(42/60),respectively,significantly higher than those of the control group[65%(39/60)and 61.7%(37/60)],with significant differences(χ^(2)=15.98,13.76;both P<0.001).At 6 months after ALA-PDT,the rate of lesion reversal in observation group was 80.0%(48/60),significantly higher than that of control group[68.3%(41/60)],with significant difference(χ^(2)=16.89,P<0.001).Conclusions Continuity care intervention based on the KAP theory can significantly improve the self-efficacy and life quality of patients with HR-HPV persistent infection complicated with CINⅠ,and optimize the clinical outcome of patients.
作者
王鑫
吴冬玲
白光霞
闫会文
刘静
李红
Wang Xin;Wu Dongling;Bai Guangxia;Yan Huiwen;Liu Jing;Li Hong(Department of Dermatology and Venereology,Beijing Ditan Hospital,Capital Medical University,100015 Beijing,China)
出处
《中华实验和临床感染病杂志(电子版)》
2025年第3期182-186,共5页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
基金
首都医科大学附属北京地坛医院院内基金(No.DTZLX201805)。
关键词
知信行理论
延续性干预
艾拉光动力治疗
高危
人类乳头瘤病毒
持续感染
宫颈上皮内瘤样变Ⅰ
Knowledge-attitude-practice theory
Continuity intervention
Aminolevulinic acid photodynamic therapy
High-risk
Human papillomavirus
Persistent infection
Cervical intraepithelial neoplasia gradeⅠ
