成人肾移植患者免疫抑制剂服药依从性管理的证据总结

doi:10.3761/j.issn.0254-1769.2023.18.005

摘要/Abstract

摘要：

目的检索、评价和汇总成人肾移植患者免疫抑制剂服药依从性管理的证据，为临床决策提供参考。方法计算机检索BMJ Best Practice、UpToDate、英国肾脏病协会、改善全球肾脏病预后组织、美国重症监护护士协会、医脉通、梅斯医学、中华医学会器官移植学分会等网站和澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、Cochrane Library、Embase、EBSCO、Web of Science、PubMed、中国生物医学数据库、中国知网、万方数据库等数据库。检索关于肾移植患者免疫抑制剂服药依从性评估及干预管理的指南、证据总结、最佳实践、专家共识、系统评价。检索时限为建库至2022年7月31日。由2名研究者进行文献质量评价和资料提取。结果共纳入13篇文献，包括2篇指南、1篇证据总结、4篇专家共识、3篇系统评价和3篇Meta分析。围绕医护人员培训、依从性评估、依从性干预3个方面形成38条证据。结论该研究总结的肾移植患者免疫抑制剂服药依从性管理的证据比较全面、科学，可协助临床医护人员制订肾移植患者免疫抑制剂服药依从性评估和干预方案，为提升移植照护质量提供循证依据。

关键词: 肾移植, 服药依从性, 免疫抑制剂, 证据总结, 循证护理学

Abstract:

Objective To search，evaluate and summarize the best evidence on the management of immunosuppressive drug adherence in adult renal transplant recipients，so as to provide references to clinical decision making. Methods BMJ Best Practice，UpToDate，British Nephrology Association，Organization for Improving the Prognosis of Global Nephropathy，American Association of Intensive Care Nurses，Medical Pulse，Mays Medicine，Chinese Medical Association Organ Transplantation Credit Association and other websites，Joanna Briggs Institute of Australia evidence-based health care center database，Cochrane Library，Embase，EBSCO，Web of Science，PubMed，China Biomedical Database，CNKI，Wanfang were searched by the computer. Guidelines，evidence summaries，best practices，expert consensuses，systematic reviews on the assessment of adherence to immunosuppressive drugs and management of interventions in renal transplant recipients were retrieved. The time for the search was from database creation to July 31，2022. Literature quality evaluation and data extraction was performed by 2 investigators. Results A total of 13 articles were involved，including 2 guidelines，1 evidence summary，4 expert consensuses，3 systematic reviews and 3 meta-analyses. 38 pieces of best evidence were generated in 3 areas，namely healthcare worker training，adherence assessment，and adherence intervention. Conclusion The results of this study could assist nurses to manage adherence to immunosuppressant medication in renal transplant recipients and provide an evidence-based basis for improving the quality of transplant care.

Key words: Renal Transplantation, Medication Adherence, Immunosuppressant, Evidence Summary, Evidence-Based Nursing

沈鸣雁. 成人肾移植患者免疫抑制剂服药依从性管理的证据总结[J]. 中华护理杂志, 2023, 58(18): 2207-2215.

SHEN Mingyan. Evidence summary for compliance management of immunosuppressive agents in adult renal transplant recipients[J]. Chinese Journal of Nursing, 2023, 58(18): 2207-2215.

图/表 4

图1 文献筛选流程图

Figure 1 Flow chart of literature screening

表1 纳入文献的基本特征（n=13）

Table 1 The basic characteristics of the included literature（n=13）

表2 纳入指南的质量评价结果（n=2）

Table 2 Quality evaluation of clinical practice guidelines（n=2）

表3 成人肾移植患者免疫抑制剂服药依从性管理的最佳证据总结

Table 3 Evidence summary for compliance management of immunosuppressive agents in adult renal transplant recipients

参考文献 39

[1]	黄洁夫. 中国器官移植发展报告(2020)[M]. 北京: 中国科学技术出版社, 2022.
	Huang JF. China organ transplantation development report(2020)[M]. Beijing: China Science & Technology Press, 2022.
[2]	Muduma G, Shupo FC, Dam S, et al. Patient survey to identify reasons for non-adherence and elicitation of quality of life concepts associated with immunosuppressant therapy in kidney transplant recipients[J]. Patient Prefer Adherence, 2016, 10:27-36.
[3]	World Health Organization. Adherence to long-term therapies:evidence for action[EB/OL].(2012-06-16)[2022-10-01]. https://apps.who.int/iris/handle/10665/42682.
[4]	Fine RN, Becker Y, De Geest S, et al. Nonadherence consensus conference summary report[J]. Am J Transplant, 2009, 9(1):35-41. DOI PMID
[5]	Kuypers DRJ. From nonadherence to adherence[J]. Transplanta-tion, 2020, 104(7):1330-1340.
[6]	Mathes T, Groβpietsch K, Neugebauer EAM, et al. Interventions to increase adherence in patients taking immunosuppressive drugs after kidney transplantation:a systematic review of controlled trials[J]. Systematic Reviews, 2017, 6(1):236. DOI PMID
[7]	Sanders-Pinheiro H, Colugnati F, Marsicano EO, et al. Prevalence and correlates of non-adherence to immunosuppressants and to health behaviours in patients after kidney transplantation in Brazil-the ADHERE BRAZIL multicentre study:a cross-sectional study protocol[J]. BMC Nephrol, 2018, 19(1):41. DOI PMID
[8]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):199l-1994.
	Zhu Z, Hu Y, Xing WJ, et al. The composition of different types of evidence based problems[J]. J Nurses Train, 2017, 32(21):199l-1994.
[9]	朱政, 胡雁, 周英凤, 等. 推动证据向临床转化(五)证据临床转化研究中的文献质量评价[J]. 护士进修杂志, 2020, 35(11):996-1000.
	Zhu Z, Hu Y, Zhou YF, et al. Promotion evidence to clinical transformation:evidence resource retrieval for the purpose of clinical transformation[J]. J Nurses Train, 2020, 35(11):996-1000.
[10]	顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8):70.
	Gu Y, Zhang HW, Zhou YF, et al. JBI evidence-based health center’s quality assessment tool for different types of research:the quality evaluation of diagnostic and economic evaluation[J]. J Nurses Train, 2018, 33(8):70.
[11]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018.
	Hu Y, Hao YF. Evidence based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018.
[12]	Foster MJ, Shurtz S. Making the critical appraisal for sum- maries of evidence(CASE) for evidence-based medicine(EBM):critical appraisal of summaries of evidence[J]. J Med Libr Assoc, 2013, 101(3):192-198. DOI URL
[13]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence preclassification and evidence rank system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[14]	Stephenson M, Koh G. Adult kidney transplantation:interventions to improve medication adherence[EB/OL]. (2021-08-26)[2022-07-31]. http://ovidsp.ovid.com/ovidweb.cgiT=JS&PAGE=reference&D=jbi&NEWS=N&AN=JBI10940.
[15]	European Association of Urology. EAU guidelines on renal transplantation[EB/OL]. (2019-03-01)[2022-07-31]. https://uroweb.org/guidelines/renal-transplantation.
[16]	Baker RJ, Mark PB, Patel RK, et al. Renal association clinical practice guideline in post-operative care in the kidney transplant recipient[J]. BMC Nephrol, 2017, 18(1):174. DOI PMID
[17]	刘晓曼, 陈杰. 肾移植患者免疫抑制剂长期管理医药专家共识[J]. 今日药学, 2022, 32(11):801-816.
	Liu XM, Chen J. Expert consensus on the long-term management of immunosuppressive agents in kidney transplant patients[J]. Pharmacy Today, 2022, 32(11):801-816.
[18]	陈文倩, 张雷. 实体器官移植他克莫司个体化治疗专家共识[J]. 实用器官移植电子杂志, 2022, 10(4):301-308.
	Chen WQ, Zhang L. Expert consensus on individualized treatment of tacrolimus in solid organ transplantation[J]. Pract J Organ Transplant(electron version), 2022, 10(4):301-308.
[19]	Neuberger JM, Bechstein WO, Kuypers DR, et al. Practical recommendations for long-term management of modifiable risks in kidney and liver transplant recipients:a guidance report and clinical checklist by the consensus on managing modifiable risk in transplantation(COMMIT) group[J]. Transplantation, 2017, 101(Suppl 2):S1-S56.
[20]	中华医学会器官移植学分会. 肾移植术后随访规范(2019版)[J]. 器官移植, 2019, 10(6):667-671.
	Chinese Society of Organ Transplantation. Specification for follow-up after renal transplantation(2019 edition)[J]. Organ Transplant, 2019, 10(6):667-671.
[21]	Lee H, Shin BC, Seo JM. Effectiveness of eHealth interventions for improving medication adherence of organ transplant patients:a systematic review and Meta-analysis[J]. PLoS One, 2020, 15(11):e0241857. DOI URL
[22]	Zhu Y, Zhou Y, Zhang L, et al. Efficacy of interventions for adherence to the immunosuppressive therapy in kidney transplant recipients:a meta-analysis and systematic review[J]. J Investig Med, 2017, 65(7):1049-1056. DOI URL
[23]	Ladin K, Daniels A, Osani M, et al. Is social support associated with post-transplant medication adherence and outcomes?A systematic review and Meta-analysis[J]. Transplant Rev(Orlando), 2018, 32(1):16-28.
[24]	Eslami S, Khoshrounejad F, Golmakani R, et al. Effectiveness of IT-based interventions on self-management in adult kidney transplant recipients:a systematic review[J]. BMC Med Inform Decis Mak, 2021, 21(1):2. DOI
[25]	van Heuckelum M, van den Ende CHM, Houterman AEJ, et al. The effect of electronic monitoring feedback on medication adherence and clinical outcomes:a systematic review[J]. PLoS One, 2017, 12(10):e0185453. DOI URL
[26]	Low JK, Williams A, Manias E, et al. Interventions to improve medication adherence in adult kidney transplant recipients:a systematic review[J]. Nephrol Dial Transplant, 2015, 30(5):752-761. DOI URL
[27]	Low JK, Manias E, Crawford K, et al. Improving medication adherence in adult kidney transplantation(IMAKT):a pilot randomised controlled trial[J]. Sci Rep, 2019, 9(1):7734. DOI
[28]	Kvarnström K, Westerholm A, Airaksinen M, et al. Factors contributing to medication adherence in patients with a chronic condition:a scoping review of qualitative research[J]. Pharmaceutics, 2021, 13(7):1100. DOI URL
[29]	王莎莎, 刘红霞, 高凤莉, 等. 肾移植受者免疫抑制药物依从性现况分析[J]. 中国护理管理, 2020, 20(3):354-359.
	Wang SS, Liu HX, Gao FL, et al. Analysis of medication adherence to immunosuppressive treatment in recipients with kidney transplant[J]. Chin Nurs Manag, 2020, 20(3):354-359.
[30]	杨国莉, 刘佳, 赵洪圉, 等. 肾移植患者服药依从性的行为特征[J]. 中南大学学报(医学版), 2022, 47(6):762-770.
	Yang GL, Liu J, Zhao HY, et al. Characteristics of medication compliance behavior in renal transplantation patients[J]. J Cent South Univ(medical science), 2022, 47(6):762-770.
[31]	Institute of Nursing Science,Faculty of Medicine,University of Basel. Basel Assessment of Adherence to Immunosuppressi-ve Medications Scale[EB/0L]. (2021-02-12)[2022-10-01]. https://baasis.Nursing.unibas.ch/.
[32]	Taj SM, Baghaffar H, Alnajjar DK, et al. Prevalence of nonadherence to immunosuppressive medications in kidney transplant recipients:barriers and predictors[J]. Ann Transplant, 2021, 26:e928356.
[33]	Zomahoun H, Guénette L, Grégoire JP, et al. Effectiveness of motivational interviewing interventions on medication adherence in adults with chronic diseases:a systematic review and meta-analysis[J]. Int J Epidemiol, 2017, 46(2):589-602. DOI PMID
[34]	刘蓓蓓, 黄间开, 陈艳, 等. 肾移植受者应对方式对服药依从性及自我管理的影响[J]. 中华移植杂志(电子版), 2020, 14(5):279-284.
	Liu BB, Huang JK, Chen Y, et al. The impact of coping styles on medication adherence and self-management among kidney transplant recipients[J]. Chin J Transplant(electronic edition), 2020, 14(5):279-284.
[35]	林韦彤, 刘立芳, 万晶晶, 等. 肾移植受者恐惧疾病进展现状及影响因素研究[J]. 中华护理志, 2022, 57(1):73-78.
	Lin WT, Liu LF, Wan JJ, et al. The status and factors associated with fear of progression in recipients of renal transplantation[J]. Chin J Nurs, 2022, 57(1):73-78. DOI URL
[36]	Low JK, Williams A, Manias E, et al. Interventions to improve medication adherence in adult kidney transplant recipients:a systematic review[J]. Nephrol Dial Transplant, 2015, 30(5):752-761. DOI URL
[37]	Williams AM, Low JK, Manias E, et al. Trials and tribulations with electronic medication adherence monitoring in kidney transplantation[J]. Res Social Adm Pharm, 2016, 12(5):794-800. DOI PMID
[38]	何加敏, 朱政, 卢洪洲. HIV感染者合并慢性非传染性疾病多药依从性管理的研究进展[J]. 中华护理杂志, 2022, 57(14):1788-1793. DOI URL
	He JM, Zhu Z, Lu HZ. Research progress on polypharmacy adherence management in HIV-infected people with chronic non-communicable diseases[J]. Chin J Nurs, 2022, 57(14):1788-1793. DOI URL
[39]	赵继明, 房晓, 孟俏, 等. 肾移植患者个人生活掌控感现状及其影响因素研究[J]. 中华护理杂志, 2022, 57(10):1213-1218. DOI URL
	Zhao JM, Fang X, Meng Q, et al. Status and influencing factors of personal mastery in kidney transplant patients[J]. Chin J Nurs, 2022, 57(10):1213-1218. DOI URL