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外来受診解析に基づくてんかん患者の行動特性に関する研究

中村, 悠一 北海道大学

2023.12.25

概要

【背景と目的】 てんかん患者、特に特発性全般てんかん(IGE)患者は、服薬
アドヒアランスの欠如によって不利益を被るリスクが高い。受診行動が服薬ア
ドヒアランスの代替指標となる可能性が示唆されている。我々は、IGE 患者は他
のてんかん診断と比較して受診のアドヒアランスが不良である仮説を立てた。
これを実証するために、てんかん患者における受診行動(欠席と遅刻)を評価し、
てんかん診断を含む様々な因子との関連性を検証することとした。
【対象と方法】 2017 年 1 月~2019 年 12 月に北海道大学病院精神科神経科を
受診したてんかん患者を対象として後方視的研究を行った。てんかん患者に関
する人口統計学的データおよび臨床データを診療録から、受診データを医療情
報システムから抽出した。外来予約の欠席を「事前連絡なしに予約日に現れない
場合」、外来予約の遅刻を「来院時間が予約時間を 15 分超過した場合」と定義し
て評価項目とした。欠席と遅刻のそれぞれを目的変数とし、抽出した因子を説明
変数として、混合効果ロジスティック回帰分析を実施した。それぞれ下位診断ご
とのサブグループ解析を行った。さらに、研究対象者をてんかんの下位診断ごと
に層別化した後、主解析と同様の解析をサブグループ解析として実施した。
【結果】 欠席とてんかん診断の関連性の検証を目的とした研究では、総予約数
9151 件のうち、413 件が欠席であり、全体の欠席率は 4.5%であった。欠席を目
的変数とした混合効果ロジスティック回帰分析の結果、IGE の診断は焦点てん
かん(FE)と比べて欠席の増加と関連していた(オッズ比(OR) 2.02; 95%信
頼区間(CI)1.20-3.39; p=0.008)。生活保護受給歴は欠席の増加と関連していた
(OR 2.35;95% CI 1.38-4.02;p=0.002)。高学歴(大学・専門卒以上)は欠席の
減少と関連していた(OR 0.64; 95% CI 0.43-0.96; p=0.029)。IGE 患者のみを対象
としたサブグループ解析の結果、午後の予約は欠席の減少と関連していた(OR
0.38; 95% CI 0.20-0.71; p=0.003)。若年ミオクロニーてんかん(JME)の診断は JME
以外の IGE と比較して欠席が少ない傾向が示されたが、有意な差ではなかった
(OR 0.39; 95% CI 0.14-1.09; p=0.072)。FE 患者のみを対象としたサブグループ解
析の結果、側頭葉てんかん(TLE)の診断はその他の FE と比べて欠席の減少と
関連していた(OR 0.58; 95%CI 0.35-0.95; p=0.032)。生活保護受給歴は欠席の増
加と関連していた(OR 2.37;95% CI 1.32-4.26;p=0.004)。高学歴(大学・専門
卒以上)は欠席の減少と関連していた(OR 0.60; 95% CI 0.38-0.94; p=0.025)。 ...

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