中图分类号 R969.3；R195 文献标志码 A 文章编号 1001-0408（2018）02-0263-06
DOI 10.6039/j.issn.1001-0408.2018.02.28
摘 要 目的：考察中文版8条目Morisky用药依从性量表（MMAS-8）测量类风湿关节炎（RA）患者用药依从性的信效度。方法：利用中文版MMAS-8就中国风湿病公众论坛微信公众号上发布的招募信息与电子版问卷作出回应的200例RA患者进行用药依从性评价，分析上述量表的项目、同质性、信度和效度。结果：量表总得分前后27%的两个极端组的8条目平均分的Levene法F检验差异均有统计学意义（P<0.001），方差不相等t检验差异均有统计学意义（P<0.001）；7条目与总分的相关系数均大于0.400，且8条目与总分均显著相关（P<0.001）；内部一致性系数（Cronbach’s α）为0.657，标准化Cronbach’s α为0.662；结构效度（KMO值为0.638，Bartlett’s球形检验值为246.278），采用因素分析法共提取3个公共因子，可解释总方差的58.846%；聚合效度方面中文版MMAS-8总分与用药依从性视觉模拟评分的Pearson相关系数为0.435（P<0.001）。结论：中文版MMAS-8用于测量RA患者的信效度较好。
关键词 8条目Morisky用药依从性量表；中文版；类风湿关节炎；用药依从性；信度；效度
ABSTRACT OBJECTIVE： To investigate the reliability and validity of the Chinese version Morisky Medication Adherence Scales-8 in assessing medication compliance of the patients with rheumatoid arthritis. METHODS： The Chinese version of MMAS-8 was used to evaluate the compliance of 200 rheumatoid arthritis patients who responded to the WeChat public issue from the public forum of China rheumatism.Item analysis， homogeneity test， reliability analysis， and validity analysis were all conducted. RESULTS： The eight items showed significant difference between the two extreme groups as head and tail 27% of the total score in Levene method F test （P<0.001）. t test of variance inequality was adopted， with significant difference （P<0.001）. Correlation coefficient between the 7 items and the total score was higher than 0.400， and the 8 items were significantly correlated with the total score （P<0.001）. Internal consistency reliability coefficient Cronbach’s α was 0.657， and standardized Cronbach’s α was 0.662. For construct validity， KMO was 0.638， Bartlett’s sphericity test was 246.278， factor analysis method was adopted to extract 3 common factors， and explainable total variance was 58.846%. Pearson correlation coefficient was 0.435 between MMAS-8 total score and MA-VAS score （P<0.001）. CONCLUSIONS： Reliability and validity of the Chinese version MMAS-8 for the determination of medication compliance in patients with rheumatoid arthritis are good.
KEYWORDS MMAS-8； Chinese version； Rheumatoid arthritis； Medication adherence； Reliability； Validity
类风湿关节炎（Rheumatoid arthritis， RA）是一种以侵袭性滑膜炎为特征的自身免疫性疾病，该病病程迁延、致残率高，在我国有超过500万的患者。根据国内外指南[1-3]，抗风湿药物（Disease modifying anti-rheumatic drugs，DMARDs）可有效控制RA患者的病情活动度和放射学进展，并改善预后，减轻关节损害，提高生活质量。然而RA患者的用药依从性并不理想，用药依从率约为30%～80%[4]。在临床实践中，问卷法是测量患者用药依从性的常用方法。目前有3种用药依从性问卷被用于RA患者：Morisky用药依从性量表（Morisky medication adherence scale， MMAS）、用药依从性报告量表（Medication adherence report scale，MARS）和风湿病依从性问卷（Compliance questionnaire on rheumatology，CQR）。其中MMAS尚缺乏针对RA患者群的信效度证据，也尚未有MMAS用于我国RA患者用药依从性研究的相關报道。Morisky DE等1986年发布了用于测量高血压患者用药依从性的4条目MMAS（MMAS-4）[5]，又于2008年发布了8条目MMAS（MMAS-8）[6]。MMAS-8在信效度方面更优于MMAS-4，其简单、经济、实施性强，被翻译成多国语言版本，广泛用于多种慢性病患者的用药依从性研究。本研究将以我国RA患者为样本评价中文版MMAS-8的信效度，考察该问卷是否适用于测量我国RA患者的用药依从性。
