摘要
目的 分析长期抗反转录病毒治疗(ART)的HIV/AIDS患者的生存状况及其影响因素.方法 从四川省艾滋病治疗信息管理系统中获取符合条件的病例资料,采用回顾性队列研究,寿命表法估算累积生存率,Kaplan-Meier(K-M)法绘制生存曲线,Cox 比例风险回归模型分析生存时间的影响因素.结果 纳入HIV/AIDS患者630 例,平均年龄(52.24±13.68)岁.全因死亡221 例,平均生存时间139.37(95%CI 133.54～145.21)月.启动ART后第1、3、5、7、10 年的累积生存率分别为 0.89(95%CI 0.87～0.91)、0.82(95%CI 0.78～0.86)、0.77(95%CI 0.73～0.81)、0.71(95%CI 0.67～0.75)、0.66(95%CI 0.62～0.70).多因素Cox 比例风险回归模型结果显示:女性患者的死亡风险是男性患者的0.57 倍(95%CI 0.41～0.79);已婚或同居的患者和离异或分居的患者的死亡风险分别是未婚患者的 2.07 倍(95%CI 1.36～3.14)、2.50 倍(95%CI 1.61～3.88);基线CD4 + T淋巴细胞51～200 cells/μl组和＞200 cells/μl组患者的死亡风险分别是基线CD4 + T淋巴细胞≤50 cells/μl组患者的0.51 倍(95%CI 0.36～0.73)和0.40 倍(95%CI 0.28～0.56);基线CD8 + T淋巴细胞578～1169 cells/μl组患者的死亡风险是基线CD8 + T淋巴细胞≤577 cells/μl组患者的0.66 倍(95%CI 0.48～0.90);基线病毒载量＞1000 copies/ml组患者的死亡风险是基线病毒载量≤1000 copies/ml组的3.20 倍(95%CI 2.44～4.20).结论 影响长期ART的 HIV/AIDS患者生存时间的主要因素为性别、婚姻状况、基线CD4 + T淋巴细胞计数、基线CD8 + T淋巴细胞计数、基线病毒载量.尽早启动ART有利于延长生存时间.
Abstract
Objective To analyze the survival status and influencing factors of long-term ART among a group of HIV/AIDS patients.Methods The eligible case data were obtained from the AIDS treatment information management system in Si-chuan Province.The retrospective cohort study was used to estimate the cumulative survival rate,Kaplan Meier(K-M)method was used to draw the survival curve,and Cox proportional hazard regression model was used to analyze the factors affecting the survival time.Results 630 HIV/AIDS patients were included in the study criteria.The average age was(52.24±13.68)years old.221 cases died from all causes,with an average survival time of 139.37(95%CI 133.54～145.21)months.The cumulative survival rates at 1,3,5,7 and 10 years after ART initiation were 0.89(95%CI 0.87～0.91),0.82(95%CI 0.78～0.86),0.77(95%CI 0.73～0.81),0.71(95%CI 0.67～0.75),0.66(95%CI 0.62～0.70),respectively.The results of multifactorial Cox propor-tional risk regression modeling showed that the risk of death in female patients was 0.57 times(95%CI 0.41～0.79)higher than that in male,and that the risk of death in married or cohabiting patients and divorced or separated patients was 2.07 times(95%CI 1.36～3.14)and 2.50 times(95%CI 1.61～3.88)higher than that in unmarried patients,respectively.Patients in the base-line CD4 + T lymphocytes 51 to 200 cells/μl and＞200 cells/μl groups had 0.51 times(95%CI 0.36～0.73)and 0.40 times(95%CI0.28～0.56)the risk of death as compared to patients in the baseline CD4 + T lymphocytes≤50 cells/μl group,and the risk of death of patients in the baseline CD8 + T lymphocytes 578 to 1169 cells/μl group patients had 0.66 times(95%CI 0.48～0.90)the risk of death as compared to patients in the baseline CD8 + T lymphocytes≤577 cells/μl group.The risk of death for patients in the baseline viral load＞1000 copies/ml group was 3.20 times higher than that in the baseline viral load≤1000 copies/ml group(95%CI2.44～4.20).Conclusion The main factors affecting the survival time of HIV/AIDS patients with long-term ART are gender,marital status,baseline CD4 +T lymphocyte count,baseline CD8 +T lymphocyte count,and base-line viral load.Early initiation of ART is beneficial for prolonging patient survival time.
维普
万方数据