CAJ | 학술논문

目的探讨我国获得性免疫缺陷综合征(AIDS)患者免费抗病毒治疗策略在控制AIDS患者病死率方面的效果及其影响因素.方法采用回顾性队列研究法,在我国免费抗病毒治疗开展较早地区以典型整群抽样法抽取河南省驻马店市和安徽省阜阳市,选取2008年8月30日前确诊的MDS患者为调查对象,收集整理其发病、死亡等相关信息,采用Cox回归进行分析.结果共收集AIDS患者10 394例,平均年龄(41.7±9.3)岁,男性占50.3%(5233/10 394),在婚者占85.0%(8808/10 394),农民占95.1%(9880/10 394),既往不安全有偿采供血(浆)感染者占81.2%(8438/10 394).调查对象中免费抗病毒治疗比例从2002年的5.2%上升到2008年的66.5%.AIDS患者总病死率从2002年的35.4/100人年降到2008年的5.9/100人年.Cox回归分析显示AIDS患者最主要死亡风险是没有抗病毒治疗(HR=4.3,95%CI:4.0～4.7),治疗者基线CD_4~+淋巴细胞<50个/μl、50～199个/μL者死亡风险均高于≥200个/μl者(风险比HR分别为7.9、2.8),治疗基线合并机会性感染症状数多者死亡风险高(HR=2.1),其他不可变死亡风险为男性、年龄≥50岁、既往不安全有偿采供血(浆)以外其他感染途径或途径不详者(HR分别为1.4,1.6,1.8).结论我国农村免费抗病毒治疗显著降低并且稳定遏制了MDS患者病死率,提示扩大治疗覆盖率可进一步降低AIDS患者病死率.
목적 탐토아국획득성면역결함종합정(AIDS)환자면비항병독치료책략재공제AIDS환자병사솔방면적효과급기영향인소.방법 채용회고성대렬연구법,재아국면비항병독치료개전교조지구이전형정군추양법추취하남성주마점시화안휘성부양시,선취2008년8월30일전학진적MDS환자위조사대상,수집정리기발병、사망등상관신식,채용Cox회귀진행분석.결과 공수집AIDS환자10 394례,평균년령(41.7±9.3)세,남성점50.3%(5233/10 394),재혼자점85.0%(8808/10 394),농민점95.1%(9880/10 394),기왕불안전유상채공혈(장)감염자점81.2%(8438/10 394).조사대상중면비항병독치료비례종2002년적5.2%상승도2008년적66.5%.AIDS환자총병사솔종2002년적35.4/100인년강도2008년적5.9/100인년.Cox회귀분석현시AIDS환자최주요사망풍험시몰유항병독치료(HR=4.3,95%CI:4.0～4.7),치료자기선CD_4~+림파세포<50개/μl、50～199개/μL자사망풍험균고우≥200개/μl자(풍험비HR분별위7.9、2.8),치료기선합병궤회성감염증상수다자사망풍험고(HR=2.1),기타불가변사망풍험위남성、년령≥50세、기왕불안전유상채공혈(장)이외기타감염도경혹도경불상자(HR분별위1.4,1.6,1.8).결론 아국농촌면비항병독치료현저강저병차은정알제료MDS환자병사솔,제시확대치료복개솔가진일보강저AIDS환자병사솔.
Objective To determine the effect of national. free highly active anriretroviral. treatment (HAART) on reduction of mortality and relevant risk factors among adult Acquired immunodeficiency syndrome( AIDS) patients. Methods A retrospective cohort study was conducted and all AIDS patients diagnosed before Aug. 30th,2008 in Zhumadian,Henan province,and Fuyang, Anhui province were enrolled in this study,where HAART initiated in early time. The data and information were collected such as AIDS progress,diagnosis,treatment,death and et al. Results Among 10 394 AIDS patients, the mean age was (41. 7 ±9. 3) year-old,50. 3% (5233/10 394) were male,85. 0% (8808/10 394) were married,95.1% (9880/10 394) were farmers, and 81.2% (8438/10 394) were former plasma donors (FPDs).The coverage of HAART increased from 5.2% in 2002 to 66.5% in 2008. Conversely, the overall mortality declined from 35.4/100 person-years in 2002 to 5.9/100 person-years in 2008. In a multivariate Cox proportional. hazards analysis,the greatest risk factor for mortality was non-HAART,with a hazard ratio (HR) 4.3 (95%CI:4.0-4.7). Among treated patients,compared with higher CD/ T cell counts ( >200 cells/μl),those initiating therapy with lower CD_4~+ T cell counts, were at greater risk to death ( <50 cells/μl,HR = 7. 9; 50-199 cells/μl, HR = 2. 8). Number of opportunistic infections ( OIs ) was risk to mortality (HR = 2. 1). In addition, other risk factors included male, age ( ≥ 50 years old) , and other infection way except FPDs ( HR were 1.4, 1.6 and 1.8) .Conclusion The national. free treatment program has significantly reduced the AIDS mortality rate among HIV-infected FPDs through the use of generic antiretroviral. drugs in rural. clinical. settings. The effective reduction of AIDS mortality could be realized through increased coverage of therapy.