CAJ | 학술논문

目的了解伊犁哈萨克自治州美沙酮维持治疗门诊中HIV感染者的死亡率及其影响因素.方法采用回顾性队列研究方法,从AIDS综合防治信息系统中的美沙酮维持治疗系统和HIV/AIDS报告系统中收集新疆维吾尔自治区伊犁哈萨克自治州5个美沙酮门诊就诊者中所有HIV阳性就诊者(860例)的基线、治疗、随访和死亡信息.收集的信息包括人口学特征、美沙酮每日服药情况、CD4检测情况、抗病毒治疗情况以及死亡情况等.基线信息从2005年8月建立第一个美沙酮门诊起开始收集,随访信息收集到2011年5月.对缺失数据采用回归插补法进行处理,采用Cox比例风险回归对影响死亡的因素进行研究,使用Schoenfeld检验对比例风险假设进行检验.采用R软件对数据进行整理和统计学分析.结果共分析860例HIV阳性海洛因成瘾者,平均年龄为(32.9±6.4)岁,67.3％( 579/860)的为已婚.美沙酮服药剂量为(38.2±20.7)mg/d,27.8％(239/860)参加了抗病毒治疗,38.7％(333/860)的从未检测过CD4.观察期间出现151例死亡病例,研究队列共观察了 2192.9人年,平均每人观察2.6年,全死因死亡率为68.9‰.Cox比例风险模型分析显示,参加抗病毒治疗(HR =0.53,95％CI:0.32～0.88)、基线CD4计数在200～350个/μl(HR=0.35,95％ CI:0.20 ～0.60)、基线CD4计数大于350个/μl(HR=0.16,95％CI:0.09～0.29)、已婚(HR =0.55,95％CI:0.37 ～0.82)是保护因素；年龄大于45岁(HR=5.20,95％ CI:2.60～10.20)、曾经共用过注射器(HR=1.40,95％CI:1.02 ～2.00)与参照组比较是死亡的危险因素.结论伊犁哈萨克自治州美沙酮门诊中HIV感染者的死亡率较高,坚持抗病毒治疗有利于降低感染者的死亡率.
목적 료해이리합살극자치주미사동유지치료문진중HIV감염자적사망솔급기영향인소.방법 채용회고성대렬연구방법,종AIDS종합방치신식계통중적미사동유지치료계통화HIV/AIDS보고계통중수집신강유오이자치구이리합살극자치주5개미사동문진취진자중소유HIV양성취진자(860례)적기선、치료、수방화사망신식.수집적신식포괄인구학특정、미사동매일복약정황、CD4검측정황、항병독치료정황이급사망정황등.기선신식종2005년8월건립제일개미사동문진기개시수집,수방신식수집도2011년5월.대결실수거채용회귀삽보법진행처리,채용Cox비례풍험회귀대영향사망적인소진행연구,사용Schoenfeld검험대비례풍험가설진행검험.채용R연건대수거진행정리화통계학분석.결과 공분석860례HIV양성해락인성은자,평균년령위(32.9±6.4)세,67.3％( 579/860)적위이혼.미사동복약제량위(38.2±20.7)mg/d,27.8％(239/860)삼가료항병독치료,38.7％(333/860)적종미검측과CD4.관찰기간출현151례사망병례,연구대렬공관찰료 2192.9인년,평균매인관찰2.6년,전사인사망솔위68.9‰.Cox비례풍험모형분석현시,삼가항병독치료(HR =0.53,95％CI:0.32～0.88)、기선CD4계수재200～350개/μl(HR=0.35,95％ CI:0.20 ～0.60)、기선CD4계수대우350개/μl(HR=0.16,95％CI:0.09～0.29)、이혼(HR =0.55,95％CI:0.37 ～0.82)시보호인소；년령대우45세(HR=5.20,95％ CI:2.60～10.20)、증경공용과주사기(HR=1.40,95％CI:1.02 ～2.00)여삼조조비교시사망적위험인소.결론 이리합살극자치주미사동문진중HIV감염자적사망솔교고,견지항병독치료유리우강저감염자적사망솔.
Objective To investigate the mortality of HIV infected clients from methadone maintenance treatment(MMT) clinics in Yili Kazakh autonomous prefecture as well as the factors associated with mortality of HIV infected clients.Methods A retrospective cohort study was performed.Data of 860 cases were collected from National Methadone Maintenance Treatment database,National AIDS/HIV database and antiretroviral therapy (ART) treatment database for adults.Information collected included demographic information of HIV infected clients,methadone daily treatment information,CD4 testing information,ART treatment information and death information.Recruiting began from August,2005 through May,2011.Cox proportional regression was used to indentify factors associated with mortality.The proportional hazard assumption was assessed using Schoenfeld's residuals test.Missing values were imputed using the multiple linear regression method.R software (version 2.13.0) was used to perform data analysis.Results A total of 860 HIV positive MMT clients were analyzed.The methadone dose for study subjects was (38.2 +20.7) mg/d.27.8％ ( 239/860 ) of study subjects participated in ART treatment,38.7％ ( 333/860 ) had never tested for CD4 count.The age for study subjects was (32.9 ± 6.4 ) years old.Among all these subjects,67.3％ (579/860) were married.During the observation period,151 deaths were observed in 2192.9 person years.The average observation time was 2.6 year for each subject.The all-cause mortality rate was 68.9‰o.Cox proportion model showed that ART treatment (HR =0.53,95％ CI:0.32 -0.88 ),baseline CD4 count at 200 - 350 cells/μl ( HR =0.35,95％ CI:0.20 - 0.60 ),baseline CD4 count more than 350 cells/μl ( HR =0.16,95％ CI:0.09 - 0.29 ),and marriage ( HR =0.55,95％ CI:0.37 - 0.82 ) were associated with less mortality compared with control group.Age ( more than 45 years old ) ( HR =5.20,95 ％ CI:2.60 - 10.20) and sharing needles ( HR =1.40,95 ％ CI:1.02 - 2.00 ) were risk factors associated with death.Conclusion High mortality rate was observed among HIV infected clients.Methadone clinic should provide ART treatment or ART referral services.