CAJ | 학술논문

目的调查我国年轻男男性行为者(young men who have sex with men,YMSM)中梅毒新发感染状况及影响因素,为在YMSM人群中开展性病预防干预提供依据.方法以18 ～ 25岁YMSM且梅毒抗体检测为阴性者为研究对象,于2009年5至11月采用滚雪球的方法在北京、上海、昆明、贵阳、重庆、成都、乌鲁木齐和南宁8个城市招募符合条件的研究对象1 037名,建立研究队列并完成基线调查,分别于基线调查后的第6个月和12个月进行随访调查.调查内容包括社会人口学特征、艾滋病相关知识、态度、近6个月性行为及安全套使用情况.同时,采集静脉血8ml,进行梅毒血清学检测.采用x2检验比较基线与2次随访时研究对象的人口学特征；运用Cox回归分析的方法,探讨YMSM人群梅毒感染的影响因素.结果在1 037名YMSM研究对象中,在第6、12个月随访时,队列随访率分别为79.85％ (828/1 037)和82.16％ (852/1 037).在12个月的随访期间共新发梅毒感染39例,随访期间累计观察时间为1 106.67人年,梅毒新发感染率为3.5％；多因素Cox回归分析显示,YMSM梅毒感染的危险因素包括文化程度为高中或中专[以文化程度为大学及以上者为参考组,RR(95％ CI):2.19(1.21 ～3.98)]、性取向为双性[以同性性取向者为参考组,RR(95％ CI):2.19(1.21 ～3.97)]、HIV相关知识得分＜8分[以得分为8分者为参考组,RR(95％CI):2.39(1.35～4.21)]、近6个月有多个同性性伴且不能坚持使用安全套[以坚持使用安全套为参考组,RR(95％CI):3.10(1.39 ～6.91)].结论我国YMSM梅毒新发感染率处于较高水平,且多性伴和高危性行为等危险因素广泛存在.
목적 조사아국년경남남성행위자(young men who have sex with men,YMSM)중매독신발감염상황급영향인소,위재YMSM인군중개전성병예방간예제공의거.방법 이18 ～ 25세YMSM차매독항체검측위음성자위연구대상,우2009년5지11월채용곤설구적방법재북경、상해、곤명、귀양、중경、성도、오로목제화남저8개성시초모부합조건적연구대상1 037명,건립연구대렬병완성기선조사,분별우기선조사후적제6개월화12개월진행수방조사.조사내용포괄사회인구학특정、애자병상관지식、태도、근6개월성행위급안전투사용정황.동시,채집정맥혈8ml,진행매독혈청학검측.채용x2검험비교기선여2차수방시연구대상적인구학특정；운용Cox회귀분석적방법,탐토YMSM인군매독감염적영향인소.결과 재1 037명YMSM연구대상중,재제6、12개월수방시,대렬수방솔분별위79.85％ (828/1 037)화82.16％ (852/1 037).재12개월적수방기간공신발매독감염39례,수방기간루계관찰시간위1 106.67인년,매독신발감염솔위3.5％；다인소Cox회귀분석현시,YMSM매독감염적위험인소포괄문화정도위고중혹중전[이문화정도위대학급이상자위삼고조,RR(95％ CI):2.19(1.21 ～3.98)]、성취향위쌍성[이동성성취향자위삼고조,RR(95％ CI):2.19(1.21 ～3.97)]、HIV상관지식득분＜8분[이득분위8분자위삼고조,RR(95％CI):2.39(1.35～4.21)]、근6개월유다개동성성반차불능견지사용안전투[이견지사용안전투위삼고조,RR(95％CI):3.10(1.39 ～6.91)].결론 아국YMSM매독신발감염솔처우교고수평,차다성반화고위성행위등위험인소엄범존재.
Objectives To investigate the incidence of syphilis infection and to determine the risk factors related to syphilis infection among young men who had sex with men (YMSM),which were documented for developing effective intervention to prevent sexually transmitted diseases among YMSM.Methods A cohort study was conducted in 8 cities (Beijing,Shanghai,Kunming,Guiyang,Chongqing,Chengdu,Urumqi and Nanning) from May to December,2009.A total of 1 037 syphilisnegative YMSM aged 18-25 were enrolled in the cohort and the two follow-up surveys were carried out every six months.The contents of study included sociodemographic characteristics,HIV-related knowledge,sexual behavior and condom use in the 6 months prior to survey.All participants were tested for syphilis with whole blood specimens.Chi-square test was used to compare demographic characteristics of participants in baseline with those of two follow-up,and Cox regression analysis was used to identify risk factors associated with syphilis infection.Results The rates of participants in 6,12 months follow-up surveys was 79.85％ (828/1 037) and 82.16％ (852/1 037) respectively.39 syphilis seroconversions were found in the 12 months follow-up survey.Cumulative observed person-years during follow-up time was 1 106.67.The syphilis incidence rate was 3.5％.The Multivariate Cox regression analysis showed that the education of senior high school (senior high school vs some college or higher,RR =2.19,95％ CI:1.21-3.98),bisexual orientation (bisexual orientation vs homosexual orientation,RR =2.19,95％ CI:1.21-3.97),score of HIV/AIDS knowledge ＜8 (score of HIV/AIDS knowledge ＜ 8 vs knowledge =8,RR =2.39,95％ CI:1.35-4.21),had two and more sexual partners and inconsistent condom use in the past 6 months (inconsistent condom use vs consistent condom use,RR =3.10,95％ CI:1.39-6.91) were significantly associated with syphilis seroconversion in the 12-month period.Conclusions The syphilis incidence was high and risk behaviors were common among YMSM of China.