艾滋病抗病毒治疗死亡患者的生存时间及相关因素分析
애자병항병독치료사망환자적생존시간급상관인소분석
A retrospective cohort study on survival time of AIDS death cases receiving Antiretroviral Therapy and related factors
  • 万方数据
    中华预防医学杂志 중화예방의학잡지
    CHINESE JOURNAL OF
    2014年 6期 466-470 ,共5页

    郝连正%朱晓艳%王国永%林彬%钱跃升%陶小润%胡军%杨兴光%康殿民

    학련정%주효염%왕국영%림빈%전약승%도소윤%호군%양흥광%강전민

    获得性免疫缺陷综合征%HIV%抗病毒治疗%生存时间%回顾性研究 穫得性免疫缺陷綜閤徵%HIV%抗病毒治療%生存時間%迴顧性研究
    획득성면역결함종합정%HIV%항병독치료%생존시간%회고성연구
    Acquired immunodeficiency syndrome%HIV%Antiretroviral therapy%Survival time%Retrospective study
    目的 探析艾滋病抗病毒治疗死亡患者的生存时间及相关因素.方法 采用回顾性队列研究方法,通过中国疾病预防控制系统艾滋病综合防治信息系统收集2003年7月至2012年12月间山东省接受过艾滋病抗病毒治疗的死亡患者信息,采用Kaplan-Meier乘积极限法估算抗病毒治疗死亡患者的中位生存时间,比较不同年龄、性别、婚姻状况、感染途径、WHO临床分期、基线CD4+T淋巴细胞水平、开始治疗距确认HIV感染的时间间隔组生存时间的差异,采用寿命表法和生存曲线描述其生存分布,采用Cox危险比例回归模型筛选艾滋病死亡的相关因素.结果 共收集142例艾滋病抗病毒治疗死亡患者为研究对象,其中艾滋病相关死亡125例(88.03％),艾滋病非相关死亡17例(11.97％);研究对象治疗中位生存时间为3.100(95％ CI:2.279～3.921)个月,接受治疗后的前3个月、3～6个月、6～12个月的累积生存率分别为(52±4)％、(33±4)％、(26±4)％.已婚或同居组治疗中位生存时间为2.670(95％ CI:1.470 ～3.870)个月,单身(未婚、离异、分居或丧偶)组为5.870 (95％ CI:2.617 ～9.123)个月;WHO临床分期Ⅰ期或Ⅱ期组治疗中位生存时间为5.870(95％ CI:3.989 ～7.751)个月,Ⅲ期或Ⅳ期为1.700(95％ CI:0.885 ～2.515)个月;基线CD4+T淋巴细胞≤50个/μl组治疗中位生存时间为1.670(95％CI:0.759 ～2.581)个月,51 ～ 199个/μl组为4.400(95％ CI:2.735 ～6.065)个月,≥200个/μl组为7.100(95％CI:0.000～14.542)个月;不同婚姻状况、WHO临床分期、基线CD4+T淋巴细胞水平组间生存时间差异均有统计学意义(P＜0.05).单身(未婚、离异、分居或丧偶)组死亡风险是已婚或同居组的0.641倍,WHO临床分期Ⅲ期或Ⅳ期患者的死亡风险是Ⅰ期或Ⅱ期患者的1.856倍,基线CD4+T淋巴细胞为51 ～199个/μl组、≥200个/μl组患者的死亡风险分别是≤50个/μl组的0.582倍和0.551倍.结论 研究对象治疗后生存时间较短,死亡集中发生于开始治疗后的前6个月,随着时间延长,死亡速度减缓;已婚或同居、基线CD4+T淋巴细胞水平低、WHO临床分期Ⅲ期或Ⅳ期是抗病毒治疗患者死亡的危险因素.
    목적 탐석애자병항병독치료사망환자적생존시간급상관인소.방법 채용회고성대렬연구방법,통과중국질병예방공제계통애자병종합방치신식계통수집2003년7월지2012년12월간산동성접수과애자병항병독치료적사망환자신식,채용Kaplan-Meier승적겁한법고산항병독치료사망환자적중위생존시간,비교불동년령、성별、혼인상황、감염도경、WHO림상분기、기선CD4+T림파세포수평、개시치료거학인HIV감염적시간간격조생존시간적차이,채용수명표법화생존곡선묘술기생존분포,채용Cox위험비례회귀모형사선애자병사망적상관인소.결과 공수집142례애자병항병독치료사망환자위연구대상,기중애자병상관사망125례(88.03％),애자병비상관사망17례(11.97％);연구대상치료중위생존시간위3.100(95％ CI:2.279～3.921)개월,접수치료후적전3개월、3～6개월、6～12개월적루적생존솔분별위(52±4)％、(33±4)％、(26±4)％.이혼혹동거조치료중위생존시간위2.670(95％ CI:1.470 ～3.870)개월,단신(미혼、리이、분거혹상우)조위5.870 (95％ CI:2.617 ～9.123)개월;WHO림상분기Ⅰ기혹Ⅱ기조치료중위생존시간위5.870(95％ CI:3.989 ～7.751)개월,Ⅲ기혹Ⅳ기위1.700(95％ CI:0.885 ～2.515)개월;기선CD4+T림파세포≤50개/μl조치료중위생존시간위1.670(95％CI:0.759 ～2.581)개월,51 ～ 199개/μl조위4.400(95％ CI:2.735 ～6.065)개월,≥200개/μl조위7.100(95％CI:0.000～14.542)개월;불동혼인상황、WHO림상분기、기선CD4+T림파세포수평조간생존시간차이균유통계학의의(P＜0.05).단신(미혼、리이、분거혹상우)조사망풍험시이혼혹동거조적0.641배,WHO림상분기Ⅲ기혹Ⅳ기환자적사망풍험시Ⅰ기혹Ⅱ기환자적1.856배,기선CD4+T림파세포위51 ～199개/μl조、≥200개/μl조환자적사망풍험분별시≤50개/μl조적0.582배화0.551배.결론 연구대상치료후생존시간교단,사망집중발생우개시치료후적전6개월,수착시간연장,사망속도감완;이혼혹동거、기선CD4+T림파세포수평저、WHO림상분기Ⅲ기혹Ⅳ기시항병독치료환자사망적위험인소.
    Objective To analyze survival time of AIDS death cases receiving Antiretroviral Therapy and related factors.Methods A retrospective cohort study was carried out to collect the data on death cases receiving Antiretroviral Therapy by the National HIV/AIDS Comprehensive Response Information Management System.Kaplan-Meier was used to calculate the median survival time,and compare survival time among different groups of age,sex,marriage status,infectious routes,WHO clinical stage,baseline CD4 +T cell counts,and interval time from the start of ART to HIV confirmation.Life table and survival curve were applied to describe survival distribution.Cox proportional hazard model was used to determine the factors associated with the survival time.Results Among 142 AIDS death cases,125 (88.03％) were related with AIDS and 17(11.97％) were not.The total median survival time was 3.100 months(95％ CI:2.279-3.921).The cumulative survival rate was (52 ±4)％,(33 ±4)％,(26 ±4)％ in the first 3 months,3-6 months,and 6-12 months.The median survival time of married or cohabitation group was 2.670 months (95％ CI:i.470-3.870),and single (unmarried,divorced,separation,widowed) group was 5.870 months (95％ CI:2.617-9.123).The median survival time of WHO clinical stage Ⅰ orⅡ group was 5.870 months (95％CI:3.989-7.751),and WHO clinical stage Ⅲ or Ⅳ group was 1.700 months(95％ CI:0.885-2.515).The median survival time of baseline CD4 + T cell counts≤50/μl group was 1.670 months (95％CI:0.759-2.581),and 51-199 /μl group was 4.400 months (95％ CI:2.735-6.065),and ≥ 200/μl group was 7.100 months (95％ CI:0.000-14.542).The survival time was significantly different among different baseline marital status groups,different WHO clinical stage groups,and different CD4 + T cell counts groups.The mortality risk of Single (unmarried,divorced,separation,widowed) group was 0.641 times of the risk in married or cohabitation group.The mortality risk of WHO clinical stage Ⅲ or Ⅳ was 1.856 times of the risk in stage Ⅰ or Ⅱ.The mortality risk of baseline CD4 + T cell counts 51-199/μl group was 0.582 times of the risk in ≤50/μl group,and ≥200/μl group was 0.551 times of the risk in ≤50/μl group.Conclusion The total median survival time was relatively short.Most AIDS deaths happened in the first 3 months or 3-6 months after they received Antiretroviral Therapy,and the mortality trend slowed down in the following months.Married or cohabitation,low-baseline CD4 + T cell counts,or WHO clinical stage Ⅲ or Ⅳ were found to be the risk factors associated with AIDS death cases receiving Antiretroviral Therapy.
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