中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2014年
4期
368-371
,共4页
蒋忠胜%江建宁%冯献湘%蒋志宇
蔣忠勝%江建寧%馮獻湘%蔣誌宇
장충성%강건저%풍헌상%장지우
人免疫缺陷病毒%获得性免疫缺陷综合征%预后
人免疫缺陷病毒%穫得性免疫缺陷綜閤徵%預後
인면역결함병독%획득성면역결함종합정%예후
Human immunodeficiency virus,HIV%Acquired immunodeficiency syndrome%Prognosis
目的 评价已接受高效抗反转录病毒治疗的老年人类免疫缺陷病毒感染/艾滋病(HIV/AIDS)患者基线临床和实验室检测指标及其与病死率的相关性,探讨影响老年HIV/AIDS患者远期预后的独立危险因素. 方法 对1671例老年HIV/AIDS患者的临床资料进行回顾性队列研究,随访时间2d至120个月,平均427 d,根据是否发生艾滋病相关性死亡事件分为死亡组(183例)和非死亡组(1488例). 结果 男性病死率(12.5％)高于女性(6.9％)(x2=10.42,P＜0.01),WHO分期Ⅲ期和Ⅳ期病死率高于Ⅰ期和Ⅱ期(x2=18.67,P＜0.01),基线CD4+T淋巴细胞≤100个/mm3者的病死率明显高于＞100个/mm3者(x2=52.59,P＜0.01),死亡组患者血小板、血红蛋白和血糖均低于非死亡组(P＜0.05),死亡组血肌酐和谷草转氨酶高于非死亡组(P＜0.05);不同婚姻状况和不同传播途径的病死率差异无统计学意义(P＞0.05),死亡组患者白细胞、血尿素氮、总胆固醇、三酰甘油、谷丙转氨酶和总胆红素与非死亡组之间的差异无统计学意义(P＞0.05).多因素非条件Logistic回归分析显示,WHO分期(OR=0.777,95％CI:0.612～0.987,P＜0.05)和基线CD4+T淋巴细胞水平(OR=1.345,95％CI:1.089～1.662,P＜0.01)是预测老年HIV/AIDS患者远期预后的独立危险因子. 结论 对于老年HIV/AIDS患者,WHO分期和基线CD4+T淋巴细胞水平是其远期预后的独立危险因素,早期发现、早期开始高效抗反转录病毒治疗可有效改善老年HIV/AIDS患者的远期预后.
目的 評價已接受高效抗反轉錄病毒治療的老年人類免疫缺陷病毒感染/艾滋病(HIV/AIDS)患者基線臨床和實驗室檢測指標及其與病死率的相關性,探討影響老年HIV/AIDS患者遠期預後的獨立危險因素. 方法 對1671例老年HIV/AIDS患者的臨床資料進行迴顧性隊列研究,隨訪時間2d至120箇月,平均427 d,根據是否髮生艾滋病相關性死亡事件分為死亡組(183例)和非死亡組(1488例). 結果 男性病死率(12.5％)高于女性(6.9％)(x2=10.42,P＜0.01),WHO分期Ⅲ期和Ⅳ期病死率高于Ⅰ期和Ⅱ期(x2=18.67,P＜0.01),基線CD4+T淋巴細胞≤100箇/mm3者的病死率明顯高于＞100箇/mm3者(x2=52.59,P＜0.01),死亡組患者血小闆、血紅蛋白和血糖均低于非死亡組(P＜0.05),死亡組血肌酐和穀草轉氨酶高于非死亡組(P＜0.05);不同婚姻狀況和不同傳播途徑的病死率差異無統計學意義(P＞0.05),死亡組患者白細胞、血尿素氮、總膽固醇、三酰甘油、穀丙轉氨酶和總膽紅素與非死亡組之間的差異無統計學意義(P＞0.05).多因素非條件Logistic迴歸分析顯示,WHO分期(OR=0.777,95％CI:0.612～0.987,P＜0.05)和基線CD4+T淋巴細胞水平(OR=1.345,95％CI:1.089～1.662,P＜0.01)是預測老年HIV/AIDS患者遠期預後的獨立危險因子. 結論 對于老年HIV/AIDS患者,WHO分期和基線CD4+T淋巴細胞水平是其遠期預後的獨立危險因素,早期髮現、早期開始高效抗反轉錄病毒治療可有效改善老年HIV/AIDS患者的遠期預後.
목적 평개이접수고효항반전록병독치료적노년인류면역결함병독감염/애자병(HIV/AIDS)환자기선림상화실험실검측지표급기여병사솔적상관성,탐토영향노년HIV/AIDS환자원기예후적독립위험인소. 방법 대1671례노년HIV/AIDS환자적림상자료진행회고성대렬연구,수방시간2d지120개월,평균427 d,근거시부발생애자병상관성사망사건분위사망조(183례)화비사망조(1488례). 결과 남성병사솔(12.5％)고우녀성(6.9％)(x2=10.42,P＜0.01),WHO분기Ⅲ기화Ⅳ기병사솔고우Ⅰ기화Ⅱ기(x2=18.67,P＜0.01),기선CD4+T림파세포≤100개/mm3자적병사솔명현고우＞100개/mm3자(x2=52.59,P＜0.01),사망조환자혈소판、혈홍단백화혈당균저우비사망조(P＜0.05),사망조혈기항화곡초전안매고우비사망조(P＜0.05);불동혼인상황화불동전파도경적병사솔차이무통계학의의(P＞0.05),사망조환자백세포、혈뇨소담、총담고순、삼선감유、곡병전안매화총담홍소여비사망조지간적차이무통계학의의(P＞0.05).다인소비조건Logistic회귀분석현시,WHO분기(OR=0.777,95％CI:0.612～0.987,P＜0.05)화기선CD4+T림파세포수평(OR=1.345,95％CI:1.089～1.662,P＜0.01)시예측노년HIV/AIDS환자원기예후적독립위험인자. 결론 대우노년HIV/AIDS환자,WHO분기화기선CD4+T림파세포수평시기원기예후적독립위험인소,조기발현、조기개시고효항반전록병독치료가유효개선노년HIV/AIDS환자적원기예후.
Objective To evaluate the correlation of the baseline clinical and laboratory test index with death,and to discuss the independent risk factors for long-term prognosis in elderly HIV/ AIDS patients who had accepted highly active antiretroviral therapy (HAART).Methods 1671 cases of HIV/AIDS patients were included in retrospective cohort study,divided into death group (183 cases) and non-death group (1488 cases) according to HIV/AIDS related death event,and followed up for 2 days to 120 months,an average of 427 days.Results During the period of followup,the proportion of male (12.45％) was higher than that of women (6.9％) in death group(x2 =10.42,P＜0.01).The mortality ratio of the WHO stage Ⅲ and Ⅳ was higher than that of the WHO stage Ⅰ and Ⅱ (x2 =18.67,P＜0.01).The mortality ratio was significantly higher in HIV/AIDS patients with baseline CD4+ T lymphocyte cell ＜100 cells/mm3 than ＞100 cells/mm3 (x2 =52.59,P＜0.01).The platelet (PLT),hemoglobin (HB),and blood glucose levels were lower in death group than in non-death group (P ＜ 0.05),but serum creatinine (SCR) and AST (aspartate aminotransferase) levels were higher than that in the non-death group (P＜0.05).There was no significantly differences between the death group and the non-death group in the index of white blood cell (WBC),blood urea nitrogen (BUN),total cholesterol (CH),triglyceride (TG),alanine aminotransferase (ALT) and total bilirubin (TB) levels (all P＞ 0.05).Multiple logistic regression analysis revealed that the WHO stage (OR=0.777,95％ CI:0.612～0.987,P＜0.05) and the baseline level of CD4+ T lymphocytes cell (OR=1.345,95％ CI:1.089～1.662,P＜0.01) were independent risk factors for long-term outcomes in elderly HIV/AIDS patients.Conclusions The WHO stage and baseline CD4+ T lymphocyte cell level are the independent risk factors for long-term prognosis in HIV/AIDS patients over 60 years of age.Early discovery and early beginning HAART can effectively improve the prognosis of elderly HIV/AIDS patients.
