CAJ | 학술논문

目的分析四川省凉山州2008-2013年艾滋病患者抗病毒治疗情况,探讨其生存时问及影响因素,为制订艾滋病综合防治策略提供科学依据.方法采用回顾性队列研究方法,从国家艾滋病综合防治信息管理系统选取凉山州2008-2013年期间诊断的艾滋病患者,收集其基本人口学及感染、发病、治疗、死亡等相关信息,利用Cox比例风险回归模型分析可能影响因素.结果 8 321例艾滋病患者确诊艾滋病年龄范围18 ～ 87.5岁,平均(34.2±9.8)岁,死亡3 021例,接受抗病毒治疗(ART)患者3 721例.研究对象总病死率由2008年的43.9/100人年下降到2013年的20.7/100人年,治疗组病死率由2008年的27.3/100人年下降到2013年的5.1/100人年,未治疗组病死率维持在45.0/100人年至50.8/100人年;治疗比例逐年上升,由2008年的5.8％上升到2013年的54.5％.所有艾滋病患者中位生存时间为35.1个月,其中未治疗组为18.4个月;所有艾滋病患者生存时间与治疗、确诊艾滋病年龄以及感染HIV途径有关(P＜0.05),未接受治疗患者的死亡风险是接受治疗者的5.78倍,但与性别、民族无关(P＞0.05);治疗组艾滋病患者生存时间与性别、确诊艾滋病时年龄、民族、感染HIV途径、确诊艾滋病时CD4+T细胞计数、治疗基线CD4+T细胞计数和基线贫血有关(P＜0.05);未治疗组艾滋病患者生存时间主要与确诊艾滋病年龄有关(P＜0.05),与其余因素无关(P＞0.05).结论抗病毒治疗是影响艾滋病患者生存时间的重要因素,治疗时机对于治疗效果至关重要,治疗基线CD4+T淋巴细胞计数水平是影响治疗效果的关键指标,提示加强CD4+T淋巴细胞计数的检测与监测、及早发现和确证艾滋病患者、扩大抗病毒治疗覆盖面、选择合适的治疗时机是提高抗病毒治疗效果、降低病死率、延长艾滋病患者生存时间的重要途径.
목적 분석사천성량산주2008-2013년애자병환자항병독치료정황,탐토기생존시문급영향인소,위제정애자병종합방치책략제공과학의거.방법 채용회고성대렬연구방법,종국가애자병종합방치신식관리계통선취량산주2008-2013년기간진단적애자병환자,수집기기본인구학급감염、발병、치료、사망등상관신식,이용Cox비례풍험회귀모형분석가능영향인소.결과 8 321례애자병환자학진애자병년령범위18 ～ 87.5세,평균(34.2±9.8)세,사망3 021례,접수항병독치료(ART)환자3 721례.연구대상총병사솔유2008년적43.9/100인년하강도2013년적20.7/100인년,치료조병사솔유2008년적27.3/100인년하강도2013년적5.1/100인년,미치료조병사솔유지재45.0/100인년지50.8/100인년;치료비례축년상승,유2008년적5.8％상승도2013년적54.5％.소유애자병환자중위생존시간위35.1개월,기중미치료조위18.4개월;소유애자병환자생존시간여치료、학진애자병년령이급감염HIV도경유관(P＜0.05),미접수치료환자적사망풍험시접수치료자적5.78배,단여성별、민족무관(P＞0.05);치료조애자병환자생존시간여성별、학진애자병시년령、민족、감염HIV도경、학진애자병시CD4+T세포계수、치료기선CD4+T세포계수화기선빈혈유관(P＜0.05);미치료조애자병환자생존시간주요여학진애자병년령유관(P＜0.05),여기여인소무관(P＞0.05).결론 항병독치료시영향애자병환자생존시간적중요인소,치료시궤대우치료효과지관중요,치료기선CD4+T림파세포계수수평시영향치료효과적관건지표,제시가강CD4+T림파세포계수적검측여감측、급조발현화학증애자병환자、확대항병독치료복개면、선택합괄적치료시궤시제고항병독치료효과、강저병사솔、연장애자병환자생존시간적중요도경.
Objective To investigate the survival time and affecting factors among AIDS patients under antiretroviral treatment,between 2008 and 2013 in Liangshan,Sichuan province.Methods Observational retrospective cohort study method was applied.AIDS patients were chosen from China' s national comprehensive prevention and control management system of AIDS in Liangshan,during 2008-2013.Related information on demographics,source of infection,pathogenesis,treatment and death was collected.Cox proportional hazards model was applied to analyze the factors that might affect the survival on patients.Results Among the 8 321 cases,ranging from 18 to 87.5 years old (mean age as 34.2 ± 9.8),3 021 died and 3 721 patients had received HAART treatment.The total mortality rate dropped from 43.9/100 person-years to 20.7/100 person-years from 2008 to 2013.In the treatment group,mortality rate dropped from 27.3/100 person-years to 5.1/100 person-years,while in the untreated group it remained high-between (45.0-50.8)/100 person-years.Proportion for the treatment coverage increased gradually,from 5.8％ in 2008 to 54.5％ in 2013.Median survival time of all the AIDS patients was 35.1 months,but 18.4 months in the untreated group.Survival of all the AIDS patients was associated with factors as:treatment,age when AIDS diagnosis was made and route of HIV infection (P＜0.05).The risk of death among untreated patients was 5.78 times to the treated ones,but did not seem to relate to gender or nationality (P＞0.05).Survival of the treated group was associated with factors as gender,age when AIDS diagnosis was made,nationality,route of HIV infection,CD4 + T cell count when AIDS diagnosis was made,CD4+T cell count at treatment baseline,anemia at the treatment baseline (P＜ 0.05).Survival of the untreated group was mainly associated with age when AIDS was diagnosed (P＜ 0.05) while other factors did not seem to be significantly related (P＞0.05).Conclusion Antiretroviral therapy appeared an important factor that affecting the survival of AIDS patients,timely treatment and CD4 +T cell count provided at the baseline for treatment,were two key factors that affecting the outcome of treatment.Our findings pointed out that tactic factors as:strengthening the detection,monitoring on CD4 +T cell count,early diagnose and treatment,expanding the coverage of antiretroviral therapy,and appropriate timing for treatment etc.,were important ways to enhance the effects of treatment,so as to reduce the mortality rate and prolong the time of survival.