北京大学学报（医学版）
北京大學學報（醫學版）
북경대학학보（의학판）
JOURNAL OF BEIJING MEDICAL UNIVERSITY(HEALTH SCIENCES)
2015年
3期
474-482
,共9页
获得性免疫缺陷综合征%HIV感染%抗HIV药%抗药性,病毒%Meta分析
穫得性免疫缺陷綜閤徵%HIV感染%抗HIV藥%抗藥性,病毒%Meta分析
획득성면역결함종합정%HIV감염%항HIV약%항약성,병독%Meta분석
Acquired immunodeficiency syndrome%HIV infections%Anti-HIV agents%Drug resistance,viral%Meta-analysis
目的：：了解中国未接受抗逆转录病毒治疗的人类免疫缺陷病毒/获得性免疫缺陷综合征( human immuno-deficiency virus infection and acquired immune deficiency syndrome,HIV/AIDS)人群HIV原发耐药水平。方法：检索5个数据库：《中国生物医学文献数据库》( Chinese BioMedical Literature Database, CBM)、《中国期刊全文数据库》( Chinese Journal Full-text Database, CNKI)、《中文科技期刊数据库-维普》( Chinese Science-Technology Journal Data-base, VIP)、万方数据知识服务平台及PubMed数据库,提取HIV耐药数据,使用随机效应模型对数据进行合并,对采样时间、采样地点、人群特征(平均年龄及感染状态)、样本量进行亚组分析。结果：共纳入76篇文献(中文46篇,英文30篇),中国未接受抗病毒治疗的HIV/AIDS人群HIV原发整体耐药率、非核苷类反转录酶抑制剂( non-nucleoside reverse transcriptase inhibitor,NNRTI)耐药率、核苷类反转录酶抑制剂( nucleoside reverse transcriptase in-hibitor,NRTI)耐药率、蛋白酶抑制剂(protease inhibitor,PI)耐药率分别为4.7%(95%CI：4.0%~5.4%)、2.3%(95%CI：1.8%~2.8%)、1.8%(95%CI：1.3%~2.3%)、1.4%(95%CI：1.1%~1.8%)。上述4类耐药率均是2007年之前高于之后,且都存在显著地区差异(P<0.05),其中,中南及西南地区整体耐药率均高于5%。平均年龄、感染状态亚组中,组间差异较为复杂,其中小于25岁及新发、新确认组其整体耐药率低于25岁以上及非新发、新确认组。样本量<100的亚组,各耐药率均高于样本量≥100的亚组,且差异都有统计学意义(P<0.05)。结论：中国HIV/AIDS人群HIV病毒原发总耐药率为4.7%,仍处于低流行状态,但已接近WHO提出的5%中度耐药警戒线,中南及西南地区整体耐药率已经超过该警戒线,应进一步加强监测。
目的：：瞭解中國未接受抗逆轉錄病毒治療的人類免疫缺陷病毒/穫得性免疫缺陷綜閤徵( human immuno-deficiency virus infection and acquired immune deficiency syndrome,HIV/AIDS)人群HIV原髮耐藥水平。方法：檢索5箇數據庫：《中國生物醫學文獻數據庫》( Chinese BioMedical Literature Database, CBM)、《中國期刊全文數據庫》( Chinese Journal Full-text Database, CNKI)、《中文科技期刊數據庫-維普》( Chinese Science-Technology Journal Data-base, VIP)、萬方數據知識服務平檯及PubMed數據庫,提取HIV耐藥數據,使用隨機效應模型對數據進行閤併,對採樣時間、採樣地點、人群特徵(平均年齡及感染狀態)、樣本量進行亞組分析。結果：共納入76篇文獻(中文46篇,英文30篇),中國未接受抗病毒治療的HIV/AIDS人群HIV原髮整體耐藥率、非覈苷類反轉錄酶抑製劑( non-nucleoside reverse transcriptase inhibitor,NNRTI)耐藥率、覈苷類反轉錄酶抑製劑( nucleoside reverse transcriptase in-hibitor,NRTI)耐藥率、蛋白酶抑製劑(protease inhibitor,PI)耐藥率分彆為4.7%(95%CI：4.0%~5.4%)、2.3%(95%CI：1.8%~2.8%)、1.8%(95%CI：1.3%~2.3%)、1.4%(95%CI：1.1%~1.8%)。上述4類耐藥率均是2007年之前高于之後,且都存在顯著地區差異(P<0.05),其中,中南及西南地區整體耐藥率均高于5%。平均年齡、感染狀態亞組中,組間差異較為複雜,其中小于25歲及新髮、新確認組其整體耐藥率低于25歲以上及非新髮、新確認組。樣本量<100的亞組,各耐藥率均高于樣本量≥100的亞組,且差異都有統計學意義(P<0.05)。結論：中國HIV/AIDS人群HIV病毒原髮總耐藥率為4.7%,仍處于低流行狀態,但已接近WHO提齣的5%中度耐藥警戒線,中南及西南地區整體耐藥率已經超過該警戒線,應進一步加彊鑑測。
목적：：료해중국미접수항역전록병독치료적인류면역결함병독/획득성면역결함종합정( human immuno-deficiency virus infection and acquired immune deficiency syndrome,HIV/AIDS)인군HIV원발내약수평。방법：검색5개수거고：《중국생물의학문헌수거고》( Chinese BioMedical Literature Database, CBM)、《중국기간전문수거고》( Chinese Journal Full-text Database, CNKI)、《중문과기기간수거고-유보》( Chinese Science-Technology Journal Data-base, VIP)、만방수거지식복무평태급PubMed수거고,제취HIV내약수거,사용수궤효응모형대수거진행합병,대채양시간、채양지점、인군특정(평균년령급감염상태)、양본량진행아조분석。결과：공납입76편문헌(중문46편,영문30편),중국미접수항병독치료적HIV/AIDS인군HIV원발정체내약솔、비핵감류반전록매억제제( non-nucleoside reverse transcriptase inhibitor,NNRTI)내약솔、핵감류반전록매억제제( nucleoside reverse transcriptase in-hibitor,NRTI)내약솔、단백매억제제(protease inhibitor,PI)내약솔분별위4.7%(95%CI：4.0%~5.4%)、2.3%(95%CI：1.8%~2.8%)、1.8%(95%CI：1.3%~2.3%)、1.4%(95%CI：1.1%~1.8%)。상술4류내약솔균시2007년지전고우지후,차도존재현저지구차이(P<0.05),기중,중남급서남지구정체내약솔균고우5%。평균년령、감염상태아조중,조간차이교위복잡,기중소우25세급신발、신학인조기정체내약솔저우25세이상급비신발、신학인조。양본량<100적아조,각내약솔균고우양본량≥100적아조,차차이도유통계학의의(P<0.05)。결론：중국HIV/AIDS인군HIV병독원발총내약솔위4.7%,잉처우저류행상태,단이접근WHO제출적5%중도내약경계선,중남급서남지구정체내약솔이경초과해경계선,응진일보가강감측。
Objective:To estimate the prevalence of antiretroviral drug resistance in treatment-naive in-dividuals with human immunodeficiency virus ( HIV ) in China. Methods: Five electronic databases [ Chinese BioMedical Literature Database ( CBM) , Chinese Journal Full-text Database ( CNKI) , Chinese Science-Technology Journal Database ( VIP) , Wanfang Data, and PubMed] were searched for studies of HIV drug resistance in untreated individuals. Drug resistance data were abstracted then pooled using the random effect model. Subgroup analysis was done across sampling time, location, study population ( mean age and infection status) , and sample size. Results: Seventy-six studies were included for our meta-analysis (46 in Chinese, 30 in English). The pooled rates of drug resistance to total, to non-nucleoside reverse transcriptase inhibitor ( NNRTI ) , to nucleoside reverse transcriptase inhibitor (NRTI), and to protease inhibitor ( PI) were 4. 7% (95%CI:4. 0% -5. 4%), 2. 3% (95%CI:1. 8% -2. 8%), 1. 8% (95%CI:1. 3% -2. 3%), and 1. 4% (95%CI:1. 1% -1. 8%), respective-ly. All the rates before 2007 were higher than those for 2008 or later. Meanwhile, significant differences were found in the sample areas (P <0. 05), in which, the rates in South-central and Southwest were both higher than 5%. The difference was complex between mean age and infection status subgroup, and we found the total prevalence in the group under 25 years and the newly infected, and confirmed group was lower than in the others. For sample size, all the rates in the group under 100 samples were higher than in the others, and the difference was significant (P<0. 05). Conclusion: The prevalence of HIV primary drug resistance in China was 4. 7%, which stayed low, but was also close to the line set by WHO. Enhanced surveillance for drug resistance is necessary in high epidemic areas including the South-central and Southwest China whose prevalence has crossed the line.
