HAART药物依从性对CD_4细胞增长率的影响研究  

Adherence effects on CD_4 increase rate in HAART for AIDS patients

作　　者：于兰[1] 豆智慧[2] 曲淑霞[3] 张福杰[1] 文毅[1] 赵燕[1] 

机构地区：[1]中国疾病预防控制中心性病艾滋病预防控制中心,北京100050 [2]兰州大学公共卫生学院,甘肃兰州730000 [3]运城市疾病预防控制中心,山西运城044000

出　　处：《中国艾滋病性病》2005年第4期255-257,共3页Chinese Journal of Aids & STD

摘　　要：目的探讨依从性(停药、漏服)对艾滋病(AIDS)患者高效抗逆转录病毒治疗(HAART)效果(CD4细胞增长率)的影响,为制定提高依从性的策略和措施提供科学依据.方法采用前瞻性队列观察研究,收集2省6县88例成人艾滋病患者6个月免费抗病毒治疗随访资料,应用SPSS 12.0软件分析.结果CD4细胞增长率属偏态分布(u偏=13.81,u峰=30.29,P偏＜0.01,P峰＜0.01),而且在不同疗程(0～3月、3～6月、0～6月)上的增长幅度有统计学差异(H检验,x2=17.12,P＜0.01),0～6月间总体增长幅度四分位数分别为5.87、38.30、129.60.CD4细胞增长率与年龄分组(rs=-0.01,P＜0.05)、停药次数(rs=-0.39,P＜0.01)、漏服次数(rs=-0.47,P＜0.01)、治疗前CD4细胞水平(rs=-0.51,P＜0.01)分别为负相关,与治疗模式(rs=0.54,P＜0.01呈正相关,而与性别(rs=-0.01,P＞0.05)、文化程度(rs=-0.10,P＞0.05)、要求监督次数(rs=-0.07,P＞0.05)无相关.漏服对CD4细胞增长率的影响程度比无漏服大,OR为11.89[95%CI 2.66～53.25];间断停药对CD4细胞增长率的影响程度比无间断停药大,OR为10.96[95%CI 2.87～41.85].结论CD4细胞增长率是反映HAART效果的较好指标,停药和漏服是影响CD4增长率的重要危险因素.Objective To investigate the impact of adherence（discontinuation of ARV and missed doses） on the effects of HAART, as using by the increase rate of CD4 counts as an indicator. The overall goal of the study is to provide scientific data for developing strategies to promote involving patients＇ adherence. Methods Data were obtained from a six-month prospective cohort study involving 88 adult AIDS patients in six counties of two provinces who receiving ART through the National Free ARV drugs program. SPSS 12.0 was used for the statistical analyses. Results The distribution of the increase rate of the CD4 count was abnormal（for skew, distribution u = 13.81,P〈0.01;for kurtosis distribution u=13.81, P〈0.01. Significant differences in the rate of increase were seen by comparing different periods of observation i. e, months0-3, months 3-6, and months0-6（H test,χ^2=17.12, P〈0.01 ）. The increase rate of CD4 count during the 0-6 month time period was 5.87,38.30, and 129.60 at the 25^th, 50^th and 75^th percentiles, respectively. The increase rate of the CD4 count was negatively correlated with age group （rs=-0.01, P〈4 0.05）, frequency of ARV diseontinua-tion （rs=-0.39, P〈0.01 ）, number of missed doses （rs=-0.47, P〈0.01 ）, and the CD4 count before treatment （rs=-0.51, P〈0.01 ）. A positive correlation was found with ART regimen （rs=0.54, P〈0.01 ）, and no correlation was found with gender （rs=-0.01, P〉0.05）, education level （rs= -0.10, P〉0.05）, and number of follow-up visits performed by community health worker （rs=-0.07, P〉0.05）. Missed ARV doses had a significant negative effect on the increase rate in the CD4 count when compared with persis-tence in taking all ARV doses[OR=11.89 （95 % CI 2.66-53.25）. Intermittent discontinuation of ARV drugs also had a significant negative effect on the increase rate in CD4 count when compared with continuous ARV therapy[OR=10.96（95%CI 2,87-41.85）] .Conclusion The increase rate CD4 count is a sensitive and reliable in

关 键 词：艾滋病 高效逆转录病毒治疗 依从性 CD4细胞增长率 

分 类 号：R512.19[医药卫生—内科学] R373.9[医药卫生—临床医学]