我国不同的预防艾滋病母婴传播措施的效果研究  

Effectiveness evaluation of different interventions for prevention of mother to child transmission of HIV/AIDS in China

作　　者：王临虹[1] 方利文[1] 王前[1] 蒋岩[2] 龚双燕[1] 张麒[1] 莫云[3] 孙定勇[4] 张伟[5] 李燕[6] 

机构地区：[1]中国疾病预防控制中心妇幼保健中心,北京100013 [2]中国疾病预防控制中心性病艾滋病预防控制中心,北京100050 [3]广西壮族自治区妇幼保健院,南宁530003 [4]河南省疾病预防控制中心性病艾滋病防治研究所,郑州450003 [5]新疆维吾尔自治区疾病预防控制中心妇幼保健中心,乌鲁木齐830002 [6]云南省妇幼保健院,昆明650051

出　　处：《中国艾滋病性病》2009年第4期352-355,共4页Chinese Journal of Aids & STD

基　　金：国家"十五"科技攻关课题资助(2004BA719A03)

摘　　要：目的分析我国不同的预防艾滋病母婴传播措施的效果。方法采用随访(纵向)研究的方法,在艾滋病病毒(HIV)感染相对高发的4省15个县(市、区),选择2004年12月至2008年1月确诊的312名HIV-1感染孕产妇,收集其接受抗逆转录病毒药物、安全助产和喂养指导等预防艾滋病母婴传播服务情况,并对HIV-1感染孕产妇随访追踪,对其分娩的满18个月的312名婴幼儿检测HIV抗体,明确其HIV感染状态。结果对不同的预防艾滋病母婴传播措施进行比较分析,结果显示,规范应用抗逆转录病毒药物的调查对象,其母婴传播发生率低于未按方案规范用药或未用药的孕产妇(4.41%∶15.16%)(χ2=5.31,P<0.05)。分娩方式中,剖宫产的母婴传播发生率高于阴道分娩(17.29%∶9.50%)(2χ=4.15,P<0.05)。非人工喂养的婴儿母婴传播发生率比人工喂养的婴儿高(28.57%∶11.27%)(χ2=6.83,P<0.01)。未采取任何预防艾滋病母婴传播措施的HIV感染孕产妇,其艾滋病母婴传播率为28.57%(8/28);规范应用逆转录抗病毒药物和人工喂养的孕产妇,其艾滋病母婴传播率降为4.41%(3/68)(2χ=5.32,P<0.05),与未采取任何预防措施相比,母婴传播下降率达84.56%。多因素分析表明,采取人工喂养(OR=0.27,95%CI:0.08,0.95)、抗逆录病毒药物的规范应用(OR=0.30,95%CI:0.08,0.97)、剖宫产分娩(OR=2.61,95%CI:1.19,5.76)与艾滋病母婴传播发生率相关联。结论预防艾滋病母婴传播措施能有效降低艾滋病母婴传播水平。Objective To assess the effectiveness of different interventions for prevention of mother to child transmission of HIV/AIDS （PMTCT）. Methods Longitudinal study was employed to investigate 312 HIV-1 infected maternal women in 15 counties （cities/districts） of 4 provinces with a relatively high prevalence of HIV/AIDS from December of 2004 to January of 2008, and HIV-1 infection status of their children was tested to identify MTCT. The infected maternal women and their children were provided with different interventions for PMTCT including ARV regimen, safe delivery assistance,infant feeding counseling and support and others. The infection status of the surveyed women was followed up by questionnaire interview in combination with medical record review and their 312 children over 18 months were tested for HIV antibody. Results Comparative evaluation of different interventions for MTCT showed that the women who followed standardized ARV regimen had lower transmissions rate than those who failed to do so （4.41%： 15.16 %） （Х^2 =5.31,P〈0.05） ;the transmission rate in women with cesarean section was higher than those with vaginal delivery （17.29% ： 9.50%） （Х^2=4.15,P〈0.05） and the transmission rate in women with breast feeding was higher than in those with artificial feeding （28.57% ： 11.27%） （Х^2 =6.83,P〈0.01）. The MTCT rate was 28. 57% （8/28） among those who had not taken any preventive interventions,and that dropped to 4.41% （3/68） among mother and their babies who followed standardized ARV regimen and artificial feeding （Х^2 = 5.32, P〈0.05）. Alternatively, the risk to MTCT was reduced by 84.56 % due to adoption of appropriate preventive interventions. Logistic regression analysis showed that MTCT risk was associated with ar- tificial feeding （OR：0.27,95%CI：0.08,0.95） ,standardized ARV regiment （OR=0.30,95%CI：0.08,0. 97） and delivery with cesarean section （OR： 2.61,95%CI： 1.19,5.76）. Conclusion Relevant preventive interventions could re

关 键 词：艾滋病 母婴传播 

分 类 号：R512.91[医药卫生—内科学]