云南省盈江县1142例艾滋病患者抗病毒治疗后生存分析  

Survival analysis on 1 142 HIV/AIDS patients receiving antiretroviral therapy in Yingjiang county, Yunnan province

作　　者：王继娇 思志生 聂永英 杨建华[1] 冯晓静[1] 赵余仙 王蓉[1] 余顺俊 李燕[1] 杨炳丽[1] 杨增源[1] 武学维 段松[2] 何纳[3] 张铁军[3] 

机构地区：[1]云南省盈江县疾病预防控制中心性病艾滋病防制科,云南盈江679300 [2]云南省德宏州疾病预防控制中心性病艾滋病防制科 [3]复旦大学公共卫生学院流行病学教研室,公共卫生安全教育部重点实验室

出　　处：《现代预防医学》2013年第19期3673-3677,共5页Modern Preventive Medicine

基　　金：国家自然科学基金资助(81072345)

摘　　要：目的 了解云南省盈江县艾滋病患者抗病毒治疗后的生存情况。方法 采用回顾性研究方法，对盈江县2004年7月1日～2011年12月31日年满15周岁接受国家免费抗病毒治疗的所有艾滋病患者进行分析。结果 共1 142例艾滋病患者入组治疗，平均年龄（39.4 ± 9.5）岁。病例平均治疗时间29.0个月，因艾滋病死亡85例（死亡密度为3.1／100人年）。抗病毒治疗后第1、2、3、4、5、6、7、7＋年的累计生存概率分别为0.94、0.92、0.91、0.90、0.90、0.87、0.87、0.87。多因素Cox比例风险回归模型分析显示在控制年龄、性别、婚姻状况等潜在混杂因素的影响后，传播途径、基线CD4＋T淋巴细胞计数水平、入组前WHO临床分期及初始治疗方案等与生存时间存在统计学关联。经性传播途径感染HIV的患者死于艾滋病相关疾病的风险低于经静脉吸毒传播途径感染HIV的患者，基线CD4＋T淋巴细胞计数在100～350／mm3之间的患者死于艾滋病相关疾病的风险低于基线CD4＋T淋巴细胞计数在0～99／mm3之间的患者，入组前WHO临床分期为1、2、3期的患者死于艾滋病相关疾病的风险低于4期的患者，初始治疗方案为AZT＋3TC＋NVP／EFV和D4T＋3TC＋NVP／EFV的患者死于艾滋病相关疾病的风险低于其他治疗方案的患者。结论 免费抗病毒治疗可明显改善AIDS患者的预后，提高患者生存率。OBJECTIVE In order to explore the survival rate of HIV/AIDS patients after receiving antiretroviral therapy （ART） in Yinjiang County, Yunnan province. METHODS During July 2004 to Dec 2011, a retrospective study was con- ducted among HIV/AIDS patients older than 15 and under ART. RESULTS A total of 1 142 HIV/AIDS patients with mean age of 39.5 ~ 9.5 years were included in the study. The average therapy period was 29.0 months, and 85 cases died of AIDS （incidence density： 3.1 deaths per 100 person years）. The cumulative survival rate of antiretroviral treatment after 1, 2, 3, 4, 5, 6, 7 and 7＋ years were 0.94, 0.92, 0.91, 0.90, 0.90, 0.87, 0.87 and 0.87, respectively. Cox proportional hazard regression model analysis indicated that, after adjustment for age, gender, and marital status, transmission route, the baseline CD4T cell counts, WHO clinical stages before initial of ART and initial regimen could significantly predicate the rates of survival. Those who got HIV infection through sex transmission were less likely to die of AIDS than through injecting drug use. Patients with baseline CD4＋T cell counts as 100-350/mm3 were less likely to die of AIDS than those with CD4＋T cell counts 〈 90/mm3, and Patients in WHO 1-3 were less likely to die of AIDS than those in stage 4 before therapy. Those who with initial regimen as AZT＋3TC＋NVP/EFV and D4T＋3TC＋NVP/EFV were less likely to die of AIDS than who with other regimens. CONCLUSION Free highly active antiretroviral therapy could significantly improve prognosis and survival rate of HIV/AIDS patients.

关 键 词：艾滋病患者 抗病毒治疗 生存分析 

分 类 号：R512.91[医药卫生—内科学]