HIV感染/AIDS者结核感染的影响因素分析  

Analysis of influencing factors of Mycobacterium tuberculosis infection in HIV/AIDS patients

作　　者：张兴[1] 王凤鸣[1] 吕旭峰[1] 华天齐 张学军 蒋靖怡 丁陈丽 朱伟[4] 夏国栋 吉俊敏[1] 赵飞 ZHANG Xing;WANG Feng-ming;LYU Xu-feng;HUA Tian-qi;ZHANG Xue-jun;JIANG Jing-yi;DING Chen-li;ZHU Wei;XIA Guo-dong;JI Jun-min;ZHAO Fei(Changzhou Center for Disease Control and Prevention,Jiangsu Province,Changzhou 213000,China)

机构地区：[1]江苏省常州市疾病预防控制中心,213000 [2]江苏省常州市新北区疾病预防控制中心 [3]江苏省常州市常武太湖医院 [4]溧阳市疾病预防控制中心 [5]江苏省常州市金坛区疾病预防控制中心 [6]北京医院国家老年医学中心临床试验研究中心

出　　处：《中国防痨杂志》2020年第4期360-365,共6页Chinese Journal of Antituberculosis

基　　金：江苏省自然科学基金(BK20151176);江苏省青年医学人才计划(QNRC2016309);江苏省预防医学科研项目(Y2013016);常州市科技计划项目(CJ20140042、CJ20160037)。

摘　　要：目的 分析HIV感染/AIDS者结核感染情况及其影响因素.方法 于2017年1 7月采用随机整群抽样的方法,抽取江苏省常州地区3家社区医院,以其10年累计登记的HIV感染/AIDS者作为研究对象,最终纳入475例,平均年龄(44.44±13.85)岁,其中,男378例(79.58%),女97例(20.42%);HIV感染者273例(57.47%),AIDS患者202例(42.53%).收集研究对象的社会人口学信息及临床相关信息;采集研究对象外周静脉血,检测HIV病毒载量,并选取CD4+T细胞计数>200个/μl者采用QuantiFERON(R)-TB Gold (QFT)检测结核感染情况;分析研究对象结核感染情况,并采用多因素非条件logistic回归分析结核感染的影响因素.结果 研究对象中CD4+T细胞计数>200个/μ1者有429例,结核感染率为10.02%(43/429).单因素分析显示,CD4+T细胞计数>200个/μl者中有结核病接触史者结核感染率(30.30%,10/33)高于无接触史者(8.33%,33/396);CD4+T细胞计数>500个/μl者结核感染率(13.15%,33/251)高于CD4+T细胞计数为200~500个/μl者(5.62%,10/178),差异均有统计学意义(x2分别为16.30、6.55,P值均<0.05).进一步的非条件logistic回归分析显示,CD4+T细胞计数>200个/μl的HIV感染/AIDS者中,有结核病患者接触史者结核感染风险是无接触史者的4.61倍[调整OR值(95%CI值)为4.61(2.00~10.63)];CD4+T细胞计数>500个/μl的HIV感染/AIDS者结核感染风险是CD4+T细胞计数200~500个/μl者的2.47倍[调整OR值(95%CI值)为2.47(1.17~5.21)].结论 免疫水平低下的HIV感染/AIDS者结核感染检出率低;结核病患者接触史、免疫水平是HIV感染/AIDS者结核感染的重要影响因素.Objective To analyze the MTB infection and its influencing factors in HIV/AIDS patients.Methods From January to July 2017,3 community hospitals were selected by a random cluster sampling method in Changzhou,in which HIV/AIDS patients by the 10-year cumulative registration were used as the research subjects.As a result,a total of 475 subjects were included,with an average age(44.44±13.85)years,including 378 males(79.58%)and 97 females(20.42%);273 HIV-infected patients(57.47%)and 202 AIDS patients(42.53%).The sociodemographic information and clinically relevant information of the subjects were collected.Peripheral venous blood from subjects was tested for HIV viral load,then the subjects with CD4^+T cell counts>200 cells/pl were selected for MTB infection detection using QuantiFERON~■-TB Gold(QFT).The MTB infection status of the subjects was analyzed and influencing factors of MTB infection were analyzed by multivariate non-conditional logistic regression.Results There were 429 subjects with CD4^+T cell counts>200 cells/μl,and the MTB infection rate was 10.02%(43/429).Univariate analysis showed that the MTB infection rate of subjects with CD4^+T cell counts>200 cells/μl who had a history of tuberculosis exposure was higher than that of subjects without history of tuberculosis exposure(30.30%(10/33)vs.8.33%(33/396);χ~2=16.30,P<0.05);and the MTB infection rate of subjects with CD4^+T cell counts>500 cells/μl was higher than that of subjects with CD4^+T cell counts from200 to 500 cells/μl(13.15%(33/251)vs.5.62%(10/178);χ~2=6.55,P<0.05).Further unconditional logistic regression analysis showed that among HIV/AIDS patients with CD4^+T cell counts>200 cells/pl,the risk of MTB infection in the subjects with history of tuberculosis exposure was 4.61 times of subjects without history of tuberculosis exposure(adjusted OR=4.61,95%CI=2.00-10.63);and the MTB infection risk of HIV/AIDS patients with CD4^+T cell counts>500 cells/μl was 2.47 times of the HIV/AIDS patients with CD4^+T cell counts from 200 to 500 cells/μl

关 键 词：分枝杆菌 结核 感染 HIV感染 获得性免疫缺陷综合征 共病现象 因素分析 统计学 

分 类 号：R512.91[医药卫生—内科学] R52[医药卫生—临床医学]