湖南省2013年至2019年人类免疫缺陷病毒暴露未感染儿童的营养不良状况及其影响因素分析  

Prevalence and associated factors for malnutrition among human immunodeficiency virus-exposed uninfected children from 2013 to 2019 in Hunan Province

作　　者：李辉霞[1] 袁姗 吴芳 黄广文[1] 杨敏[1] 高洁[1] 郑剑飞[3] Li Huixia;Yuan Shan;Wu Fang;Huang Guangwen;Yang Min;Gao Jie;Zheng Jianfei(Department of Child Health Care,Hunan Provincial Maternal and Child Health Care Hospital,Changsha 410008,China;Department of Maternal and Children Health,Xiangya School of Public Health,Central South University,Changsha 410008,China;Department of Emergence Medicine,The Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]湖南省妇幼保健院儿童保健科,长沙410008 [2]中南大学湘雅公共卫生学院儿少卫生与妇幼保健学系,长沙410008 [3]中南大学湘雅二医院急诊科,长沙410011

出　　处：《中华传染病杂志》2022年第3期143-150,共8页Chinese Journal of Infectious Diseases

基　　金：湖南省自然科学基金(2020JJ5285)。

摘　　要：目的了解湖南省人类免疫缺陷病毒暴露未感染(human immunodeficiency virus-exposed uninfected,HEU)儿童营养不良发生状况及其影响因素。方法纳入2013年7月至2019年6月湖南省"预防艾滋病母婴传播管理信息系统"报告的人类免疫缺陷病毒感染母亲所生儿童为研究对象,收集母亲的人口学特征、妊娠合并症/并发症、妊娠期抗反转录病毒治疗方案,以及儿童的预防性用药、出生体质量、随访期间是否患病等资料。于1、3、6、9、12、18月龄时随访儿童的身长和体质量,评估各随访时间点的生长迟缓率、低体质量率、消瘦率和营养不良发生率。采用广义估计方程拟合logistic回归分析营养不良相关影响因素。结果共纳入656名HEU儿童。HEU儿童的生长迟缓率、低体质量率、消瘦率和营养不良发生率均在1月龄时最高,分别为11.9%(78/656)、9.1%(60/656)、7.0%(46/656)和21.0%(138/656)。母亲有妊娠合并症/并发症[调整后的比值比(adjusted odds ratio,aOR)=2.30,95%可信区间(confidence interval,CI)1.48~3.58]、妊娠期抗病毒治疗为单/双药治疗(aOR=2.38,95%CI 1.54~3.68),以及儿童出生体质量<2500 g(aOR=2.66,95%CI 1.69~4.21)和随访期间患有疾病(aOR=1.73,95%CI1.10~2.70)是HEU儿童发生营养不良的危险因素(均P<0.050);而服用齐多夫定(aOR=0.60,95%CI 0.38~0.94)、奈韦拉平(aOR=0.31,95%CI 0.18~0.52)进行预防性治疗均是HEU儿童发生营养不良的保护因素(均P<0.050)。结论HEU儿童营养不良发生率较高,并且受母亲有妊娠合并症/并发症、抗病毒治疗方案,以及儿童出生体质量、随访期间患有疾病和是否接受预防性治疗等因素影响。Objective To analyze the prevalence of malnutrition among human immunodeficiency virus-exposed uninfected(HEU)children and to identify the associated factors in Hunan Province.Methods All children born to human immunodeficiency virus(HIV)-infected mothers retrieved from Information System of Prevention of Mother-to-Child Transmission of human immunodeficiency virus Management(IPMTCT)in Hunan Province between July 2013 and June 2019 were included.Information including maternal demographic characteristic,maternal comorbidities/complications,anti-retroviral therapy during pregnancy,anti-retroviral prophylaxis for children,birth weight,and disease during follow-up was collected.The length and weight of children at one,three,six,nine,12 and 18 months of follow-up time points were detected,and the prevalences of stunting,underweight,wasting and malnutrition among HEU children were evaluated.The generalized estimating equation was used to fit the logistic regression model to analyze the associated factors for malnutrition.Results A total of 656 HEU children were finally included.The prevalences of stunting,underweight,wasting,and malnutrition among HEU children were highest at one month of age,which were 11.9%(78/656),9.1%(60/656),7.0%(45/656)and 21.0%(138/656),respectively.Maternal comorbidities/complications(adjusted odds ratio(aOR)=2.30,95%confidence interval(CI)1.48 to 3.58),mono/dual anti-retroviral therapy during pregnancy(aOR=2.38,95%CI 1.54 to 3.68),birth weight<2500 g(aOR=2.66,95%CI 1.69 to 4.21)and disease during follow-up(aOR=1.73,95%CI 1.10 to 2.70)were the risk factors for malnutrition among HEU children(all P<0.050).Both taking zidovudine(aOR=0.60,95%CI 0.38 to 0.94)and nevirapine(aOR=0.31,95%CI 0.18 to 0.52)for anti-retroviral prophylaxis were the protective factors for malnutrition among HEU children(both P<0.050).Conclusions The prevalence of malnutrition among HEU children is high.The prevalence of malnutrition is affected by maternal comorbidities/complications,anti-retroviral therapy during pregnancy

关 键 词：HIV 儿童 营养不良 HIV暴露未感染 影响因素 

分 类 号：R512.91[医药卫生—内科学]