HIV/AIDS认知功能障碍影响因素及模型预测价值  

Analysis of related influencing factors of cognitive dysfunction in HIV/AIDS patients and the value of model prediction

作　　者：黄敏 王夏青 HUANG Min;WANG Xia-qing(Wuhan Eighth Hospital,Wuhan,Hubei430010,China)

机构地区：[1]武汉市第八医院感染科,湖北武汉430010

出　　处：《中华医院感染学杂志》2022年第19期2935-2939,共5页Chinese Journal of Nosocomiology

基　　金：湖北省自然科学基金资助项目(201963)。

摘　　要：目的探讨人体免疫缺陷病毒(HIV)/获得性免疫缺陷综合征(AIDS)患者认知功能障碍的影响因素及模型预测价值。方法选择武汉市第八医院感染性疾病门诊2017年2月-2021年2月HIV/AIDS患者100例为研究对象,使用蒙特利尔认知评估量表对患者认知功能进行评分并将患者分为HIV相关神经认知功能障(HAND)组(n=34)和非HAND组(n=66)。采用限制性片段长度多态性聚合酶链法检测基质金属蛋白酶-21(MMP-21)-572C/T位点多态性。收集患者性别、年龄、HIV感染方式、吸烟、饮酒习惯、患病年限和体质量指数(BMI)等临床资料以及HIV病毒载量、血清CD~+T淋巴细胞计数、甘油三脂(TG)、总胆固醇(TC)、MMP-21水平,采用多因素Logistic回归分析HIV/AIDS患者认知功能障碍的影响因素并构建模型,通过绘制受试者工作特征(ROC)曲线评估其对HIV/AIDS患者认知功能障碍的预测价值。结果HAND组年龄大于非HAND组,患病年限长于非HAND组,血清TG、TC、MMP-21水平高于非HAND组(P<0.05);HAND组TT基因型、T等位基因频率高于非HAND组(P<0.05);以是否发生HAND为因变量进行回归分析,结果发现患病年限、血清MMP-21、MMP-21-572C/T多态性均为HIV/AIDS患者发生HAND的影响因素(P<0.05)。建立风险预测模型:logit(P)=-10.371+患病年限长×0.670+MMP-21×0.452+MMP-21-572C/T多态性×0.541;ROC曲线分析显示,当logit(P)>11.58时,曲线下面积(AUC)值为0.879,敏感度为91.18%,特异度为75.76%(P<0.05)。结论HIV/AIDS患者发生HAND的Logistic回归模型的预测价值较高,临床可通过监测血清MMP-21水平、MMP-21-572C/T多态性来预测HIV/AIDS患者认知障碍发生风险。OBJECTIVE To explore the related influencing factors of cognitive dysfunction in patients with human immunodeficiency virus(HIV)/acquired immunodeficiency syndrome(AIDS)and the predictive value of the model.METHODS A total of 100 HIV/AIDS patients from Feb.2017 to Feb.2021 in the infectious disease clinic of Wuhan Eighth Hospital were selected as the research subjects.The cognitive function of the patients was scored by the Montreal Cognitive Assessment Scale and the patients were divided into the HIV-related neurocognitive dysfunction(HAND)group(n=34)and the non-HAND group(n=66).The polymorphism of matrix metalloproteinase-21(MMP-21)-572 C/T was detected by restriction fragment length polymorphism polymerase chain reaction.Clinical data such as sex,age,HIV infection mode,smoking,drinking habits,years of illness and body mass index(BMI)were collected,as well as HIV viral load,serum levels of CDT lymphocyte count,triglyceride(TG),total cholesterol(TC)and MMP-21.Multivariate Logistic regression was used to analyze the influencing factors of cognitive dysfunction in HIV/AIDS patients and build a model.The predictive value of receiver operating characteristic curve(ROC)in cognitive dysfunction of HIV/AIDS patients was evaluated.RESULTS The age,illness duration and serum levels of TG,TC and MMP-21 of the HAND group were higher than those of the non-HAND group(P<0.05).TT genotype and T allele frequency in the HAND group were higher than those in the non-HAND group(P<0.05).The regression analysis with the occurrence of HAND as the dependent variable showed that long illness duration,high serum level of MMP-21 and MMP-21-572 C/T polymorphism were all risk factors for the occurrence of HAND in HIV/AIDS patients(P<0.05).Established a risk prediction model was:logit(P)=-10.371+length of illness×0.670+MMP-21×0.452+MMP-21-572 C/T polymorphism×0.541;ROC curve analysis showed that when logit(P)>11.58,AUC value was 0.879,the diagnostic sensitivity was 91.18%,and the specificity was 75.76%(P<0.05).CONCLUSION The risk factors o

关 键 词：人体免疫缺陷病毒 获得性免疫缺陷综合征 基质金属蛋白酶-21 基因多态性 HIV相关认知功能障碍 影响因素 诊断价值 

分 类 号：R512.91[医药卫生—内科学]