2010—2019年凉山州四个重点县艾滋病抗病毒治疗合并HCV抗体阳性人群生存情况及影响因素分析  

Survival status and influencing factors of patients receiving AIDS antiretroviral therapy combined with anti-HCV positive in Liangshan Prefecture,2010-2019

作　　者：黄玉玲 贾思艳 车双双 余刚[4] 王菊[4] 任建华 高鑫 曾亚莉[1] 卓玛拉措 唐雪峰[1] 杨一挥[1] HUANG Yu-ling;JIA Si-yan;CHE Shuang-shuang;YU Gang;WANG Ju;REN Jian-hua;GAO Xin;ZENG Ya-li;ZHUOMA La-cuo;TANG Xue-feng;YANG Yi-hui(Center for Disease Control and Prevention of Sichuan Province,Chengdu,Sichuan 610041,China;不详)

机构地区：[1]四川省疾病预防控制中心,四川成都610041 [2]四川大学华西公共卫生学院/四川大学华西第四医院 [3]成都市温江区疾病预防控制中心 [4]凉山州疾病预防控制中心

出　　处：《现代预防医学》2023年第4期736-742,共7页Modern Preventive Medicine

基　　金：四川省2021年度“卫生健康数学化发展”专项课题(2021XKY06011);四川省科技计划项目(2020YJ0449)。

摘　　要：目的了解四川省凉山州艾滋病疫情重点县艾滋病抗病毒治疗合并HCV抗体阳性人群生存情况及影响因素。方法采用回顾性队列研究的方法,从艾滋病防治基本信息系统选取2010—2019年现住址在凉山州4个重点县、年龄≥15岁、艾滋病抗病毒治疗合并HCV抗体阳性者4525例,采用Cox比例风险回归模型分析接受艾滋病抗病毒治疗合并抗-HCV阳性者生存情况及影响因素。本研究使用SPSS 17.0和R 4.0.3软件进行分析。结果共纳入研究对象4525例,不同特征接受艾滋病抗病毒治疗合并抗-HCV阳性者的生存时间比较显示,不同年龄、性别、民族、婚姻、文化程度、感染途径、感染途径、样本来源、治疗前BMI、确诊至启动治疗时间间隔、确证时疾病状态和CD4^(+)T淋巴计数、治疗初始方案、随访机构以及治疗过程中脱失情况比较,差异均有统计学意义(P<0.05)。截至观察终点,观察对象死亡802例,死亡率为17.7%;多因素Cox比例风险回归分析结果显示,女性死亡风险是男性的0.56(HR=0.56,95%CI:0.43~0.74)倍;治疗前BMI<18.5 kg/m^(2)的死亡风险是BMI为18.5~23.9的1.74(HR=1.74,95%CI:1.43~2.13)倍;启动治疗时WHO临床分期为Ⅲ期的死亡风险是Ⅰ期1.23(HR=1.23,95%CI:1.01~1.48)倍;启动治疗时基线CD4^(+)T淋巴细胞数为200~349、350~49及≥500组的死亡风险分别是<200个/μl组的0.57(HR=0.57,95%CI:0.48~0.68)倍、0.51(HR=0.51,95%CI:0.42~0.62)倍和0.40(HR=0.40,95%CI:0.32~0.51)倍;随访机构为社区卫生服务中心/乡镇卫生院的死亡风险是县级及以上医院的0.10(HR=0.10,95%CI:0.06~0.17)倍;抗病毒治疗初始方案为TDF/AZT+3TC+NVP的死亡风险是TDF/AZT+3TC+EFV的1.33(HR=1.33,95%CI:1.07~1.65)倍;确证至启动治疗时间间隔为6~12个月和≥12个月的死亡风险分别是<1个月的1.59(HR=1.59,95%CI:1.03~2.46)倍和1.53(HR=1.53,95%CI:1.04~2.25)倍。结论为降低凉山州4个重点县接受艾滋病抗病毒治疗患者合并抗-HCV阳性者�Objective To examine the survival status of patients receiving AIDS highly active antiretroviral therapy(HAART)combined with anti-HCV positive in Liangshan Prefecture and influencing factors.Methods A retrospective cohort study was used to select 4525 patients aged≥15 years old who had received HAART combined with anti-HCV positive in four key national counties of Liangshan Prefecture from 2010 to 2019 from the basic AIDS prevention information system.Cox proportional hazard regression model was used to analyze the survival status and influencing factors and SPSS 17.0 and R 4.0.3 software were used to analysis in this study.Results A total of 4525 cases were included in the study.The survival time were statistically significant differences among different age,sex,ethnicity,marriage,education level,route of infection,route of infection,source of samples,BMI before treatment,time interval from diagnosis to initiation of treatment,disease status and CD4^(+)T lymphoid count at confirmation,initial treatment plan,follow-up institution and loss during treatment(P<0.05).By the end of observation,802 cases had died and the mortality rate was 17.7%.Multivariate Cox proportional hazard regression analysis showed that the mortality risk of females was 0.56 times higher than that of males.The risk of death of patients with 18.5 kg/m^(2) before treatment was 1.74 times higher than for those with a BMI of 18.5 to 23.9.The risk of death at stage Ⅲ was 1.23 times higher than that at stageⅠ.Baseline CD4^(+)T lymphocyte counts of 200 to 349,350 to 499,and≥500 were 0.57 times greater than those of less than 200,respectively.The risk of death in community health service centers/township hospitals was 0.10 times higher than that in county-level and above hospitals.The mortality risk of TDF/AZT+3TC+NVP was 1.33 times higher than that of TDF/AZT+3TC+EFV.The risk of death was 1.59 and 1.53 times higher than that of less than 1 month with a confirmed interval of 6 to 12 months and greater than or equal to 12 months.Conclusions In

关 键 词：艾滋病 抗病毒治疗 抗-HCV阳性者 生存时间 影响因素 

分 类 号：R512.91[医药卫生—内科学]