2005-2020年保定市艾滋病患者抗艾滋病病毒治疗免疫学效果影响因素分析  

Factors Associated with Immunological Failure of Anti-HIV Therapy in Baoding, 2005-2020

作　　者：李永勤 杨学刚 粱叶 刘洋 赵静 路新利[3] LI Yongqin;YANG Xuegang;LIANG Ye;LIU Yang;ZHAO Jing;LU Xinli(Clinical Laboratory,the People's Hospital of Baoding,Baoding 071000,China;Infection Division,the People's Hospital of Baoding,Baoding 071000,China;Hebei Provincial Center for Disease Control and Prevention,Shijiazhuang 050021,China)

机构地区：[1]保定市人民医院检验科,河北保定071000 [2]保定市人民医院感染科,河北保定071000 [3]河北省疾病预防控制中心,河北石家庄050021

出　　处：《中国皮肤性病学杂志》2023年第2期196-201,共6页The Chinese Journal of Dermatovenereology

基　　金：河北省自然科学基金(H2016303006);保定市科技计划项目(2041ZF150)。

摘　　要：目的旨在了解保定市2005-2020年的艾滋病感染者接受抗逆转录病毒治疗(anti-retroviruses therapy,ART)后免疫学效果及其影响因素。方法通过对“全国艾滋病防治基本信息系统”的数据进行筛选,采用回顾性研究,使用卡方检验和多因素Logistic回归方法分析影响艾滋病患者抗逆转录病毒治疗免疫学效果的因素。结果经筛选共2354例病例被纳入本研究,其中免疫学有效组1836例(77.99%)、免疫学失败组518例(22.01%),免疫学有效组治疗后较治疗前CD4^(+)T淋巴细胞数量明显升高(P<0.05),免疫学失败组CD4^(+)T淋巴细胞数量治疗前后差异无统计学意义(P>0.05)。经多因素Logistic回归分析,51~65岁(OR=1.33,95%CI:1.01~1.74)和≥66岁(OR=1.63,95%CI:1.09~2.46),WHO临床分期Ⅱ期(OR=1.38,95%CI:1.01~1.87)、Ⅲ期(OR=2.70,95%CI:1.18~4.00)和Ⅳ期(OR=2.41,95%CI:1.54~3.78),服药依从性不良(OR=4.00,95%CI:2.25~7.14),病毒学失败(OR=5.06,95%CI:3.02~8.49)可以增加免疫学失败发生的风险(P<0.05)。治疗年限2~5年(OR=0.51,95%CI:0.39~0.67)和>5年(OR=0.34,95%CI:0.25~0.46),接受过复方新诺明预防治疗(OR=0.36,95%CI:0.26~0.50)可以降低免疫学失败发生的风险(P<0.05)。结论早期发现、早治疗、提高服药依从性、减少病毒学失败等措施能降低抗逆转录病毒治疗免疫学失败的发生。Objective To assess the immunological effect of antiretroviral therapy(ART) and related risk factors in Baoding, 2005-2020.Methods A retrospective cohort study was conducted in this work. The influencing factors of ART were confirmed via the chi-square test and multi-factor logistic regression analysis.Results A total of 2 354 cases were included in the study. Of them, 518 cases(22.01%) had the immunological failure. The count of CD4+T lymphocytes in the immunological failure group showed no difference before and after ART(P>0.05). Multivariate Logistic regression analysis showed that age 51-65(OR=1.33, 95%CI:1.01-1.74) and ≥ 66(OR=1.63, 95%CI:1.09-2.46), WHO clinical stage Ⅱ(OR=1.38, 95%CI:1.01-1.87), Ⅲ(OR=2.70, 95%CI:1.18-4.00) and Ⅳ(OR=2.41, 95%CI:1.54-3.78), poor adherence to ART(OR=4.00, 95%CI:2.25-7.14), and virologic failure(OR=5.06, 95%CI: 3.02-8.49) could elevate the risk of immunological failure(P<0.05). Duration of treatment 2-5 years(OR=0.51, 95%CI:0.39-0.67) and >5 years(OR=0.34, 95%CI:0.25-0.46), and cotrimoxazole prophylaxis(OR=0.36, 95%CI:0.26-0.50) could reduce the risk of immunological failure(P<0.05).Conclusion The early detection, the early treatment, the better medication adherence, and the reduction of virologic failure can decrease the occurrence of immunological failure.

关 键 词：艾滋病 抗病毒治疗 免疫学失败 影响因素 

分 类 号：R512.91[医药卫生—内科学]