不同性别老年HIV/AIDS患者抗病毒治疗预后影响因素及CD4^(+)T淋巴细胞恢复情况  

Immunological CD4^(+) T-cell recovery and prognostic influencing factors in elderly HIV/AIDS patients of different genders after antiviral therapy

作　　者：张洪 李珍 王刚 胡家光[3] 张鹏[3] 陈涛[3] 覃川[3] 赖菁贞 蒋忠胜[3] 梁浩 宁传艺 ZHANG Hong;LI Zhen;WANG Gang;HU Jia-Guang;ZHANG Peng;CHEN Tao;QIN Chuan;LAI Jing-zhen;JIANG Zhong-sheng;LIANG Hao;NING Chuan-yi(Life Sciences Institute,Guangxi Medical University,Nanning,Guangxi 530021,China;Guangxi Key Laboratory of AIDS Prevention and Treatment,Guangxi Medical University,Nanning,Guangxi 530021,China;Department of Infectious Diseases,Liuzhou People's Hospital,Liuzhou,Guangxi 545000,China;Nursing College,Guangxi Medical University,Nanning,Guangxi 530021,China)

机构地区：[1]广西医科大学生命科学研究院,广西南宁530021 [2]广西艾滋病防治研究重点实验室,广西南宁530021 [3]柳州市人民医院感染病科,广西柳州545000 [4]广西医科大学护理学院,广西南宁530021

出　　处：《中国热带医学》2023年第3期215-220,共6页China Tropical Medicine

基　　金：国家自然科学基金(No.81760602,No.81803295)。

摘　　要：目的通过分析老年HIV/AIDS患者基本资料及临床随访资料,了解老年HIV/AIDS患者抗病毒治疗后的预后影响因素及CD4恢复情况。方法收集2005—2015年在柳州市的艾滋病抗病毒治疗点接受抗病毒治疗(antiretroviral therapy,ART)且年龄≥50岁的HIV/AIDS患者3618例,对患者的资料包括基本信息、CD4^(+)T细胞计数、WHO临床分期、感染途径及随访情况等进行回顾性分析。采用Kaplan-Meier法比较患者生存差异,多因素Cox回归分析影响患者死亡风险的独立影响因素,比较不同性别患者随访期间CD4^(+)T细胞计数的恢复情况。结果随访期间,截止观察终点5年女性累计生存率为0.82,男性累计生存率为0.66。多因素Cox回归分析显示,影响抗病毒治疗效果的独立影响因素为年龄(OR=1.909,95%CI:1.479~2.464,P<0.001)、BMI(OR=0.744,95%CI:0.574~0.965,P=0.026)、性别(OR=0.692,95%CI:0.503~0.952,P=0.023)、除结核病外的机会性感染数目(OR=1.223,95%CI:1.028~1.454,P=0.023)和基线CD4^(+)T细胞计数(OR=0.563,95%CI:0.429~0.739,P<0.001)。CD4恢复结果显示当基线CD4^(+)T淋巴细胞计数小于200个/mm3时,女性老年HIV/AIDS患者CD4^(+)T淋巴细胞在ART治疗的各时间段均高于男性(P<0.05)。结论抗病毒治疗5年后老年女性比老年男性生存率高,年龄、BMI、性别、除结核病外的机会性感染数目和基线CD4^(+)T细胞计数可能是影响老年HIV/AIDS患者生存预后的重要预测指标。在抗病毒治疗后4年随访期间老年女性比老年男性CD4^(+)T淋巴细胞的恢复效果更好。Objective To investigate the prognostic influencing factors and recovery of CD4^(+)T lymphocytes in elderly HIV/AIDS patients after antiviral therapy by analyzing basic data and clinical follow-up data of elderly HIV/AIDS patients.Methods The clinical data of 3618 elderly AIDS patients aged≥50 yeas who received antiretroviral therapy(ART)at HIV ART sites in Liuzhou City from 2005-2015 were collected.The data,including basic information,CD4^(+)T cell count,WHO clinical stage,infection route and follow-up,were retrospectively analyzed.Kaplan-Meier method was used to compare the differences in patient survival,multivariate Cox regression to analyze the independent influencing factors influencing the risk of death,and to compare the recovery of CD4^(+)T cell counts during follow-up of patients of different genders.Results During the follow-up period,the 5-year cumulative survival rate up to the observation endpoint was 0.82(female)and 0.66(male).Multivariate logistic regression analysis showed that the risk factors affecting the effect of antiviral treatment were age(OR=1.909,95%CI:1.474-2.464,P<0.001),body mass index(BMI)(OR=0.744,95%CI:0.574-0.965,P=0.026),opportunistic infections(OI)(OR=1.223,95%CI:1.028-1.454,P=0.023),gender(OR=0.692,95%CI:0.503-0.952,P=0.023)and baseline CD4^(+)T lymphocytes count(OR=0.563,95%CI:0.429-0.739,P<0.001).Recovery of CD4^(+)T lymphocyte counts showed when baseline CD4^(+)T lymphocyte counts were less than 200 cells/mm3,older women with HIV/AIDS had higher CD4^(+)T lymphocytes than men at all times of ART treatment(P<0.05).Conclusions Older women have a higher survival rate than older men after five years of antiviral therapy.Age,BMI,gender,OI and baseline CD4^(+)T lymphocyte count may be important indicators that affect the survival of elderly HIV/AIDS patients.Older women showed better recovery of CD4^(+)T lymphocytes than older men during the 4-year follow-up period after ART.

关 键 词：老年HIV/AIDS 抗病毒治疗 性别 CD4^(+)T细胞 

分 类 号：R512[医药卫生—内科学]