成都市HIV感染孕产妇接受不同抗病毒治疗方案对早产的影响(2015-2020年)  

Influence of different antiviral treatment options for preterm birth in HIV-infected pregnant women in Chengdu (2015-2020)

作　　者：罗映娟 杨柳 巫霞 杨蕾 兰志鹏 Luo Yingjuan;Yang Liu;Wu Xia;Yang Lei;Lan Zhipeng(Health Care Department,Chengdu Women’s and Children’s Central Hospital,the Affiliated Women’s and Children’s Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610091,China)

机构地区：[1]电子科技大学医学院附属妇女儿童医院、成都市妇女儿童中心医院保健部,成都610091

出　　处：《国际流行病学传染病学杂志》2023年第5期342-346,共5页International Journal of Epidemiology and Infectious Disease

基　　金：成都市卫健委课题(2021354、2022076)

摘　　要：目的探讨孕期接受不同抗病毒治疗方案的成都市HIV感染孕产妇的早产发生率及其对早产的影响。方法以成都市2015—2020年已分娩的HIV感染孕产妇为研究对象,以不同抗病毒治疗方案为主要研究因素,采用多因素Logistic回归分析HIV感染孕产妇早产的相关因素。结果共纳入373例HIV感染孕产妇,使用齐多夫定(zidovudine,AZT)+拉米夫定(lamivudine,3TC)+洛匹那韦/利托那韦(lopinavir/ritonavir,LPV/r)、替诺福韦(tenofovir,TDF)+3TC+LPV/r和TDF+3TC+依非韦伦(efavirenz,EFV)治疗者分别占52.6%(196/373)、28.4%(106/373)和19.0%(71/373);早产发生率分别为16.8%(33/196)、7.5%(8/106)和15.5%(11/71)。基于蛋白酶抑制剂(protease inhibitor,PI)治疗方案与基于EFV的早产率差异没有统计学意义(χ^(2)=0.18,P=0.675)。经多因素Logistic回归分析,在控制了非本地居住、胎膜早破的影响下,HIV感染孕产妇不同治疗方案对早产有影响,与TDF+3TC+LPV/r方案相比,使用AZT+3TC+LPV/r方案的感染孕产妇早产风险更高(OR_(调整后)=2.446,95%CI:1.077~5.622)。结论基于成都地区HIV母婴阻断的监测数据,使用AZT+3TC+LPV/r方案早产发生的风险最高,使用TDF+3TC+LPV/r方案早产发生的风险相对较低。Objective To investigate the preterm birth rate of HIV-infected pregnant women for different antiretroviral treatment options in Chengdu,and to identify the influencing factors.Methods HIV-infected women who had delivered in Chengdu from 2015 to 2020 were enrolled,and they accepted different antiviral treatment regimens during pregnancy.Multivariate Logistic regression analysis was used to analyze the factors associated with prematurity.Results A total of 373 HIV-infected pregnant women were enrolled,among whom the proportions of zidovudine(AZT)+lamivudine(3TC)+lopinavir/ritonavir(LPV/r)protocol,tenofovir(TDF)+3TC+LPV/r protocol,TDF+3TC+efavirenz(EFV)protocol were 52.6%(196/373),28.4%(106/373)and 19.0%(71/373),respectively.The incidence rates of preterm birth were 16.8%(33/196),7.5%(8/106)and 15.5%(11/71),respectively.The difference of prematurity rates based on protease inhibitor versus EFV regimen was not statistically significant(χ^(2)=0.18,P=0.675).By multivariate Logistic regression analysis,different treatment options affected preterm birth after controlling the influencing factors of non-local residence and premature rupture of fetal membranes.Compared with TDF+3TC+LPV/r protocol,AZT+3TC+LPV/r protocol had a higher risk of preterm birth(OR_(adjusted)=2.446,95%CI:1.077-5.622).Conclusions Based on the monitoring data of blockade of mother to child transmission of HIV in Chengdu region,AZT+3TC+LPV/r protocol has the highest risk for preterm birth,while the risk of TDF+3TC+LPV/r protocol is low.

关 键 词：HIV 孕产妇 抗病毒治疗 早产 替诺福韦 

分 类 号：R714.21[医药卫生—妇产科学]