基于住院电子病历数据分析HIV感染者的共病模式  

Comorbidity patterns of HIV-infected patients based on hospital information system data

作　　者：何加敏 朱政[1,2,3] 刘晓宁 杨中方[1] 余骏雯[1] 金依霖 胡天天 卢洪洲 HE Jiamin;ZHU Zheng;LIU Xiaoning;YANG Zhongfang;YU Junwen;JIN Yilin;HU Tiantian;LU Hongzhou(School of Nursing,Fudan University,Shanghai 200032,China;Shanghai Evidence-Based Nursing Center,Shanghai 200032,China;College of Nursing,New York University,New York 10010,The United States;Shenzhen Third People's Hospital,Shenzhen 518112,Guangdong,China)

机构地区：[1]复旦大学护理学院,上海200032 [2]上海市循证护理中心,上海200032 [3]纽约大学护理学院,纽约10010 [4]深圳市第三人民医院,广东深圳518112

出　　处：《护士进修杂志》2023年第24期2295-2302,共8页Journal of Nurses Training

基　　金：国家自然科学基金资助项目(编号:72104051)。

摘　　要：目的了解HIV感染者的共病模式和核心共病,并调查不同性别和年龄亚组人群的共病差异性,为复杂情境下HIV感染者健康管理和诊疗提供科学依据。方法收集2019年12月1日-2022年1月31日在上海市公共卫生临床中心就诊的3109例HIV感染者的住院电子病历数据,共纳入49种疾病,构建了HIV感染者的共病网络以及不同年龄和性别的亚组网络,依据强度中心性、紧密中心性、中介中心性这3个中心性指标来评估共病网络中的核心共病,采用基于模块度优化的方法进行共病网络的聚类分析。结果在纳入的3109例HIV感染者中,存在共病者2538例(81.6%)。其他呼吸道疾病(J98)是不同性别和年龄HIV感染者的首要核心共病,其次是其他贫血(D64)和隐球菌病(B45);原发性高血压(I10)是≥50岁人群的第二核心共病。男性HIV感染者的共病网络疾病的平均强度高于女性HIV感染者(t=6.7,P<0.05)。“18~岁”HIV感染者与“50岁~”HIV感染者的共病网络的疾病平均强度差异无统计学(t=0.8,P=0.414)。结论需要加强对HIV感染者肺部感染、贫血、隐球菌病及其他各种感染性疾病的综合管理,做好疾病的预防和危险因素的监测,老年人群还需重点关注原发性高血压的发生,男性人群的共病网络更为复杂,需加强对其共病的管理。Objective To understand the comorbidity patterns and core comorbidity in HIV-infected patients,and to investigate the gender and age group specific differences in multimorbidity,so as to provide a scientific evidence for health management and treatment strategies in complex scenarios.Methods Hospital information system data of 3109 HIV-infected patients attending the Shanghai Public Health Clinical Center from December 1,2019 to January 31,2022 were collected,and 49 diseases were included to develop a comorbidity network of HIV-infected patients and subgroup networks based on different age and gender.Core comorbidities in the network were evaluated by using 3 centrality indicators:strength,closeness,and betweenness.The clustering analysis of the comorbidity network was performed by using a modularity-based optimization method.Results Among the included 3109 HIV-infected patients,2538(81.6%)had comorbidities.Other types of respiratory diseases(J98)was the primary core comorbidity among HIV-infected patients across all genders and ages,followed by other types of anemia(D64)and cryptococcosis(B45).Primary hypertension(I10)was the second core comorbidity among those aged 50 years and above.The mean strength of disease in the comorbidity network was higher in men than that in women(t=6.7,P<0.05).No statistically significant difference was found in the mean strength of disease in the comorbidity network between HIV-infected individuals aged 18~49 years and those aged 50 years and above(t=0.8,P=0.414).Conclusion It is necessary to enhance the holistic management approach towards pulmonary infections,anemia,cryptococcosis,and a variety of other infectious diseases in HIV-infected patients.Prevention and monitoring of disease risk factors shall be strengthened.Essential hypertension shall be paid more attention in the elderly,and comorbidity network in the male people is more intricate,and there's an increased necessity to strengthen the management of their comorbidities.

关 键 词：HIV感染 艾滋病 共病 网络分析 疾病网络 

分 类 号：R473.51[医药卫生—护理学]