中国人类免疫缺陷病毒感染者的肺动脉高压发生情况及危险因素分析  

Incidence and risk factors of pulmonary hypertension in Chinese people living with human immunodeficiency virus

作　　者：罗玲[1] 宋晓璟[1] 吕玮[1] 刘正印[1] 王焕玲[1] 李雁凌[1] 李晓霞[1] 曹玮[1] 李太生[1] Luo Ling;Song Xiaojing;Lyu Wei;Liu Zhengyin;Wang Huanling;Li Yanling;Li Xiaoxia;Cao Wei;Li Taisheng(Department of Infectious Diseases,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院感染内科,北京100730

出　　处：《中华传染病杂志》2024年第3期141-146,共6页Chinese Journal of Infectious Diseases

基　　金：北京协和医院中央高水平医院临床科研专项(2022-PUMCH-D-008)。

摘　　要：目的评估中国长期行抗反转录病毒治疗(ART)与未接受过ART的人类免疫缺陷病毒(HIV)感染者的肺动脉高压(PH)发生情况,并分析HIV感染者发生PH的危险因素,为我国HIV感染者的心血管疾病监测和管理提供依据。方法长期行ART的HIV感染者来自NCT04463810研究队列。另外,采用倾向性评分匹配方法,从NCT00872417与NCT01844297研究中选取性别匹配、未接受过ART的HIV感染者作为对照。本研究为回顾性、观察性临床研究。收集纳入HIV感染者的基本资料和临床访视资料,以及心脏彩色多普勒超声检查数据,以分析HIV感染者的PH发生率及发生PH的危险因素。统计学方法采用χ^(2)检验和多因素logistic回归分析。结果318例HIV感染者中,长期行ART和未接受过ART的患者各159例,分别为长期治疗组和未治疗组。318例HIV感染者中发生PH者30例(9.4%),其中临界性PH 23例(7.2%),轻度PH 6例(1.9%),中度PH 1例(0.3%),无重度PH。长期治疗组PH发生率为5.0%(8/159),低于未治疗组的13.8%(22/159),差异有统计学意义(χ^(2)=7.21,P=0.012)。多因素分析显示,年龄大[比值比(OR)=1.064,95%可信区间(CI)1.019~1.111,P=0.016]和病毒未被抑制(OR=2.660,95%CI 1.041~6.797,P=0.041)是HIV感染者发生PH的独立危险因素。结论长期行ART的HIV感染者的PH发生率低于未接受过ART的HIV感染者。年龄大、病毒未被抑制是HIV感染者发生PH的独立危险因素。心脏彩色多普勒超声检查有助于HIV感染者早期筛查PH,对于HIV感染者,应积极行ART以减少PH的发生。Objective To evaluate pulmonary hypertension(PH)in Chinese people living with human immunodeficiency virus(HIV)receiving long-term anti-retroviral therapy(ART)and those who had not received ART for HIV infection,and to analyze the risk factors for PH in HIV infected individuals,so as to provide evidence for the monitoring and management of cardiovascular diseases in people living with HIV in China.Methods HIV infected individuals who received long-term ART were from the NCT04463810 study cohort.In addition,using propensity score matching method,gender matched HIV infected individuals who had not received ART were selected as controls from the NCT00872417 and NCT01844297 studies.This study was a retrospective and observational clinical study.Basic data,clinical visit and cardiac Doppler ultrasonography data were collected to analyze the prevalence of PH and risk factors for PH in people living with HIV.Chi-square test and multivariate logistic regression were used for statistical analysis.Results Among the 318 HIV infected individuals,159 underwent long-term ART and 159 did not receive ART,which were divided into long-term ART group and ART-naïve group,respectively.Among 318 HIV infected individuals,30 cases(9.4%)experienced PH,including 23 cases(7.2%)with critical PH,six cases(1.9%)with mild PH,one case(0.3%)with moderate PH,and there was no severe PH.The prevalence of PH in the long-term ART group was 5.0%(8/159),which was lower than that in the ART-naïve group(13.8%,22/159).The difference was statistically significant(χ^(2)=7.21,P=0.012).Multivariate analysis showed that older age(odds ratio(OR)=1.064,95%confidence interval(CI)1.019 to 1.111,P=0.016)and unsuppressed HIV status(OR=2.660,95%CI 1.041 to 6.797,P=0.041)were independent risk factors for PH of people living with HIV.Conclusions The prevalence of PH in people living with HIV with long-term ART is lower than that of ART-naïve people living with HIV.Older age and unsuppressed HIV status are independent risk factors for PH in people living with HIV.Ca

关 键 词：HIV 肺动脉高压 心脏彩色多普勒超声 抗逆转录病毒治疗 

分 类 号：R512.91[医药卫生—内科学]