新发HIV/AIDS患者抑郁心理干预效果及其与CD_(4)^(+)T细胞计数的关系研究  

Study on Effectiveness of Psychological Intervention for Depression in Newly Diagnosed HIV/AIDS-infected Patients and the Relationship with CD_(4)^(+)T Cell Counts

作　　者：刘云 卢和丽[2] 邹卿[3] 袁也丰[3] LIU Yun;LU Heli;ZOU Qing;YUAN Yefeng(Department of Psychiatry,Psychiatric Hospital of Guangzhou Civil Affairs Bureau,Guangzhou 510430,China;Department of Psychosomatic Medicine,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Psychosomatic Medicine,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]广东省广州市民政局精神病院精神心理科,510430 [2]南昌大学第二附属医院心身医学科,江西省南昌市330006 [3]南昌大学第一附属医院心身医学科,江西省南昌市330006

出　　处：《中国全科医学》2024年第32期4009-4014,共6页Chinese General Practice

基　　金：江西省重点研发计划项目(20212BBG73042);社会组织参与艾滋病防治基金项目(2021-2022360100PYDPLWH025821C)。

摘　　要：背景HIV/AIDS与抑郁症相关,抑郁症加大HIV相关认知紊乱(HAND)风险,并降低患者抗逆转录病毒治疗(ART)依从性,加剧HIV传播风险。国内研究较少报道新发HIV/AIDS患者(PLWHA)抑郁心理干预效果及与CD_(4)^(+)T细胞计数相关性。目的探究新发PLWHA抑郁心理干预效果及与CD_(4)^(+)T细胞计数相关性,为AIDS临床诊疗提供参考。方法2020年4月—2022年6月采用方便取样方法在江西省ART定点医院抽取新发PLWHA抑郁患者,患者确诊后立即启动ART及心理干预,干预总周期为12周。在干预前后采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)进行评估,并检测CD_(4)^(+)T细胞计数进行分析。结果共纳入新发PLWHA抑郁患者200例,有效随访178例,有效率为89.0%。178例PLWHA抑郁患者轻中度88例(49.4%)、重度90例(50.6%),伴焦虑者173例(97.2%)。患者CD_(4)^(+)T细胞计数均值在干预前为(346.39±156.87)个/μL,干预后为(421.93±149.61)个/μL。干预后,新发PLWHA抑郁患者CD_(4)^(+)T细胞计数高于干预前(t_(配对)=10.971,P<0.05),HAMD、HAMA总分及各因子评分均低于干预前(P<0.05)。干预前,HAMD总分与CD_(4)^(+)T细胞计数分级(以500个/μL为分界值)呈负相关(r_(s)=-0.157,P=0.036)、与HAMA总分呈正相关(r_(s)=0.764,P<0.001)。干预后,HAMD总分与干预后CD_(4)^(+)T细胞计数呈负相关(r_(s)=-0.150,P=0.046)、与HAMA总分呈强正相关(r_(s)=0.939,P<0.001)。干预前,新发PLWHA抑郁患者CD_(4)^(+)T细胞计数<500个/μL者HAMD、HAMA总分高于CD_(4)^(+)T细胞计数≥500个/μL者(P<0.05)。结论新发PLWHA抑郁严重程度与CD_(4)^(+)T细胞计数相关,经专业心理干预能显著改善。Background HIV/AIDS is associated with depression,which increases the risk of HIV-associated neurocognitive disorders(HAND)and reduces patient compliance with antiretroviral therapy(ART),exacerbating the risk of HIV transmission.Few domestic studies have reported on the effectiveness of psychological intervention for depressed patients of people living with HIV/AIDS(PLWHA)newly diagnosed and its correlation with CD_(4)^(+)T cell counts.Objective To explore the effectiveness of psychological intervention for newly diagnosed PLWHA with depression and its correlation with CD_(4)^(+)T cell counts,providing a reference for AIDS clinical diagnosis and treatment.Methods From April 2020 to June 2022,a convenient sampling method was used to select newly diagnosed PLWHA with depression from some ART-designated hospitals in Jiangxi Province.While they were diagnosed,ART and psychological intervention were immediately initiated,and the total period of intervention was 12 weeks.Before and after the intervention,the Hamilton Depression Rating Scale(HAMD)and Hamilton Anxiety Rating Scale(HAMA)were used for evaluation,and CD_(4)^(+)T cell counts were calculated for analysis.Results A total of 200 newly diagnosed PLWHA with depression were included,178 cases of which were effectively followed up with an effective rate of 89.0%.Among 178 cases,88 were mild to moderate depression(49.4%),90 were major depressive disorder(50.6%),and 173 cases were accompanied by anxiety(97.2%).The mean CD_(4)^(+)T cell count before intervention was(346.39±156.87)cells/μL,and it was(421.93±149.61)cells/μL after intervention.After intervention,the CD_(4)^(+)T cell counts of newly diagnosed PLWHA with depression were higher than before intervention(t=10.971,P<0.05),and the total and factor scores of HAMD,HAMA were all lower than before intervention(P<0.05).Before the intervention,the total scores of HAMD were correlated with the grades of CD_(4)^(+)T cell counts negatively(500 cells/μL as the cutoff value)(r_(s)=-0.157,P=0.036)and the scores of HAM

关 键 词：获得性免疫缺陷综合征 HIV感染 CD_(4)^(+)T细胞计数 抑郁 焦虑 

分 类 号：R512.91[医药卫生—内科学]