HIV/AIDS患者持续抗病毒治疗后CD4/CD8细胞比值变化趋势及影响因素分析  

Trends of CD4/CD8 ratio changes and influencing factors among HIV/AIDS patients on long term antiretroviral therapy

作　　者：张文慧 晏定燕 师金川[1] 汪义 ZHANG Wenhui;YAN Dingyan;SHI Jinchuan;WANG Yi(Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310023,Zhejiang,China)

机构地区：[1]浙江中医药大学附属杭州市西溪医院,杭州310023

出　　处：《中国艾滋病性病》2024年第11期1117-1122,共6页Chinese Journal of Aids & STD

基　　金：浙江省医药卫生科技计划项目(2023KY196,2023KY978,2024KY1364);国家自然科学基金项目(32300769)。

摘　　要：目的了解HIV/AIDS患者c ART后CD4细胞数/CD8细胞数比值(简称CD4/CD8细胞比值)的纵向变化趋势及影响因素。方法以2005年7月至2023年1月在杭州某传染病医院感染科门诊初次进行c ART的HIV/AIDS患者为研究对象,通过问卷及《中国疾病预防控制信息系统》的子系统—传染病报告信息管理系统,收集研究对象基线资料和随访实验室数据,采用Spearman秩相关分析CD4/CD8细胞比值与c ART时间之间的相关性。采用广义线性混合模型(GLMM)分析CD4/CD8细胞比值随时间的变化规律,并分析其影响因素。结果2187例HIV/AIDS患者中,男性2071例(94.7%);初治年龄(33.0±11.0)岁。Spearman秩相关分析显示:随着治疗时间的延长,CD4细胞数(rs=0.340,P<0.001)、CD4/CD8细胞比值(rs=0.415,P<0.001)呈现上升趋势,CD8细胞数(rs=-0.182,P<0.001)呈现下降趋势。广义线性混合模型显示,控制时间效应后,女性(β=0.095,95%CI:0.061~0.129)、初治年龄(β≥60.0岁=0.153,95%CI:0.112~0.193、β30.0~<60岁=0.025,95%CI:0.009~0.041)、吸烟(β=0.062,95%CI:0.045~0.079)、治疗延迟时间≤6个月(β=0.120,95%CI:0.100~0.141)、基线CD4细胞数(β200~349个/μL=0.264,95%CI:0.239~0.289、β350~499个/μL=0.414,95%CI:0.387~0.440、β≥500个/μL=0.535,95%CI:0.505~0.564)和基线VL1×10~5~4.99999×10~5(copies/mL)(β=0.035,95%CI:0.015~0.055)是HIV/AIDS患者CD4/CD8细胞比值恢复的保护因素,文化程度(β高中=-0.048,95%CI:-0.076~-0.019、β大专=-0.078,95%CI:-0.105~-0.051、β本科=-0.104,95%CI:-0.131~-0.078、β研究生及以上=-0.098,95%CI:-0.136~-0.061)、饮酒(β=-0.034,95%CI:-0.050~-0.018)、使用过复方新诺明(β=-0.046,95%CI:-0.075~-0.018)是HIV/AIDS患者CD4/CD8细胞比值恢复的危险因素。结论随着治疗时间延长,CD4/CD8细胞比值呈上升趋势,且与性别、初治年龄、吸烟、饮酒、文化程度、治疗延迟时间、基线CD4细胞数、基线VL、使用过复方新诺明等因素相关。Objective To examine the longitudinal changes in the CD4/CD8 cell ratio among HIV/AIDS patients undergoing combination antiretroviral therapy(c ART)and analyze the factors influencing these changes.Methods This study included HIV/AIDS patients who underwent c ART at an infectious disease clinic in Hangzhou between July 2005and January 2023.Baseline data and follow-up laboratory results were collected using questionnaires and the Infectious Disease Reporting Information Management System that is a subsystem of the Information System of Chinese Center for Disease Control and Prevention.The correlation between the CD4/CD8 cell ratio and c ART duration was assessed using Spearman's rank correlation.Generalized linear mixed models(GLMM)were used to analyze temporal trends in the CD4/CD8 ratio and its influencing factors.Results Of the 2187 HIV/AIDS patients included,2071 were male(94.7%),witha mean age at treatment initiation of 33.0±11.0 years.Spearman's rank correlation analysis indicated that with longer treatment duration,the CD4 count(r=0.340,P<0.001)and CD4/CD8 ratio(r=0.415,P<0.001)exhibited increasing trends,whereas the CD8 count(r=-0.182,P<0.001)decreased.GLMM analysis revealed that after controlling for time effects,being female(β=0.095,95%CI:0.061-0.129),older age at treatment initiation(β_(≥60.0 years)=0.153,95%CI:0.112-0.193;β_(30.0–<60 years)=0.025,95%CI:0.009-0.041),smoking(β=0.062,95%CI:0.045-0.079),shorter delay in treatment initiation(≤6 months,β=0.120,95%CI:0.100-0.141),baseline CD4 count(β_(200–349 cells/μL)=0.264,95%CI:0.239-0.289;β_(350–499 cells/μL)=0.414,95%CI:0.387-0.440;β_(≥500 cells/μL)=0.535,95%CI:0.505-0.564),and baseline viral load(1×10~5-4.99999×10~5 copies/m L,β=0.035,95%CI:0.015-0.055)were protective factors for CD4/CD8 ratio recovery.Conversely,higher education level(β_(high school)=-0.048,95%CI:-0.076--0.019;β_(college)=-0.078,95%CI:-0.105--0.051;β_(undergraduate)=-0.104,95%CI:-0.131--0.078;β_(postgraduate and above)=-0.098,95%CI:-0.136--0.061),alcohol

关 键 词：艾滋病病毒感染者/艾滋病患者 CD4/CD8细胞比值 抗反转录病毒治疗 风险因素 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]