中老年HIV/AIDS患者合并慢性非传染性疾病情况与生命质量的关联研究  

Association Between the Coexistence of Chronic Non-communicable Diseases and Quality of Life in Middle-aged and Elderly People Living with HIV/AIDS

作　　者：张瑶 张弛[2] 刘聪 钟海丹 杜佩珊 李全敏 李凌华[3] 顾菁[1] ZHANG Yao;ZHANG Chi;LIU Cong;ZHONG Haidan;DU Peishan;LI Quanmin;LI Linghua;GU Jing(School of Public Health,Sun Yat-sen University,Guangzhou 510080,China;Hospital-Acquired Infection Control Department,Guangzhou Eighth People’s Hospital,Guangzhou Medical University,Guangzhou 510440,China;Infec-tious Disease Center,Guangzhou Eighth People’s Hospital,Guangzhou Medical University,Guangzhou 510440,China)

机构地区：[1]中山大学公共卫生学院,广东广州510080 [2]广州医科大学附属市八医院感染管理科,广东广州510440 [3]广州医科大学附属市八医院感染病中心,广东广州510440

出　　处：《中山大学学报(医学科学版)》2025年第1期161-171,共11页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】了解中老年HIV/AIDS患者合并慢性非传染性疾病(简称慢性病)的患病率及与生命质量的关联。【方法】采用横断面研究调查广州医科大学附属市八医院感染科门诊432名45岁及以上HIV/AIDS患者,经质量控制366名研究对象纳入分析。采用自制问卷和欧洲5维健康量表(EQ-5D-3L)调查慢性病和生命质量,采用Tobit回归分析慢性病与生命质量的关联。【结果】366名研究对象纳入分析,合并心血管疾病29人(7.9%),高血压45人(12.3%),高血糖122人(33.3%),高脂血症151人(41.3%),癌症7人(1.9%),慢性肾脏疾病17人(4.6%),慢性肝脏疾病38人(10.4%),肌肉骨骼疾病21人(5.7%),合并至少一类慢性病253人(69.1%)。EQ-5D效用指数的中位数(上下四分位数)为1.000(0.964~1.000)。多因素Tobit回归结果显示,合并癌症[b_(a)=-0.08,95%CI(-0.15,-0.01),P=0.036]、慢性肾脏疾病[b_(a)=-0.07,95%CI(-0.12,-0.02),P=0.006]、肌肉骨骼疾病[b_(a)=-0.09,95%CI(-0.13,-0.05),P<0.001]和≥3类慢性病[b_(a)=-0.05,95%CI(-0.08,-0.01),P=0.013]均与EQ-5D效用指数呈负向关联。不同CD4^(+)T细胞水平分层分析结果显示,CD4≤500个/μL组合并高血压[b_(a)=-0.07,95%CI(-0.12,-0.02),P=0.007]、慢性肾脏疾病[b_(a)=-0.10,95%CI(-0.18,-0.03),P=0.006]、肌肉骨骼疾病[b_(a)=-0.15,95%CI(-0.22,-0.07),P<0.001]和≥3类慢性病[b_(a)=-0.09,95%CI(-0.09,-0.01),P<0.001]与EQ-5D效用指数呈负向关联,CD4>500个/μL组合并癌症[b_(a)=-0.11,95%CI(-0.20,-0.01),P=0.031]与EQ-5D效用指数呈负向关联。【结论】中老年HIV/AIDS患者合并慢性非传染性疾病比例较高,合并癌症、慢性肾脏疾病等慢性病及慢性病类数与生命质量呈负向关联,但这种关联在不同CD4水平HIV/AIDS患者中存在差异,建议对HIV/AIDS患者的慢性病进行预防和早期识别,并加强艾滋病与慢性病卫生服务的联系与整合,对艾滋病和慢性病进行共同管理和控制,以提高目标人群的生命质量。【Objective】To investigate the prevalence rate of chronic non-communicable diseases(NCDs)and the association with quality of life in middle-aged and elderly patients with HIV/AIDS.【Methods】This cross-sectional study surveyed 432 patients with HIV/AIDS(aged≥45 years)in the Infectious Disease Center in Guangzhou Eighth People’s Hospital of Guangzhou Medical University,and 366 participants were included in the analysis after quality control.A questionnaire and the EuroQol 5-Dimensional 3-level version(EQ-5 D-3 L)were used to investigate NCDs and quality of life and Tobit regression model was used to estimate the association between chronic diseases and quality of life.【Results】Among the 366 participants,29(7.9%)had cardiovascular disease,45(12.3%)had hypertension,122(33.3%)had hyperglycemia,151(41.3%)had hyperlipidemia,7(1.9%)had cancer,17(4.6%)had chronic kidney disease,38(10.4%)had chronic liver disease,21(5.7%)had musculoskeletal disorders,and 253(69.1%)suffered from at least one type of chronic diseases.The median(lower and upper quartiles)of EQ-5 D utility index was 1.000(0.964~1.000).Multivariate Tobit regression results of the total population showed that cancer[b_(a)=-0.08,95%CI(-0.15,-0.01),P=0.036],chronic kidney disease[b_(a)=-0.07,95%CI(-0.12,-0.02),P=0.006],musculoskeletal disease[b_(a)=-0.09,95%CI(-0.13,-0.05),P<0.001],and≥3 types of chronic diseases[b_(a)=-0.05,95%CI(-0.08,-0.01),P=0.013]were negatively correlated with EQ-5 D utility index.The stratified analysis results of different CD4^(+)T cell levels showed that hypertension[b_(a)=-0.07,95%CI(-0.12,-0.02),P=0.007],chronic kidney disease[b_(a)=-0.10,95%CI(-0.18,-0.03),P=0.006],musculoskeletal disease[b_(a)=-0.15,95%CI(-0.22,-0.07),P<0.001]and≥3 types of chronic diseases[b_(a)=-0.09,95%CI(-0.09,-0.01),P<0.001]were negatively correlated with EQ-5 D utility index in the group with CD 4≤500(cells/μL),whereas cancer[b_(a)=-0.11,95%CI(-0.20,-0.01),P=0.031]was negatively correlated with EQ-5 D utility index in the group with CD 4>500

关 键 词：HIV 艾滋病 中老年 慢性非传染性疾病 患病情况 生命质量 

分 类 号：R512.91[医药卫生—内科学]