广州市HIV感染者合并乙型肝炎病毒感染对肝酶异常发生的长期影响  

Long-term effect of AIDS infected individuals with hepatitis B virus infection on abnormal liver enzymes in Guangzhou

作　　者：陈鸣禹 刘聪 唐小平[2] 李全敏 李凌华[2] 顾菁[1] 蔡卫平[2] CHEN Mingyu;LIU Cong;TANG Xiaoping;LI Quanmin;LI Linghua;GU Jing;CAI Weiping(Department of Medical Statistics,School of Public Health,Sun Yat-sen University,Guangzhou 510000,China;Infectious Disease Center,Guangzhou Eighth People′s Hospital,Guangzhou Medical University,Guangzhou 510000,China)

机构地区：[1]中山大学公共卫生学院医学统计学教研室,广州510000 [2]广州医科大学附属市八医院传染病中心,广州510000

出　　处：《中华疾病控制杂志》2025年第2期178-185,共8页Chinese Journal of Disease Control & Prevention

基　　金：“十三五”国家科技重大专项(2018ZX10715004)。

摘　　要：目的分析广州市人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者在长期抗病毒治疗的过程中,合并乙型肝炎病毒(hepatitis B virus,HBV)感染对HIV感染者肝酶异常发生的影响。方法利用艾滋病(acquired immune deficiency syndrome,AIDS)综合防治数据信息管理系统中2010年1月1日―2021年6月30日于广州市第八人民医院接受抗病毒治疗的HIV感染者的随访数据,于2023年12月进行回顾性队列研究,采用Joinpoint回归模型分析肝酶异常风险的变化趋势,采用倾向性评分匹配法来改善合并HBV感染者和单纯HIV感染者的组间可比性,采用多水平logistic回归分析模型分析合并HBV感染对肝酶异常的影响。结果根据纳入和排除标准筛选出13829名HIV感染者,倾向性评分匹配后共9050名HIV感染者被纳入分析。单纯HIV感染者和合并HBV的感染者中,分别有61.8%和70.4%发生了肝酶异常,其发生风险呈现为治疗开始的9个月内快速下降、治疗9~27个月缓慢下降、治疗27个月以后稳定的3个阶段。对于HIV感染者,在抗病毒治疗开始的9个月内合并HBV感染是肝酶异常的危险因素(OR=1.637,95%CI:1.437~1.866),而在抗病毒治疗持续9个月后合并HBV感染与肝酶异常间关联无统计学意义(P>0.05)。结论在AIDS随访和管理的工作中,对于合并HBV感染者开启抗病毒治疗后的首年内应重点关注其肝功能情况。Objective To analyze the impact of concurrent HBV infection on the occurrence of liver enzyme abnormalities in HIV-infected individuals during long-term antiviral therapy in Guangzhou City.Methods A retrospective cohort study was conducted in December 2023,using follow-up data from HIV-infected individuals who received antiviral treatment at the Eighth People′s Hospital of Guangzhou from January 12010,to June 302021,as recorded in the"Comprehensive AIDS Prevention and Control Data Information Management System."The study employed a joinpoint regression model to analyze the changing trend in the risk of liver enzyme abnormalities.Propensity score matching was applied to enhance comparability between individuals co-infected with HBV and those simple HIV infections.Additionally,a multilevel logistic regression model was used to analyze the impact of concurrent HBV infection on liver enzyme abnormalities.Results After applying the inclusion and exclusion criteria,13829 HIV-infected individuals were screened,and following propensity score matching,a total of 9050 HIV-infected individuals were included in the analysis.Among individuals infected with HIV alone and those with HBV,61.8%and 70.4%experienced liver enzyme abnormalities,respectively.The risk of occurrence showed a rapid decrease within 9 months of treatment,a slow decrease from 9 to 27 months of treatment,and a stable three stage period after 27 months of treatment.For HIV-infected individuals,the co-infection with HBV within the first 9 months of antiviral treatment is a risk factor for liver enzyme abnormalities(OR=1.637,95%CI:1.437-1.866),but after 9 months of continuous antiviral treatment,there was no association between ca-HBV and liver enzyme abnormalities(P>0.05).Conclusions In the follow-up and management of AIDS,the liver function of patients with HBV infection should be focused on in the first year after starting antiviral treatment.

关 键 词：人类免疫缺陷病毒 乙型病毒性肝炎 高效抗逆转录病毒疗法 

分 类 号：R181.3[医药卫生—流行病学] R512.91[医药卫生—公共卫生与预防医学]