HIV感染者/AIDS患者的神经认知功能及其影响因素  

Neurocognitive function and its influencing factors in people living with HIV/AIDS

作　　者：鲁秋玲 叶纤 陈丹 李杏莉 LU Qiuling;YE Qian;CHEN Dan;LI Xingli(Department of Epidemiology and Health Statistics,School of Public Health,Xiangya School of Medicine,Central South University,Changsha 410003;Statistics Division,Wuhan Health Information Center,Wuhan 430000,China)

机构地区：[1]中南大学湘雅公共卫生学院流行病与卫生统计学系,长沙410003 [2]武汉市卫生健康信息中心统计科,武汉430000

出　　处：《中南大学学报(医学版)》2024年第12期1902-1908,共7页Journal of Central South University :Medical Science

基　　金：湖南省自然科学基金(2022JJ30779)。

摘　　要：目的:人类免疫缺陷病毒相关神经认知功能障碍(human immunodeficiency virus associated neurocognitive disorders,HAND)在全球人类免疫缺陷病毒感染者/获得性免疫缺陷综合征患者(people living with human immunodeficiency virus/acquired immunodeficiency syndrome,PLWHA)中的患病率高达42.6%,本研究旨在探究PLWHA神经认知功能障碍及其可能的影响因素,为早期识别和干预PLWHA的HAND提供参考。方法:以2019年6至8月在长沙市第一医院接受门诊或住院治疗的18岁以上并确诊的PLWHA为研究对象。收集研究对象的社会人口学信息和人类免疫缺陷病毒(human immunodeficiency virus,HIV)/获得性免疫缺陷综合征(acquired immune deficiency syndrome,AIDS)相关信息。采用简易神经认知筛查量表(the Brief Neurocognitive Screen,BNCS)评估PLWHA神经认知功能。该量表包括数字符号测试(Digit Symbol Test,DST)和数字连线测试(Trail Making Test,TMT;分为TMT-A和TMT-B)2部分。BNCS的判定标准:DST、TMT-A、TMT-B中至少1个维度测试得分异常(DST得分<30,TMT-A耗时>60 s,TMT-B耗时>90 s)的患者被定义为神经认知功能受损。结果:共375名PLWHA纳入研究分析,神经认知功能受损者共计212例,占56.5%。女性、年龄≥50岁、小学及以下文化程度、已婚/同居的PLWHA群体神经认知功能受损阳性率分别显著高于男性、年龄<50岁、初中及以上文化程度、未婚/离异的PLWHA群体(均P<0.05)。异性性传播途径感染233例,为主要感染途径(62.1%),神经认知功能受损阳性率(69.1%)显著高于同性性传播和感染途径不详的PLWHA人群(P<0.001);WHO临床分期越高,神经认知功能受损阳性率越高(P<0.001);最低CD4^(+)T淋巴细胞计数<200个/mm^(3)、感染年限≥5年的PLWHA群体神经认知功能受损阳性率分别显著高于最低CD4^(+)T淋巴细胞计数≥200个/mm^(3)、感染年限<5年的PLWHA群体(均P<0.05)。Logistic回归分析结果显示:与最低CD4^(+)T淋巴细胞计数≥2Objective:The prevalence of human immunodeficiency virus(HIV)associated neurocognitive disorders(HAND)in people living with HIV/acquired immunodeficiency syndrome(PLWHA)worldwide is as high as 42.6%.This study aims to investigate the neurocognitive function status and its influencing factors in PLWHA,providing evidence for early identification and intervention of neurocognitive impairment in this population.Methods:PLWHA aged 18 and above who received outpatient or inpatient care at the First Hospital of Changsha between June and August 2019 were included.Sociodemographic and HIV-related information were collected.Neurocognitive function was assessed using the Brief Neurocognitive Screen(BNCS),which includes the Digit Symbol Test(DST)and Trail Making Test A and B(TMT-A and TMT-B).Impaired neurocognitive function was defined as abnormal scores in at least one dimension(DST score<30,TMT-A time>60 seconds,TMT-B time>90 seconds).Results:A total of 375 PLWHA were included,of whom 212(56.5%)exhibited neurocognitive impairment.Higher impairment rates were observed among females,individuals aged≥50 years,those with primary education or below,and those who were married/cohabiting(all P<0.05).Heterosexual transmission accounted for the majority of infections(233 cases,62.1%),with a significantly higher rate of neurocognitive impairment(69.1%)compared to homosexual transmission and unknown routes(P<0.001).Higher WHO clinical stages were associated with increased impairment rates(P<0.001).PLWHA with a nadir CD4^(+)T cell count<200 cells/mm^(3) or an infection duration≥5 years had significantly higher impairment rates than those with higher CD4^(+)T cell count or shorter infection durations(both P<0.05).Logistic regression analysis showed that patients with a nadir CD4^(+)T cell count<200 cells/mm^(3) had a significantly higher risk of neurocognitive impairment(OR=2.461,95%CI 1.116 to 5.427).Compared to WHO stage I,the risk increased progressively in stage II(OR=6.005,95%CI 2.906 to 12.407),stage III(OR=6.989,95%CI 2.502

关 键 词：人类免疫缺陷病毒 获得性免疫缺陷综合征 人类免疫缺陷病毒感染者/获得性免疫缺陷综合征患者 人类免疫缺陷病毒相关神经认知功能障碍 简易神经认知筛查量表 

分 类 号：R51[医药卫生—内科学]