2005―2023年兰州市艾滋病患者抗病毒治疗生存分析及其影响因素  

Survival analysis and influencing factors of AIDS patients treated with antiretroviral therapy in Lanzhou from 2005 to 2023

作　　者：苏国庆 黄治纲 高贤婷 蔡小林 周莹荃 王宇红[3] 张正娟 SU Guoqing;HUANG Zhigang;GAO Xianting;CAI Xiaolin;ZHOU Yingquan;WANG Yuhong;ZHANG Zhengjuan(School of Public Health,Gansu University of Chinese Medicine,Lanzhou 730000,China;Department of Infectious Diseases,Lanzhou Pulmonary Hospital,Lanzhou 730046,China;Lanzhou Center for Disease Control and Prevention,Lanzhou 730030,China)

机构地区：[1]甘肃中医药大学公共卫生学院,兰州730000 [2]兰州市肺科医院感染性疾病科,兰州730046 [3]兰州市疾病预防控制中心,兰州730030

出　　处：《中华疾病控制杂志》2025年第3期353-360,共8页Chinese Journal of Disease Control & Prevention

基　　金：兰州市卫生健康行业科研项目(A2023010)。

摘　　要：目的了解2005―2023年兰州市艾滋病(acquired immunodeficiency syndrome,AIDS)患者抗病毒治疗后的生存状况、治疗效果及影响因素。方法采用回顾性队列研究方法,收集2005―2023年兰州市接受抗病毒治疗的2766例患者信息,应用寿命表法计算研究对象的死亡概率、生存概率和累积生存率;利用Kaplan-Meier法计算研究对象截止观察终点的平均生存时间,并采用Log-rank法检验其差异有无统计学意义。采用Cox比例风险回归模型进行单因素与多因素分析。构建列线图模型,预测抗病毒治疗预后。结果患者平均确诊年龄为(38.14±13.01)岁,中位随访时间为63(31,93)月,第1、3、5、10年的累积生存率分别为98.46%、97.44%、96.99%、95.86%,总病死率为1.27/100人年,AIDS相关病死率为0.57/100人年,多因素Cox比例风险回归模型分析结果显示,基线CD4+T淋巴细胞(简称CD4)计数、最近病毒载量检测值、目前WHO临床分期是研究对象生存时间的影响因素(均P<0.05),其中基线CD4计数≥400个/μL组(HR=0.443,95%CI:0.291~0.673,P<0.001)死亡风险较低,最近病毒载量检测值≥1000 copies/mL组(HR=12.725,95%CI:6.548~24.729,P<0.001)、WHO临床分期Ⅳ期组(HR=3.517,95%CI:1.785~6.932,P<0.001)死亡风险较高。纳入上述3个影响因素构建列线图模型,模型区分度C-index=0.892(95%CI:0.847~0.934),表明模型有良好的预测能力。结论2005―2023年兰州市AIDS患者抗病毒治疗效果较好,患者生存率和病毒学抑制率较高。疾病初期进行规范治疗是降低患者死亡风险、提高生存率的关键举措。Objective To investigate the survival status,treatment effect,and influencing factors of acquired immunodeficiency syndrome(AIDS)patients after antiretroviral therapy in Lanzhou from 2005 to 2023.Methods A retrospective cohort study was conducted to collect information on 2766 patients who received antiretroviral therapy in Lanzhou from 2005 to 2023.The life table method was used to calculate the mortality probability,survival probability,and cumulative survival rate of the subjects.The Kaplan-Meier method was applied to calculate the average survival time of the subjects up to the end of observation,with the Log-rank test used to determine the statistical significance of the differences.Cox proportional hazard regression models were used for both univariate and multivariate analyses.Construction of a nomogram model was used to predict prognosis of antiretroviral therapy.Results The average age at diagnosis was(38.14±13.01)years,and the median follow-up time was 63(31,93)months.The cumulative survival rates at 1,3,5,and 10 years were 98.46%,97.44%,96.99%,and 95.86%,respectively.The total mortality rate was 1.27 per 100 person-years,and the AIDS-related mortality rate was 0.57 per 100 person-years.Multivariate Cox regression analysis revealed that baseline CD4 cell count,the most recent viral load test result,and current WHO clinical stage were significant factors influencing the survival time of the subjects,with statistical significance(P<0.05).Specifically,the group with baseline CD4≥400/μL(HR=0.443,95%CI:0.291-0.673,P<0.001)had a lower risk of death,while the group with a recent viral load test result≥1000 copies/mL(HR=12.725,95%CI:6.548-24.729,P<0.001)and the WHO clinical stageⅣgroup(HR=3.517,95%CI:1.785-6.932,P<0.001)had a higher risk of death.Incorporating the above three influencing factors to construct a nomogram model,the model differentiation C-index=0.892(95%CI:0.847-0.934),and the model possessed good predictive ability.Conclusions The antiretroviral therapy for HIV/AIDS in Lanzhou has achieve

关 键 词：艾滋病 抗病毒治疗 生存分析 

分 类 号：R512.91[医药卫生—内科学] R181[医药卫生—临床医学]