Article(id=1240375279135289618, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375270163673092, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202401053, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1704297600000, receivedDateStr=2024-01-04, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773658111603, onlineDateStr=2026-03-16, pubDate=1713974400000, pubDateStr=2024-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773658111603, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773658111603, creator=13701087609, updateTime=1773658111603, updator=13701087609, issue=Issue{id=1240375270163673092, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='8', pageStart='1345', pageEnd='1536', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773658109465, creator=13701087609, updateTime=1773658579758, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240377242795176417, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375270163673092, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240377242795176418, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375270163673092, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1518, endPage=1523, ext={EN=ArticleExt(id=1240375279995122001, articleId=1240375279135289618, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Survival conditions of HIV/AIDS patients receiving antiretroviral therapy, Jinjiang district, Chengdu, 2012-2022, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the survival situation and influencing factors of patients receiving antiretroviral therapy (ART) in Jinjiang district, Chengdu, and to evaluate the effect of ART and optimize follow-up management mode.

Methods

The follow-up data of HIV/AIDS patients were collected from the National HHART reporting system during 2012-2022. Life table method was used to describe the survival status, and Cox proportion hazard regression model was used to identify the factors related to survival time.

Results

A total number of 2 113 cases was enrolled, the average age of the study subjects was (38.65±15.65) years old, and the average survival time was 132.41 months. By the time of the follow-up observation was terminated, 71 cases died. The accumulated survival rates of 1, 3, 5 and 10 year after initiating ART were 97.86%, 96.78%, 96.43% and 95.73%, respectively. The multivariable Cox proportional hazards regression analysis indicated that the risk of death. The HR of 40-49 years, 50-59 years, and ≥60 years group were 4.233(95% CI: 1.608-11.139), 3.997(95% CI: 1.265-12.623), 19.994(95% CI: 7.424-53.846) relative to <30 years group, respectively. The HR of unmarried group was 3.359(95% CI: 1.495-7.546) relative to married group. The HR of interval time between diagnosis and treatment 31-60 days, 61-90 days group were 2.337(95% CI: 1.311-4.165), 3.430(95% CI: 1.608-7.319) relative to ≤30 days group. The HR of 200-349 cells/μl and ≥350 cells/μl baseline CD4+T cells counts group were 0.262(95% CI: 0.135-0.509), 0.206(95% CI: 0.080-0.530) relative to <200 cells/μl group. The HR of related symptoms before treatment group was 2.088(95% CI: 1.051-4.148) relative to no related symptoms before treatment group.

Conclusion

The effect of patients receiving ART in Jinjiang District is remarkable. ART coverage should be extended, and corresponding follow-up management measures and intervention means should be developed according to the actual situation in Jinjiang District.

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目的

了解成都市锦江区艾滋病患者在接受抗病毒治疗后的生存情况和影响因素,评估锦江区艾滋病抗病毒治疗效果和优化随访管理模式。

方法

利用国家艾滋病综合防治信息系统收集在锦江区2012—2022年开始接受抗病毒治疗者的随访信息,应用寿命表法描述生存情况,采用多因素Cox比例风险回归模型分析研究对象生存时间的影响因素。

结果

共2 113例接受治疗者纳入分析,平均年龄(38.65±15.65)岁,平均生存时间132.41月。至随访观察终止时间,死亡71例,治疗第1、3、5、10年的累积生存率分别为97.86%、96.78%、96.43%和95.73%,多因素Cox回归分析显示相对于入组治疗时年龄<30岁组,40~49岁、50~59岁及≥60岁组患者死亡相对危险度分别为4.233(95% CI:1.608~11.139)、3.997(95% CI:1.265~12.623)、19.994(95% CI:7.424~53.846);相对于已婚有配偶者,未婚患者死亡相对危险度为3.359(95% CI:1.495~7.546);相对于确诊至治疗间隔30天者,31~60天与61~90天患者死亡相对危险度分别为2.337(95% CI:1.311~4.165)、3.430(95% CI:1.608~7.319);相对于基线CD4计数<200个/μl者,基线CD4计数200~349个/μl与≥350个/μl组患者死亡相对危险度分别为0.262(95% CI:0.135~0.509)、0.206(95% CI:0.080~0.530);相对于治疗时未出现艾滋病相关症状者,已出现症状者死亡相对危险度为2.088(95% CI:1.051~4.148)。

结论

锦江区艾滋病抗病毒治疗效果显著,应在扩大治疗覆盖面的基础上,根据本地区实际情况,制定相应的随访管理措施与干预手段。

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付萍,E-mail:
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兰慧(1988—),女,硕士,主管医师,研究方向:艾滋病防治

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Basic information of HIV/AIDS patients receiving ART in Jinjiang from 2012 to 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名称人数(例)构成比(%)
性别
1 87888.88
23511.12
入组治疗时年龄(岁)
<3083039.28
30~3949223.28
40~4923911.31
50~5924511.59
≥6030714.53
婚姻状况
已婚有配偶66431.42
未婚1 20256.89
离异或丧偶22510.65
不详221.04
文化程度
小学及以下26012.30
初中38318.13
高中或中专48522.95
大专及以上98546.62
感染途径
异性传播1 05649.98
同性传播1 03649.03
注射毒品210.99
确诊至治疗时长(天)
≤301 17555.61
31~6030414.39
61~90974.59
>9053725.41
基线CD4计数(个/μl)
<20077536.68
200~34974935.45
≥35058927.88
开始治疗时是否出现症状
2 01295.22
1014.78
), ArticleFig(id=1240748856569295548, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375279135289618, language=CN, label=表1, caption=

锦江区2012—2022年接受抗病毒治疗HIV/AIDS患者基本情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名称人数(例)构成比(%)
性别
1 87888.88
23511.12
入组治疗时年龄(岁)
<3083039.28
30~3949223.28
40~4923911.31
50~5924511.59
≥6030714.53
婚姻状况
已婚有配偶66431.42
未婚1 20256.89
离异或丧偶22510.65
不详221.04
文化程度
小学及以下26012.30
初中38318.13
高中或中专48522.95
大专及以上98546.62
感染途径
异性传播1 05649.98
同性传播1 03649.03
注射毒品210.99
确诊至治疗时长(天)
≤301 17555.61
31~6030414.39
61~90974.59
>9053725.41
基线CD4计数(个/μl)
<20077536.68
200~34974935.45
≥35058927.88
开始治疗时是否出现症状
2 01295.22
1014.78
), ArticleFig(id=1240748856653181642, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375279135289618, language=EN, label=Table 2, caption=

Survival situation of HIV/AIDS patients receiving ART in Jinjiang from 2012 to 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
治疗月数期间观察数截尾人数有效观察数死亡人数死亡概率(%)生存概率(%)累积生存率(%)累积生存率标准误
02 113132 106.50221.0498.9698.960.00
62 078862 035.00120.5999.4198.370.00
121 980911 934.50100.5299.4897.860.00
181 8791081 825.0040.2299.7897.650.00
241 7671131 710.5030.1899.8297.480.00
301 6511361 583.0070.4499.5697.050.00
361 5081161 450.0040.2899.7296.780.00
421 3881391 318.5010.0899.9296.710.00
481 248941 201.0010.0899.9296.630.00
541 1531081 099.0000.00100.0096.630.00
601 04593998.5020.2099.8096.430.00
66950126887.0010.1199.8996.320.00
7282375785.5000.00100.0096.320.00
7874894701.0030.4399.5795.910.01
8465172615.0000.00100.0095.910.01
90579120519.0010.1999.8195.730.01
9645876420.0000.00100.0095.730.01
10238295334.5000.00100.0095.730.01
10828761256.5000.00100.0095.730.01
11422695178.5000.00100.0095.730.01
12013146108.0000.00100.0095.730.01
126853965.5000.00100.0095.730.01
132464623.0000.00100.0095.730.01
), ArticleFig(id=1240748856749650649, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375279135289618, language=CN, label=表2, caption=

锦江区2012—2022年接受抗病毒治疗HIV/AIDS患者生存分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
治疗月数期间观察数截尾人数有效观察数死亡人数死亡概率(%)生存概率(%)累积生存率(%)累积生存率标准误
02 113132 106.50221.0498.9698.960.00
62 078862 035.00120.5999.4198.370.00
121 980911 934.50100.5299.4897.860.00
181 8791081 825.0040.2299.7897.650.00
241 7671131 710.5030.1899.8297.480.00
301 6511361 583.0070.4499.5697.050.00
361 5081161 450.0040.2899.7296.780.00
421 3881391 318.5010.0899.9296.710.00
481 248941 201.0010.0899.9296.630.00
541 1531081 099.0000.00100.0096.630.00
601 04593998.5020.2099.8096.430.00
66950126887.0010.1199.8996.320.00
7282375785.5000.00100.0096.320.00
7874894701.0030.4399.5795.910.01
8465172615.0000.00100.0095.910.01
90579120519.0010.1999.8195.730.01
9645876420.0000.00100.0095.730.01
10238295334.5000.00100.0095.730.01
10828761256.5000.00100.0095.730.01
11422695178.5000.00100.0095.730.01
12013146108.0000.00100.0095.730.01
126853965.5000.00100.0095.730.01
132464623.0000.00100.0095.730.01
), ArticleFig(id=1240748856837731044, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375279135289618, language=EN, label=Table 3, caption=

Univariate analysis of survival time of HIV/AIDS patients receiving ART in Jinjiang from 2012 to 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名称治疗例数死亡例数估计生存时间(月)(95% CI)卡方值P
性别0.9360.333
1 87861132.6 (131.5~133.7)
23510130.2 (126.6~133.7)
入组治疗时年龄(岁)97.699<0.001
<3083012135.1(134.0~136.1)
30~394928134.8 (133.4~136.3)
40~492399132.0 (128.9~135.2)
50~592456131.6 (128.8~134.3)
≥6030736114.2 (108.2~120.2)
婚姻状况14.3970.002
已婚有配偶66434129.8 (127.4~132.2)
未婚1 20226134.1 (133.0~135.2)
离异或丧偶22510130.7 (126.8~134.5)
不详221118.0 (108.4~127.6)
文化程度38.332<0.001
小学及以下26021124.1 (118.6~129.6)
初中38321127.6 (124.6~130.7)
高中或中专48512133.7 (131.8~135.5)
大专及以上98517134.7 (133.6~135.8)
感染途径25.367<0.001
异性传播1 05655129.6 (127.7~131.5)
同性传播1 03615135.1 (134.1~136.0)
注射毒品211126.2 (115.1~137.3)
确诊至治疗时长(天)20.835<0.001
≤301 17529133.4 (132.1~134.7)
31~6030420128.4 (124.8~132.0)
61~90979126.2 (119.4~132.9)
>9053713133.9 (132.3~135.6)
基线CD4计数(个/μl)54.816<0.001
<20077555127.3 (124.8~129.7)
200~34974911135.0 (133.9~136.2)
≥3505895131.9 (130.9~132.9)
开始治疗时是否出现症状19.719<0.001
2 01261132.9 (131.9~133.9)
10110119.8 (112.1~127.6)
), ArticleFig(id=1240748856971948784, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375279135289618, language=CN, label=表3, caption=

锦江区2012—2022年接受抗病毒治疗HIV/AIDS患者生存时间的单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名称治疗例数死亡例数估计生存时间(月)(95% CI)卡方值P
性别0.9360.333
1 87861132.6 (131.5~133.7)
23510130.2 (126.6~133.7)
入组治疗时年龄(岁)97.699<0.001
<3083012135.1(134.0~136.1)
30~394928134.8 (133.4~136.3)
40~492399132.0 (128.9~135.2)
50~592456131.6 (128.8~134.3)
≥6030736114.2 (108.2~120.2)
婚姻状况14.3970.002
已婚有配偶66434129.8 (127.4~132.2)
未婚1 20226134.1 (133.0~135.2)
离异或丧偶22510130.7 (126.8~134.5)
不详221118.0 (108.4~127.6)
文化程度38.332<0.001
小学及以下26021124.1 (118.6~129.6)
初中38321127.6 (124.6~130.7)
高中或中专48512133.7 (131.8~135.5)
大专及以上98517134.7 (133.6~135.8)
感染途径25.367<0.001
异性传播1 05655129.6 (127.7~131.5)
同性传播1 03615135.1 (134.1~136.0)
注射毒品211126.2 (115.1~137.3)
确诊至治疗时长(天)20.835<0.001
≤301 17529133.4 (132.1~134.7)
31~6030420128.4 (124.8~132.0)
61~90979126.2 (119.4~132.9)
>9053713133.9 (132.3~135.6)
基线CD4计数(个/μl)54.816<0.001
<20077555127.3 (124.8~129.7)
200~34974911135.0 (133.9~136.2)
≥3505895131.9 (130.9~132.9)
开始治疗时是否出现症状19.719<0.001
2 01261132.9 (131.9~133.9)
10110119.8 (112.1~127.6)
), ArticleFig(id=1240748857085195002, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375279135289618, language=EN, label=Table 4, caption=

Multivariate Cox proportional risk model analysis of survival time of HIV/AIDS patients receiving ART in Jinjiang from 2012 to 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素βSEWaldHR值(95% CIP
入组治疗时年龄(岁)
<301.000
30~390.2230.4630.2321.250(0.504~3.097)0.630
40~491.4430.4948.5424.233(1.608~11.139)0.003
50~591.3850.5875.5753.997(1.265~12.623)0.018
≥602.9950.50535.11719.994(7.424~53.846)<0.001
婚姻状况
已婚有配偶1.000
未婚1.2120.4138.6053.359(1.495~7.546)0.003
离异或丧偶-0.2070.3620.3270.813(0.400~1.654)0.567
不详1.4261.0621.8034.160(0.519~33.330)0.179
确诊至治疗时长(天)
≤301.000
31~600.8490.2958.2852.337(1.311~4.165)0.004
61~901.2330.38710.1623.430(1.608~7.319)0.001
>900.3210.3430.8731.378(0.703~2.700)0.350
基线CD4计数(个/μl)
<2001.000
200~349-1.3380.33815.6530.262(0.135~0.509)<0.001
≥350-1.5810.48310.7300.206(0.080~0.530)0.001
是否出现症状0.7360.3504.4232.088(1.051~4.148)0.035
), ArticleFig(id=1240748857194246915, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375279135289618, language=CN, label=表4, caption=

锦江区2012—2022年接受抗病毒治疗HIV/AIDS患者生存时间的多因素Cox回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素βSEWaldHR值(95% CIP
入组治疗时年龄(岁)
<301.000
30~390.2230.4630.2321.250(0.504~3.097)0.630
40~491.4430.4948.5424.233(1.608~11.139)0.003
50~591.3850.5875.5753.997(1.265~12.623)0.018
≥602.9950.50535.11719.994(7.424~53.846)<0.001
婚姻状况
已婚有配偶1.000
未婚1.2120.4138.6053.359(1.495~7.546)0.003
离异或丧偶-0.2070.3620.3270.813(0.400~1.654)0.567
不详1.4261.0621.8034.160(0.519~33.330)0.179
确诊至治疗时长(天)
≤301.000
31~600.8490.2958.2852.337(1.311~4.165)0.004
61~901.2330.38710.1623.430(1.608~7.319)0.001
>900.3210.3430.8731.378(0.703~2.700)0.350
基线CD4计数(个/μl)
<2001.000
200~349-1.3380.33815.6530.262(0.135~0.509)<0.001
≥350-1.5810.48310.7300.206(0.080~0.530)0.001
是否出现症状0.7360.3504.4232.088(1.051~4.148)0.035
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成都市锦江区2012—2022年艾滋病抗病毒治疗患者生存情况分析
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兰慧 1 , 庞轶 1 , 李旭丹 1 , 文偲廙 1 , 柯玲 2 , 付萍 2
现代预防医学 | 疾病预防控制 2024,51(8): 1518-1523
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现代预防医学 | 疾病预防控制 2024, 51(8): 1518-1523
成都市锦江区2012—2022年艾滋病抗病毒治疗患者生存情况分析
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兰慧1, 庞轶1, 李旭丹1, 文偲廙1, 柯玲2, 付萍2
作者信息
  • 1.成都市锦江区疾病预防控制中心,四川 成都 610065
  • 2.中国医学科学院输血研究所
  • 兰慧(1988—),女,硕士,主管医师,研究方向:艾滋病防治

通讯作者:

付萍,E-mail:
Survival conditions of HIV/AIDS patients receiving antiretroviral therapy, Jinjiang district, Chengdu, 2012-2022
Hui LAN1, Yi PANG1, Xu-dan LI1, Si-yi WEN1, Ling KE2, Ping FU2
Affiliations
  • Chengdu Jinjang District Center for Disease Control and Prevention, Chengdu, Sichuan 610065, China
出版时间: 2024-04-25 doi: 10.20043/j.cnki.MPM.202401053
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目的

了解成都市锦江区艾滋病患者在接受抗病毒治疗后的生存情况和影响因素,评估锦江区艾滋病抗病毒治疗效果和优化随访管理模式。

方法

利用国家艾滋病综合防治信息系统收集在锦江区2012—2022年开始接受抗病毒治疗者的随访信息,应用寿命表法描述生存情况,采用多因素Cox比例风险回归模型分析研究对象生存时间的影响因素。

结果

共2 113例接受治疗者纳入分析,平均年龄(38.65±15.65)岁,平均生存时间132.41月。至随访观察终止时间,死亡71例,治疗第1、3、5、10年的累积生存率分别为97.86%、96.78%、96.43%和95.73%,多因素Cox回归分析显示相对于入组治疗时年龄<30岁组,40~49岁、50~59岁及≥60岁组患者死亡相对危险度分别为4.233(95% CI:1.608~11.139)、3.997(95% CI:1.265~12.623)、19.994(95% CI:7.424~53.846);相对于已婚有配偶者,未婚患者死亡相对危险度为3.359(95% CI:1.495~7.546);相对于确诊至治疗间隔30天者,31~60天与61~90天患者死亡相对危险度分别为2.337(95% CI:1.311~4.165)、3.430(95% CI:1.608~7.319);相对于基线CD4计数<200个/μl者,基线CD4计数200~349个/μl与≥350个/μl组患者死亡相对危险度分别为0.262(95% CI:0.135~0.509)、0.206(95% CI:0.080~0.530);相对于治疗时未出现艾滋病相关症状者,已出现症状者死亡相对危险度为2.088(95% CI:1.051~4.148)。

结论

锦江区艾滋病抗病毒治疗效果显著,应在扩大治疗覆盖面的基础上,根据本地区实际情况,制定相应的随访管理措施与干预手段。

艾滋病  /  抗病毒治疗  /  生存分析  /  影响因素
Objective

To investigate the survival situation and influencing factors of patients receiving antiretroviral therapy (ART) in Jinjiang district, Chengdu, and to evaluate the effect of ART and optimize follow-up management mode.

Methods

The follow-up data of HIV/AIDS patients were collected from the National HHART reporting system during 2012-2022. Life table method was used to describe the survival status, and Cox proportion hazard regression model was used to identify the factors related to survival time.

Results

A total number of 2 113 cases was enrolled, the average age of the study subjects was (38.65±15.65) years old, and the average survival time was 132.41 months. By the time of the follow-up observation was terminated, 71 cases died. The accumulated survival rates of 1, 3, 5 and 10 year after initiating ART were 97.86%, 96.78%, 96.43% and 95.73%, respectively. The multivariable Cox proportional hazards regression analysis indicated that the risk of death. The HR of 40-49 years, 50-59 years, and ≥60 years group were 4.233(95% CI: 1.608-11.139), 3.997(95% CI: 1.265-12.623), 19.994(95% CI: 7.424-53.846) relative to <30 years group, respectively. The HR of unmarried group was 3.359(95% CI: 1.495-7.546) relative to married group. The HR of interval time between diagnosis and treatment 31-60 days, 61-90 days group were 2.337(95% CI: 1.311-4.165), 3.430(95% CI: 1.608-7.319) relative to ≤30 days group. The HR of 200-349 cells/μl and ≥350 cells/μl baseline CD4+T cells counts group were 0.262(95% CI: 0.135-0.509), 0.206(95% CI: 0.080-0.530) relative to <200 cells/μl group. The HR of related symptoms before treatment group was 2.088(95% CI: 1.051-4.148) relative to no related symptoms before treatment group.

Conclusion

The effect of patients receiving ART in Jinjiang District is remarkable. ART coverage should be extended, and corresponding follow-up management measures and intervention means should be developed according to the actual situation in Jinjiang District.

AIDS  /  Antiretroviral therapy  /  Survival analysis  /  Influencing factor
兰慧, 庞轶, 李旭丹, 文偲廙, 柯玲, 付萍. 成都市锦江区2012—2022年艾滋病抗病毒治疗患者生存情况分析. 现代预防医学, 2024 , 51 (8) : 1518 -1523 . DOI: 10.20043/j.cnki.MPM.202401053
Hui LAN, Yi PANG, Xu-dan LI, Si-yi WEN, Ling KE, Ping FU. Survival conditions of HIV/AIDS patients receiving antiretroviral therapy, Jinjiang district, Chengdu, 2012-2022[J]. Modern Preventive Medicine, 2024 , 51 (8) : 1518 -1523 . DOI: 10.20043/j.cnki.MPM.202401053
目前全世界范围内仍缺乏根治HIV感染有效药物,高效抗逆转录病毒治疗(highly active anti-retroviral therapy, HAART)是目前治疗艾滋病最有效的方法[1],它能有效提高患者生存质量,减少病死率,延长生存时间,同时也是预防艾滋病传播的重要措施[2],而有效的随访管理是抗病毒治疗成功的关键。锦江区自2012年开始实行定点医疗机构制定抗病毒治疗方案、社区卫生服务机构管理随访、疾控中心进行技术指导与质量控制的管理模式,本研究分析锦江区接受抗病毒治疗患者的生存情况,探讨相关影响因素,对现有随访管理模式效果进行评价,旨在为本地优化随访管理措施提供依据。
2012—2022年期间开始接受抗病毒治疗且初始治疗在锦江区的艾滋病病毒感染者和艾滋病病人(HIV/AIDS),病例相关数据来自国家艾滋病综合防治信息系统。
收集患者的相关资料,包括:(1)人口学特征:性别、年龄、治疗时年龄、文化程度、婚姻状况等;(2)感染信息:确诊日期、感染途径、抗病毒治疗时间、死亡时间及死亡原因、基线CD4+淋巴细胞检测值(简称基线CD4计数)、治疗时是否出现艾滋病相关症状等。观察起点时间:研究对象接受抗病毒治疗的开始时间。终点时间:2023年6月30日。研究结局:研究对象在随访时间因艾滋病相关死亡。截尾数据:研究对象在随访时间内死于车祸、溺水、自杀、心脑血管疾病等其他疾病,失访或者在到达研究结束时间还未死亡。
应用SPSS 24.0软件对数据进行统计分析。采用寿命表法研究患者的生存率、死亡率,并绘制生存曲线,采用Kaplan-Meier中的Log-Rank检验对生存时间进行单因素分析,比较不同组别患者生存时间的差异。将单因素分析中生存时间具有差异的因素纳入Cox比例风险回归模型中进行多因素分析,确定检验水准α=0.05。
纳入研究对象共2 113例,其中男性1 878例(88.88%),女性235例(11.12%);入组治疗时年龄在15~88岁,平均年龄(38.65±15.65)岁,<30岁年龄组占比最高,共830例(39.28%);婚姻状况以未婚为主,共1 202例(56.89%);文化程度以大专以上为主,共985例(46.62%);感染途径以异性传播和同性传播为主,分别为1 056例(49.98%)和1 036例(49.03%);确诊后30天内启动抗病毒治疗的人数居多,共1 175例(55.61%);基线CD4细胞计数以0~199个/μl居多,共775例(36.68%),其次为200~349个/μl,共749例(35.45%);治疗时未出现症状者居多,共2 012例(95.22%)。详见表1
截止2023年6月30日,共死亡71例,截尾数据共2 042例。接受抗病毒治疗患者平均生存时间为132.41(95% CI:131.35~133.46)个月。治疗第1、3、5、10年的累积生存率为97.86%、96.78%、96.43%和95.73%,详见表2。生存曲线在0~20个月内累积生存率下降最快,治疗时间超过20个月后,下降趋于平缓。详见图1
以是否因艾滋病相关疾病死亡为因变量,将性别、入组治疗时年龄、婚姻状况、文化程度、感染途径、确诊至治疗间隔时长、基线CD4计数、开始治疗时是否出现艾滋病相关症状作为自变量进行Log-Rank检验单因素分析。分析结果显示,有统计学意义的变量有入组治疗时年龄、婚姻状况、文化程度、感染途径、确诊至治疗间隔时长、基线CD4计数、开始治疗时是否出现艾滋病相关症状(P<0.05)。详见表3
将单因素分析中P<0.05的变量作为纳入Cox比例风险回归模型候选变量,结果显示。与入组治疗时年龄<30岁组患者相比,40~49岁、50~59岁及≥60岁组患者死亡风险较高,相对危险度分别为4.233、3.997和19.994;与已婚有配偶相比,未婚患者死亡风险较高,相对危险度为3.359;与确诊至治疗间隔时长≤30天组患者相比,31~60天组和61~90天组死亡风险较高,相对危险度为2.337和3.430;与基线CD4计数<200个/μl组相比,200~349个/μl组和≥350个/μl组患者死亡风险较低,相对危险度分别为0.262和0.206;开始治疗时出现症状者比未出现症状者死亡风险更大,相对危险度为2.088。详见表4
本研究对锦江区2012年以来接受抗病毒治疗的2 113例艾滋病患者进行生存分析,研究显示,锦江区抗病毒治疗患者第1、3、5、10年累积生存率分别为97.86%、96.78%、96.43%和95.73%,高于湖北省[3]、河南省[4]和重庆市[5]等地的研究结果,说明锦江区抗病毒治疗效果总体较为显著。原因可能是锦江区长期以来对社区卫生服务机构开展了艾滋病随访管理标准化建设工作,规范了社区卫生服务机构随访管理制度,艾滋病患者发现后的动员转介、治疗随访开展良好,定期的CD4+淋巴细胞和病毒载量检测也对治疗效果进行了及时监测。但锦江区生存率略低于北京市[6]和上海市[7]的研究结果,可能与北京、上海经济和医疗水平较高,患者整体文化程度较高,依从性教育好[6-7]等有关。
多因素Cox比例风险回归模型分析研究结果显示,开始治疗时年龄越大的治疗对象艾滋病相关死亡的风险更高,随着患者年龄的增加,其免疫重建潜力及身体机能等均较差,治疗失败风险增加[8]。未婚患者的死亡风险高于已婚有配偶患者,可能是与已婚患者获得的家庭支持、生活照料更多相关[9]。与确诊后立即(30天内)开始治疗的患者相比,确诊至治疗间隔31~60天组和61~90天组的死亡风险增加,这与国内相关研究结果一致[10],提示在艾滋病发现后即时治疗是防止病情进展为艾滋病和降低患者死亡风险的关键因素[11]。基线CD4计数为≥200个/μl组的死亡风险低于基线CD4计数<200个/μl组,基线CD4计数越高的患者死亡风险越低,与其他研究结果相似[7,12]。CD4+T细胞检测值随着发现时间的推后逐渐降低,机会性感染增加,因此要尽早发现早期感染的病人。治疗时已有艾滋病相关症状也是死亡的危险因素,提示早治疗对降低死亡风险至关重要,同时早治疗也是预防HIV传播的重要措施[13]
锦江区艾滋病随访管理工作成效显著,但随着艾滋病患者人数的不断增多,对患者的随访管理措施需要进一步细化。今后应加强对老年人、未婚患者和CD4较低患者的随访管理工作,扩大HIV筛查覆盖面,同时加大艾滋病“发现即治疗”策略的宣传动员力度,做到早发现早治疗。以期通过规范、有效地开展综合随访管理,使更多的艾滋病患者及时知晓自己的感染状况,改变危险行为,减少艾滋病病毒传播,让更多的艾滋病患者获得必要的治疗、关怀和支持,延长生命,提高生活质量。
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2024年第51卷第8期
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doi: 10.20043/j.cnki.MPM.202401053
  • 接收时间:2024-01-04
  • 首发时间:2026-03-16
  • 出版时间:2024-04-25
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  • 收稿日期:2024-01-04
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    1.成都市锦江区疾病预防控制中心,四川 成都 610065
    2.中国医学科学院输血研究所

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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