Article(id=1241022948404949059, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202408200, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1723651200000, receivedDateStr=2024-08-15, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812527991, onlineDateStr=2026-03-18, pubDate=1742832000000, pubDateStr=2025-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812527991, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812527991, creator=13701087609, updateTime=1773812527991, updator=13701087609, issue=Issue{id=1241022939957621542, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773812525976, creator=13701087609, updateTime=1773815469296, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241035285174219432, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241035285174219433, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1138, endPage=1143, ext={EN=ArticleExt(id=1241022948774047849, articleId=1241022948404949059, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of survival time and influencing factors of HIV/AIDS patients, Hebei Province, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the survival time of HIV/AIDS patients in Hebei province, and to explore the influencing factors, so as to provide basis for improving the quality of life of patients.

Methods

Retrospective cohort study was used to collect information of HIV/AIDS in Hebei province from 1989 to 2022. Life table was used to describe the survival status. Log-rank test and Cox regression were used to analysis the influencing factors of survival time.

Results

There were 22 563 cases of HIV/AIDS, with males accounting for 88.7% and homosexual transmission accounting for 62.1%. The average age at the time of discovery was 38.1±13.9. The 1-year,3-year,5-year and 10-year cumulative survival rates of HIV/AIDS patients were 91.46%,88.03%, 85.56% and 79.34%. The risk of death in female was lower than that in male (HR=0.824, 95% CI: 0.713-0.953). The risk of death in patients receiving antiviral treatment was lower than in those who have not received treatment (HR=0.079, 95% CI:0.069-0.091). Baseline CD4 cell counts ranging from 200 to 349 cells/μl (HR=0.451, 95% CI: 0.222-0.914), 350 to 499 cells/μl (HR=0.354, 95% CI: 0.175-0.719), and above 500 cells/μl (HR=0.342, 95% CI: 0.168-0.693) have a lower risk of death. People over 50 years old have a higher risk of death (HR=2.585, 95% CI: 2.143-3.117). Among the sources of case samples, the case death risk of those from HIV testing and counseling was lower than the cases from medical institutions(HR=0.444,95% CI: 0.387-0.510). And the case death risk of those from detainees was lower than the cases from medical institutions(HR=0.417,95% CI: 0.297-0.584).

Conclusion

Gender, educational level, baseline CD4 cell count, sample source, age at discovery, and antiviral treatment were influencing factors on survival time. Early detection, early treatment, strengthening the publicity and education of key groups, paying attention to the elderly cases over 50 years old, and strengthening medical personnel to actively carry out AIDS testing and consulting services have a positive effect on prolonging the survival time of HIV/AIDS cases.

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目的

分析河北省感染艾滋病病毒感染者和艾滋病患者(HIV/AIDS)的生存时间,探索其影响因素,为提高患者生存质量提供依据。

方法

采用回顾性队列研究方法,收集河北省1989—2022年发现的HIV/AIDS病例的各类随访信息,用寿命表法描述其生存情况,用log-rank检验及Cox回归分析生存时间的影响因素。

结果

22 563例HIV/AIDS病例,男性占88.7%,同性传播占62.1%,发现时平均年龄为38.1±13.9岁。1年生存率91.46%,3年生存率88.03%,5年生存率85.56%,10年生存率达79.34%。多因素分析结果显示,女性死亡风险小于男性(HR=0.824,95% CI:0.713~0.953)。接受抗病毒治疗者死亡风险低于未治疗者(HR=0.079,95% CI:0.069~0.091)。基线CD4细胞计数在200~349个/μl(HR=0.451,95% CI:0.222~0.914)、计数在350~499个/μl(HR=0.354,95% CI:0.175~0.719)、计数在500个/μl以上者(HR=0.342,95% CI:0.168~0.693)死亡风险较低。50岁以上者死亡风险较高(HR=2.585,95% CI:2.143~3.117)。病例样本来源中,来源于检测咨询的病例死亡风险低于来源于医疗机构的病例(HR=0.444,95% CI:0.387~0.510),来源于羁押人员的病例死亡风险低于来源于医疗机构的病例(HR=0.417,95% CI:0.297~0.584)。

结论

性别、文化程度、基线CD4细胞计数、样本来源、发现时年龄、是否开展抗病毒治疗是生存时间的影响因素。早发现,早治疗,加强重点人群的宣传教育,关注50岁以上中老年病例,强化医务人员主动开展艾滋病检测咨询服务,对于延长HIV/AIDS病例的生存时间具有积极的作用。

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王伟,E-mail:
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张亚丽(1978—),女,硕士,副主任技师,研究方向:性病艾滋病宣传教育与干预

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(In Chinese), articleTitle=Survival time and influencing factors of HIV/AIDS cases in Xinxiang, Henan, 1995-2019, refAbstract=null), Reference(id=1241022962074186606, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948404949059, doi=null, pmid=null, pmcid=null, year=2021, volume=21, issue=11, pageStart=1075, pageEnd=1080, url=null, language=null, rfNumber=[14], rfOrder=26, authorNames=董贤雅, 胡安艳, 李正旭, journalName=中国热带医学, refType=null, unstructuredReference=董贤雅,胡安艳,李正旭,等.云南省保山市1990-2020年HIV/AIDS病例生存分析[J].中国热带医学2021, 21(11): 1075-1080., articleTitle=云南省保山市1990-2020年HIV/AIDS病例生存分析, refAbstract=null), Reference(id=1241022962216792953, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948404949059, doi=null, pmid=null, pmcid=null, year=2021, volume=21, issue=11, pageStart=1075, pageEnd=1080, url=null, language=null, rfNumber=[14], rfOrder=27, authorNames=Dong XY, Hu AY, Li ZX, journalName=China Tropical Medicine, refType=null, unstructuredReference=Dong XY, Hu AY, Li ZX, et al. Survival analysis among HIV-infected individual and AIDS patients in Baoshan, Yunnan,1990-2020[J]. China Tropical Medicine, 2021, 21(11): 1075-1080. (In Chinese), articleTitle=Survival analysis among HIV-infected individual and AIDS patients in Baoshan, Yunnan,1990-2020, refAbstract=null), Reference(id=1241022962346816383, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948404949059, doi=null, pmid=null, pmcid=null, year=2022, volume=36, issue=7, pageStart=84, pageEnd=86, url=null, language=null, rfNumber=[15], rfOrder=28, authorNames=黎源, 孙程, 童文舟, journalName=中国初级卫生保健, refType=null, unstructuredReference=黎源,孙程,童文舟,等.浙江省兰溪市艾滋病病毒感染者和艾滋病病例晚发现影响因素分析[J].中国初级卫生保健2022, 36(7): 84-86., articleTitle=浙江省兰溪市艾滋病病毒感染者和艾滋病病例晚发现影响因素分析, refAbstract=null), Reference(id=1241022962485228421, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948404949059, doi=null, pmid=null, pmcid=null, year=2022, volume=36, issue=7, pageStart=84, pageEnd=86, url=null, language=null, rfNumber=[15], rfOrder=29, authorNames=Li Y, Sun C, Tong WZ, journalName=Chinese Primary Health Care, refType=null, unstructuredReference=Li Y, Sun C, Tong WZ, et al. Influencing factors late detection of HIV/AIDS cases in lanxi of Zhejiang province[J]. Chinese Primary Health Care, 2022, 36(7): 84-86. (In Chinese), articleTitle=Influencing factors late detection of HIV/AIDS cases in lanxi of Zhejiang province, refAbstract=null)], funds=[Fund(id=1241022957150073444, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948404949059, awardId=172777185, language=CN, fundingSource=河北省重点研发计划自筹项目(172777185), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241022951286436052, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948404949059, xref=null, ext=[AuthorCompanyExt(id=1241022951294824661, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948404949059, companyId=1241022951286436052, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, Hebei 050021, China), AuthorCompanyExt(id=1241022951307407573, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948404949059, companyId=1241022951286436052, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=河北省疾病预防控制中心,河北 石家庄 050021)])], figs=[ArticleFig(id=1241022956307018269, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948404949059, language=EN, label=Table 1, caption=

Life table for 22 563 HIV/AIDS cases

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确诊后年数(年)期间观察数期间删失例数死亡例数死亡概率(%)生存概率(%)期末累计生存概率(%)累计生存概率标准误
022 56301 9288.5491.4691.460.00
120 6351 0204342.1697.8489.480.00
219 1812 1642931.6298.3888.030.00
316 7242 2232451.5798.4386.650.00
414 2561 9901681.2798.7385.560.00
512 0982 1231601.4598.5584.310.00
69 8151 8951351.5298.4883.030.00
77 7851 7171021.4798.5381.810.00
85 9661 495721.3898.6280.680.00
94 3991 219631.6698.3479.340.00
103 117822461.7098.3077.990.00
112 249639261.3598.6576.940.00
121 584421221.6098.4075.710.01
131 141293252.5197.4973.800.01
14823170111.4998.5172.700.01
15642161132.3297.6871.020.01
16468104122.8897.1268.970.01
173526472.1997.8167.460.01
182816562.4197.5965.830.01
192104942.1697.8464.410.01
201576243.1796.8362.370.02
21911622.4197.5960.870.02
22731022.9497.0659.080.02
2361811.7598.2558.040.02
2452023.8596.1555.810.03
2550000.00100.0055.810.03
2650012.0098.0054.690.03
2749136.1993.8151.310.03
2845024.4495.5649.030.04
29434200.00100.0049.030.04
301000.00100.0049.030.04
311000.00100.0049.030.04
321100.00100.0049.030.04
), ArticleFig(id=1241022956407681575, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948404949059, language=CN, label=表1, caption=

22 563例HIV/AIDS病例寿命表

, figureFileSmall=null, figureFileBig=null, tableContent=
确诊后年数(年)期间观察数期间删失例数死亡例数死亡概率(%)生存概率(%)期末累计生存概率(%)累计生存概率标准误
022 56301 9288.5491.4691.460.00
120 6351 0204342.1697.8489.480.00
219 1812 1642931.6298.3888.030.00
316 7242 2232451.5798.4386.650.00
414 2561 9901681.2798.7385.560.00
512 0982 1231601.4598.5584.310.00
69 8151 8951351.5298.4883.030.00
77 7851 7171021.4798.5381.810.00
85 9661 495721.3898.6280.680.00
94 3991 219631.6698.3479.340.00
103 117822461.7098.3077.990.00
112 249639261.3598.6576.940.00
121 584421221.6098.4075.710.01
131 141293252.5197.4973.800.01
14823170111.4998.5172.700.01
15642161132.3297.6871.020.01
16468104122.8897.1268.970.01
173526472.1997.8167.460.01
182816562.4197.5965.830.01
192104942.1697.8464.410.01
201576243.1796.8362.370.02
21911622.4197.5960.870.02
22731022.9497.0659.080.02
2361811.7598.2558.040.02
2452023.8596.1555.810.03
2550000.00100.0055.810.03
2650012.0098.0054.690.03
2749136.1993.8151.310.03
2845024.4495.5649.030.04
29434200.00100.0049.030.04
301000.00100.0049.030.04
311000.00100.0049.030.04
321100.00100.0049.030.04
), ArticleFig(id=1241022956604813880, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948404949059, language=EN, label=Table 2, caption=

Log-rank test for survival time of 22 563 HIV/AIDS cases

, figureFileSmall=null, figureFileBig=null, tableContent=
基本特征例数构成比(%)χ2P
性别63.052<0.001
男性20 00988.7
女性2 55411.3
发现时年龄(岁)1 007.157<0.001
<253 82816.9
25~4913 75761.0
≥504 97822.1
婚姻状况341.984<0.001
已婚10 42246.2
未婚7 91235.1
离异或丧偶4 22918.7
文化程度991.913<0.001
小学或文盲3 10913.8
初中8 88839.4
高中或中专5 23723.2
大专及以上5 32923.6
民族0.4330.511
汉族21 59195.7
少数民族5262.3
疾病进程98.801<0.001
HIV13 12158.2
AIDS9 44241.8
是否开展抗病毒治疗13 579.526<0.001
19 99988.6
2 56411.4
感染途径628.849<0.001
同性传播14 01062.1
异性传播7 27332.2
血液传播6462.9
注射吸毒1200.5
母婴传播2130.9
不详3011.3
样本来源815.114<0.001
医疗机构10 56546.8
检测咨询7 77434.5
羁押人员3451.5
其他3 87917.2
基线CD4计数(个/μl)14 789.274<0.001
<2006 25527.7
200~3495 53324.5
350~4994 81421.3
≥5004 46619.8
未查1 4956.6
), ArticleFig(id=1241022956697088576, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948404949059, language=CN, label=表2, caption=

22 563例HIV/AIDS病例生存时间的log-rank检验

, figureFileSmall=null, figureFileBig=null, tableContent=
基本特征例数构成比(%)χ2P
性别63.052<0.001
男性20 00988.7
女性2 55411.3
发现时年龄(岁)1 007.157<0.001
<253 82816.9
25~4913 75761.0
≥504 97822.1
婚姻状况341.984<0.001
已婚10 42246.2
未婚7 91235.1
离异或丧偶4 22918.7
文化程度991.913<0.001
小学或文盲3 10913.8
初中8 88839.4
高中或中专5 23723.2
大专及以上5 32923.6
民族0.4330.511
汉族21 59195.7
少数民族5262.3
疾病进程98.801<0.001
HIV13 12158.2
AIDS9 44241.8
是否开展抗病毒治疗13 579.526<0.001
19 99988.6
2 56411.4
感染途径628.849<0.001
同性传播14 01062.1
异性传播7 27332.2
血液传播6462.9
注射吸毒1200.5
母婴传播2130.9
不详3011.3
样本来源815.114<0.001
医疗机构10 56546.8
检测咨询7 77434.5
羁押人员3451.5
其他3 87917.2
基线CD4计数(个/μl)14 789.274<0.001
<2006 25527.7
200~3495 53324.5
350~4994 81421.3
≥5004 46619.8
未查1 4956.6
), ArticleFig(id=1241022956801946184, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948404949059, language=EN, label=Table 3, caption=

Multivariate analysis of survival time for 22 563 HIV/AIDS cases

, figureFileSmall=null, figureFileBig=null, tableContent=
β标准误χ2PHR值(95% CI
性别6.7860.009
男性1.000
女性-0.1930.0746.7860.0090.824(0.713~0.953)
文化程度48.324<0.001
文盲或小学1.000
初中-0.1280.0603.2790.0340.880(0.782~0.991)
高中或中专-0.2460.07713.2520.0020.782(0.672~0.910)
大专及以上-0.6230.09247.957<0.0010.536(0.447~0.642)
基线CD4计数(个/μl)463.731<0.001
<2001.000
200~349-0.7970.3614.8750.0270.451(0.222~0.914)
350~499-1.0380.3618.2720.0040.354(0.175~0.719)
≥500-1.0740.3618.8610.0030.342(0.168~0.693)
未查0.4040.3571.2790.2581.498(0.744~3.016)
样本来源245.712<0.001
医疗机构1.000
检测咨询-0.8110.070134.508<0.0010.444(0.387~0.510)
羁押人员-0.8750.17225.856<0.0010.417(0.297~0.584)
其他-0.8730.069160.234<0.0010.418(0.365~0.478)
发现时年龄(岁)147.841<0.001
<251.000
25~490.3630.08816.969<0.0011.438(1.210~1.710)
≥500.9500.09698.745<0.0012.585(2.143~3.117)
是否治疗1 235.729<0.001
1.000
-2.5370.0721 235.729<0.0010.079(0.069~0.091)
), ArticleFig(id=1241022956915192405, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022948404949059, language=CN, label=表3, caption=

22 563例HIV/AIDS病例生存时间的多因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
β标准误χ2PHR值(95% CI
性别6.7860.009
男性1.000
女性-0.1930.0746.7860.0090.824(0.713~0.953)
文化程度48.324<0.001
文盲或小学1.000
初中-0.1280.0603.2790.0340.880(0.782~0.991)
高中或中专-0.2460.07713.2520.0020.782(0.672~0.910)
大专及以上-0.6230.09247.957<0.0010.536(0.447~0.642)
基线CD4计数(个/μl)463.731<0.001
<2001.000
200~349-0.7970.3614.8750.0270.451(0.222~0.914)
350~499-1.0380.3618.2720.0040.354(0.175~0.719)
≥500-1.0740.3618.8610.0030.342(0.168~0.693)
未查0.4040.3571.2790.2581.498(0.744~3.016)
样本来源245.712<0.001
医疗机构1.000
检测咨询-0.8110.070134.508<0.0010.444(0.387~0.510)
羁押人员-0.8750.17225.856<0.0010.417(0.297~0.584)
其他-0.8730.069160.234<0.0010.418(0.365~0.478)
发现时年龄(岁)147.841<0.001
<251.000
25~490.3630.08816.969<0.0011.438(1.210~1.710)
≥500.9500.09698.745<0.0012.585(2.143~3.117)
是否治疗1 235.729<0.001
1.000
-2.5370.0721 235.729<0.0010.079(0.069~0.091)
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河北省HIV/AIDS病例生存时间及影响因素分析
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张亚丽 , 王敬丘 , 王伟 , 吴小雪 , 马琳 , 成效莹
现代预防医学 | 临床与预防 2025,52(6): 1138-1143
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现代预防医学 | 临床与预防 2025, 52(6): 1138-1143
河北省HIV/AIDS病例生存时间及影响因素分析
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张亚丽, 王敬丘, 王伟 , 吴小雪, 马琳, 成效莹
作者信息
  • 河北省疾病预防控制中心,河北 石家庄 050021
  • 张亚丽(1978—),女,硕士,副主任技师,研究方向:性病艾滋病宣传教育与干预

通讯作者:

王伟,E-mail:
Analysis of survival time and influencing factors of HIV/AIDS patients, Hebei Province
Ya-li ZHANG, Jing-qiu WANG, Wei WANG , Xiao-xue WU, Lin MA, Xiao-ying CHENG
Affiliations
  • Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, Hebei 050021, China
出版时间: 2025-03-25 doi: 10.20043/j.cnki.MPM.202408200
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目的

分析河北省感染艾滋病病毒感染者和艾滋病患者(HIV/AIDS)的生存时间,探索其影响因素,为提高患者生存质量提供依据。

方法

采用回顾性队列研究方法,收集河北省1989—2022年发现的HIV/AIDS病例的各类随访信息,用寿命表法描述其生存情况,用log-rank检验及Cox回归分析生存时间的影响因素。

结果

22 563例HIV/AIDS病例,男性占88.7%,同性传播占62.1%,发现时平均年龄为38.1±13.9岁。1年生存率91.46%,3年生存率88.03%,5年生存率85.56%,10年生存率达79.34%。多因素分析结果显示,女性死亡风险小于男性(HR=0.824,95% CI:0.713~0.953)。接受抗病毒治疗者死亡风险低于未治疗者(HR=0.079,95% CI:0.069~0.091)。基线CD4细胞计数在200~349个/μl(HR=0.451,95% CI:0.222~0.914)、计数在350~499个/μl(HR=0.354,95% CI:0.175~0.719)、计数在500个/μl以上者(HR=0.342,95% CI:0.168~0.693)死亡风险较低。50岁以上者死亡风险较高(HR=2.585,95% CI:2.143~3.117)。病例样本来源中,来源于检测咨询的病例死亡风险低于来源于医疗机构的病例(HR=0.444,95% CI:0.387~0.510),来源于羁押人员的病例死亡风险低于来源于医疗机构的病例(HR=0.417,95% CI:0.297~0.584)。

结论

性别、文化程度、基线CD4细胞计数、样本来源、发现时年龄、是否开展抗病毒治疗是生存时间的影响因素。早发现,早治疗,加强重点人群的宣传教育,关注50岁以上中老年病例,强化医务人员主动开展艾滋病检测咨询服务,对于延长HIV/AIDS病例的生存时间具有积极的作用。

艾滋病  /  生存时间  /  影响因素  /  Cox回归
Objective

To analyze the survival time of HIV/AIDS patients in Hebei province, and to explore the influencing factors, so as to provide basis for improving the quality of life of patients.

Methods

Retrospective cohort study was used to collect information of HIV/AIDS in Hebei province from 1989 to 2022. Life table was used to describe the survival status. Log-rank test and Cox regression were used to analysis the influencing factors of survival time.

Results

There were 22 563 cases of HIV/AIDS, with males accounting for 88.7% and homosexual transmission accounting for 62.1%. The average age at the time of discovery was 38.1±13.9. The 1-year,3-year,5-year and 10-year cumulative survival rates of HIV/AIDS patients were 91.46%,88.03%, 85.56% and 79.34%. The risk of death in female was lower than that in male (HR=0.824, 95% CI: 0.713-0.953). The risk of death in patients receiving antiviral treatment was lower than in those who have not received treatment (HR=0.079, 95% CI:0.069-0.091). Baseline CD4 cell counts ranging from 200 to 349 cells/μl (HR=0.451, 95% CI: 0.222-0.914), 350 to 499 cells/μl (HR=0.354, 95% CI: 0.175-0.719), and above 500 cells/μl (HR=0.342, 95% CI: 0.168-0.693) have a lower risk of death. People over 50 years old have a higher risk of death (HR=2.585, 95% CI: 2.143-3.117). Among the sources of case samples, the case death risk of those from HIV testing and counseling was lower than the cases from medical institutions(HR=0.444,95% CI: 0.387-0.510). And the case death risk of those from detainees was lower than the cases from medical institutions(HR=0.417,95% CI: 0.297-0.584).

Conclusion

Gender, educational level, baseline CD4 cell count, sample source, age at discovery, and antiviral treatment were influencing factors on survival time. Early detection, early treatment, strengthening the publicity and education of key groups, paying attention to the elderly cases over 50 years old, and strengthening medical personnel to actively carry out AIDS testing and consulting services have a positive effect on prolonging the survival time of HIV/AIDS cases.

AIDS  /  Survival time  /  Influencing factors  /  Cox
张亚丽, 王敬丘, 王伟, 吴小雪, 马琳, 成效莹. 河北省HIV/AIDS病例生存时间及影响因素分析. 现代预防医学, 2025 , 52 (6) : 1138 -1143 . DOI: 10.20043/j.cnki.MPM.202408200
Ya-li ZHANG, Jing-qiu WANG, Wei WANG, Xiao-xue WU, Lin MA, Xiao-ying CHENG. Analysis of survival time and influencing factors of HIV/AIDS patients, Hebei Province[J]. Modern Preventive Medicine, 2025 , 52 (6) : 1138 -1143 . DOI: 10.20043/j.cnki.MPM.202408200
自1981年美国报告首例艾滋病(acquired immunodeficiency syndrome, AIDS)病例以来,40余年时间里,AIDS在全球范围内迅速传播蔓延,已成为危害社会经济发展和人民健康的重大传染病。据联合国艾滋病规划署估计,2022年全球存活HIV(human immunodeficiency virus, HIV)/AIDS约为3 900万人,2022年全球有63万人死于艾滋病。我国2023年报告存活HIV/AIDS病例达到128.97万例[1]。HIV/AIDS病例的生存时间是AIDS研究领域的重要问题,分析生存时间的影响因素,对于病死率的降低,具有重要的意义[2]。既往未曾有河北省HIV/AIDS病例生存时间的相关研究。本研究基于1989年1月1日至2022年12月31日河北省有记录的HIV/AIDS病例的各类随访情况,编制寿命表,了解其生存时间,并探讨相关影响因素,为相关防治策略的制定提供科学依据。
将1989年1月1日至2022年12月31日期间河北省发现的HIV/AIDS病例共计22 563例作为研究对象。研究对象按病程进展分为HIV和AIDS两个阶段,病程阶段的划分依据《艾滋病和艾滋病病毒感染诊断标准》(WS293-2019)和《全国艾滋病检测技术规范》(2020年修订版)要求。本研究经过河北省疾病预防控制中心伦理委员会批准,伦理审批号:IRBS2021-012。
研究对象被发现后,由所在县区疾病预防控制中心经过统一培训的调查员进行随访(HIV的随访频次为半年一次,AIDS的随访频次为三个月一次),收集相关资料,填写随访记录表,包括年龄、性别、民族、婚姻状况、文化程度等一般人口学信息、抗病毒治疗情况、干预等,对于死亡病例,通过医疗机构或患者家属收集死亡信息,并将资料统一录入到中国疾病预防控制信息系统艾滋病预防控制信息系统。本次研究所涉及数据均来自该系统。
采用回顾性队列研究,观察起点为病例确诊时间,观察终点为2024年5月31日或观察期内病例死亡。观察结局为病例死亡,截尾值为截至观察终点时病例的状态为存活或失访。
用EXCEL 2021软件建立数据库,用SPSS 23.0软件进行统计学描述和分析。用寿命表法计算累计生存率,用log-rank检验进行生存时间的单因素分析,在单因素分析基础上,将差异有统计学意义的变量纳入Cox回归模型,采用Forward:LR法进行生存时间的多因素分析。检验水准α=0.05,双侧检验。
22 563例HIV/AIDS,性别以男性为主占88.7%;发现时平均年龄为38.1±13.9岁,25~49岁者占病例总数的61.0%;婚姻状况以已婚为主占46.2%;文化程度以初中为主占39.4%,其次为大专及以上占23.6%;民族以汉族为主占95.7%;感染途径以同性传播为主占62.1%,其次为异性传播占32.2%;开展抗病毒治疗者占88.6%;样本来源主要为医疗机构占46.8%,其次为检测咨询占34.5%;观察终点时疾病进程为HIV的占58.2%;基线疾病进程为HIV的占72.3%,进程为AIDS的占27.7%;基线CD4细胞计数在200个/μl以下的占27.7%,计数在200~349个/μl之间的占24.5%。
22 563例HIV/AIDS,1年生存率91.46%,3年生存率88.03%,5年生存率85.56%,10年生存率达79.34%。详见表1
对可能影响HIV/AIDS病例生存时间的因素进行单因素log-rank检验,结果显示病例的性别、发现时年龄、婚姻状况、文化程度、疾病进程、是否开展抗病毒治疗、感染途径、样本来源、基线CD4计数差异有统计学意义(P<0.05)。详见表2
将单因素分析中差异有统计学意义的变量纳入Cox回归模型,多因素分析结果显示,性别、文化程度、基线CD4细胞计数、样本来源、发现时年龄、是否开展抗病毒治疗是生存时间的影响因素。详见表3。感染途径、疾病进程、婚姻状况三个因素差异无统计学意义。女性死亡风险是男性的0.824倍,文化程度越高,死亡风险越低。基线CD4细胞计数在200以上者,死亡风险低于计数在200以下者。来源于医疗机构的病例死亡风险最高,来自检测咨询的病例死亡风险是医疗机构病例的0.444倍。
河北省HIV/AIDS病例以男性为主,婚姻状况以已婚为主,发现时年龄主要集中在25~49岁,传播途径主要是同性传播,这与北京[3]、天津[4]等地的流行状况类似。但受社会经济发展、人群特点、当地防治经费投入等多项因素影响,不同地区之间的HIV/AIDS病例生存时间可能存在着差异。分析河北省HIV/AIDS病例的生存时间,探索其影响因素,对于延长患者生存时间,改善生存质量,有着积极的作用。
研究发现,河北省HIV/AIDS病例的生存时间受抗病毒治疗的影响。未接受过抗病毒治疗的HIV/AIDS病例死亡的相对危险度是接受过抗病毒治疗患者的12.66倍,与广西桂林[5]、山东临沂[6]的研究结果类似。抗病毒治疗可以降低各种机会性感染的发生几率,增加体内CD4+T淋巴细胞计数,降低患者体内病毒载量,增强机体免疫力,延长生存时间。同时抗病毒治疗也可减少高危行为时HIV的传播风险,起到治疗即预防的目的[7]
寿命表显示,病例在确诊1年内死亡概率最高,与江苏徐州[8]结果相一致。基线CD4计数在200个/μl的以上的病例死亡风险低于计数在200以下者,与河南省[9]结果一致。部分患者在感染HIV后,并没有被及时检测出。直到疾病后期,各种临床症状的出现,才被发现报告,确诊感染时间远远滞后于实际感染时间。此时患者体内的免疫系统破坏严重,伴随着各种并发症的出现,即使开展了抗病毒治疗,效果也难以达到预期,死亡相对危险度高于早期发现者。在疾病的早期发现,并及时采取抗病毒治疗和干预措施,则可以明显提高病例的生存时间[10]。此外,CD4计数在200个/μl以上者,病例病程阶段处于HIV期,此时为疾病的早期阶段,相较于计数在200个/μl以下者,自然生存时间较长。在观察截止时,未出现死亡结局的比例较高,可能会在估算CD4计数对死亡结局的关联程度上造成一定影响。
年龄是影响病例生存时间的重要因素。随着年龄的增长,死亡风险也在相应增加。老年人由于身体免疫机能下降,恢复能力降低,发生各种合并感染的机会较高,死亡风险较大,从而导致生存时间减小[11]。近年来,河北省报告的老年病例在持续增加[12],对于新发现的老年感染者,应加大关注力度。文化程度也是生存时间的影响因素,文化程度越高,生存时间越长。这可能与高文化程度者对疾病的认识程度较高有关,能够尽早检测,及早被发现,在开展治疗后依从性较好,能克服药物副反应,坚持治疗,从而取得较好的生存时间[13]
不同样本来源的病例生存时间不同,来源于检测咨询的病例死亡相对危险度是医疗机构来源的0.444倍。来自于检测咨询的病例,对于疾病本身及相关的感染风险有一定程度的认识,对自己健康状况较为关心,在发生疾病相关高危行为后能主动求询并接受检测,更易在疾病的早期被发现。来自于医疗机构的病例,大多是直到临床症状或体征的出现,才在医疗机构就诊被检出,发现较晚[14]。这也提示我们,在今后的工作中,应加大对艾滋病相关知识的宣传,提升有高危风险人群主动检测意识,同时鼓励医务人员主动开展艾滋病检测咨询服务[15],避免未能及早被发现而错过了接受抗病毒治疗的最佳时机。
综上所述,早发现,早治疗,加强重点人群的宣传教育,关注50岁以上中老年病例,强化医务人员主动开展艾滋病检测咨询服务,对于延长HIV/AIDS病例的生存时间具有积极的作用。
  • 河北省重点研发计划自筹项目(172777185)
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doi: 10.20043/j.cnki.MPM.202408200
  • 接收时间:2024-08-15
  • 首发时间:2026-03-18
  • 出版时间:2025-03-25
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  • 收稿日期:2024-08-15
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河北省重点研发计划自筹项目(172777185)
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    河北省疾病预防控制中心,河北 石家庄 050021

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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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