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Article(id=1324078249613074596, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078037817504735, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202506488, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1750867200000, receivedDateStr=2025-06-26, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614454891, onlineDateStr=2026-11-02, pubDate=1770652800000, pubDateStr=2026-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614454891, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614454891, creator=13701087609, updateTime=1793614454891, updator=13701087609, issue=Issue{id=1324078037817504735, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='3', pageStart='385', pageEnd='576', issueExtLink='null', onlineDate='null', pubDate='1770652800000', pubDateStr='2026-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614404396, creator='13701087609', updateTime=1793614474144, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078330420527919, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078037817504735, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078330420527920, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078037817504735, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=424, endPage=428, ext={EN=ArticleExt(id=1324078249835372709, articleId=1324078249613074596, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Impact of tuberculosis on the survival of HIV/AIDS patients based on time-dependent Cox regression model, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To retrospectively analyze the survival status of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients infected with tuberoulosis (TB) in Baise City from 2005 to 2019, and to provide a scientific basis for better prevention and control of HIV-tuberoulosis (HIV-TB) dual infection.

Methods

A retrospective dynamic cohort study was used to download the historical database in the AIDS comprehensive prevention and control information system. HIV/AIDS patients diagnosed from 2005 to 2019 were selected. According to the conditions of gender, age of enrollment,time of diagnosis of AIDS, route of infection, whether to receive antiviral therapy and first CD4+ count, the double infected patients diagnosed with tuberculosis infection were selected as the HIV-TB group, and the non-tuberculosis infected HIV/AIDS patients were matched according to the matching condition of 1:1 ratio as the HIV/AIDS group. The Kaplan-Meier method was used to draw the survival curve, the life table method was used to estimate the cumulative survival rate, and the time-dependent Cox regression model was used to analyze the influencing factors of survival.

Results

A total of 1 188 cases were enrolled in the observation cohort, with 594 cases in the HIV-TB group and 594 cases in the HIV/AIDS group. There were 251 and 183 deaths in HIV-TB group and HIV/AIDS group, respectively. The mortality rates were 42.26% and 30.81%,respectively. The median follow-up time was 108 (IQR: 70-150) months and 106 (IQR: 67-147) months, respectively. The median survival time was 130 (95% CI: 108.283-152.411) months and >180 months, respectively. The 1-, 5-, 10-, and 15-year cumulative survival rates were 89.23%, 72.87%, 53.29%, 40.65% and 91.08%, 80.60%, 65.44%, 56.40%, respectively. The results of multivariate time-dependent Cox regression model analysis showed that the risk of death in HIV-TB group was 1.391 times higher than that in HIV/AIDS group (95% CI: 1.115-1.735). Among males (HR=1.394, 95% CI: 1.105-1.758), participants aged <45 years (HR=1.411, 95% CI: 1.020-1.951), farmers (HR=1.557, 95% CI: 1.198-2.024), those with junior high school education or below (HR=1.426, 95% CI: 1.130-1.799), those not receiving antiviral therapy (HR=2.004, 95% CI: 1.267-3.169), and those with a first CD4+ count <200 cells/μL (HR=1.480, 95% CI: 1.137-1.926), HIV-TB patients had a higher risk of death than HIV/AIDS patients.

Conclusion

Compared with HIV/AIDS patients, the survival time of HIV-TB patients is significantly shorter, especially those who are male, younger, with low education level, without receiving antiviral therapy and with low immune level. It is necessary to carry out targeted publicity and education, strengthen health monitoring and management of high-risk groups, achieve early detection, early diagnosis and early treatment, reduce the risk of death of HIV-TB co-infected patients, and improve the survival time of HIV-TB co-infected patients.

, authors=Rui LIU1, Jian CHEN1, 2, Jian-ying LIAO1, Xiao-ting HE2, An-heng HUANG2, authorsList=Rui LIU, Jian CHEN, Jian-ying LIAO, Xiao-ting HE, An-heng HUANG, authorCompany=null, correspAuthors=Jian CHEN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324078250573570216, articleId=1324078249613074596, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=基于伴时Cox回归模型的结核病对艾滋病患者的生存影响研究, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

回顾性分析广西壮族自治区百色市2005—2019年人类免疫缺陷病毒/获得性免疫缺陷综合征（human immunodeficiency virus/acquired immunodeficiency syndrome，HIV/AIDS）患者感染结核病后的生存状况，为更好地开展HIV合并结核分技杆菌（HIV-tuberoulosis，HIV-TB）双重感染防控工作提供科学依据。

方法

采用回顾性动态队列研究，在艾滋病综合防治信息系统中下载历史数据库。选取2005—2019年确诊的HIV/AIDS患者，按照性别、入组年龄、确诊艾滋病时间、感染途径、是否接受抗病毒治疗及首次CD4+计数等条件，以确诊结核感染的双重感染者为HIV-TB组，根据匹配条件1∶1比例匹配非结核感染HIV/AIDS患者为HIV/AIDS组。使用Kaplan-Meier法绘制生存曲线，运用寿命表法估计累积生存率，利用伴时Cox回归模型进行生存影响因素分析。

结果

入组观察队列1 188例，HIV-TB组和HIV/AIDS组病例各594例。HIV-TB组和HIV/AIDS组死亡病例各251和183例，病死率分别为42.26%和30.81%，中位随访时间分别为108个月(IQR:70～150)和106个月(IQR:67～147)，中位生存时间分别为130个月(95% CI:108.283～152.411)和>180个月，第1、5、10和15年累积生存率分别为89.23%、72.87%、53.29%、40.65%和91.08%、80.60%、65.44%、56.40%。经多因素伴时Cox回归模型分析结果显示：HIV-TB组的死亡风险是HIV/AIDS组的1.391倍(95% CI:1.115～1.735)；其中男性、入组年龄<45岁、农民、文化程度为初中及以下、未接受抗病毒治疗和首次CD4+计数<200个/μl的HIV-TB患者死亡风险分别是HIV/AIDS患者的1.394(95% CI:1.105～1.758)、1.411(95% CI:1.020～1.951)、1.557(95% CI:1.198～2.024)、1.426(95% CI:1.130～1.799)、2.004(95% CI:1.267～3.169)和1.480倍(95% CI:1.137～1.926)。

结论

与HIV/AIDS患者相比，HIV-TB患者的生存时间明显较短，尤其是男性、年龄较小、文化程度低下、未接受抗病毒治疗以及免疫水平低者，需要针对性地开展宣传教育，加强高危人群健康监测管理，做到早发现、早诊断、早治疗，降低HIV-TB双重感染者的死亡风险，提升HIV-TB双重感染者的生存时间。

, authors=刘蕊1, 陈坚1, 2, 廖建英1, 何筱婷2, 黄安恒2, authorsList=刘蕊, 陈坚, 廖建英, 何筱婷, 黄安恒, authorCompany=null, correspAuthors=陈坚, authorNote=

刘蕊(1998—)，女，硕士在读，研究方向：民族地区疾病控制与健康促进

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陈坚，E-mail:
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Analysis of risk factors of acquired immunodeficiency syndrome complicated with tuberculosis infection[J].China Medical Herald, 2020, 17(17): 145-148. 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Epidemiological characteristics and treatment status of TB/HIV co-infection in Inner Mongolia autonomous region from 2016 to 2023[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2024, 46(s1): 50-55. (In Chinese), articleTitle=Epidemiological characteristics and treatment status of TB/HIV co-infection in Inner Mongolia autonomous region from 2016 to 2023, refAbstract=null), Reference(id=1324078259264168191, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, doi=null, pmid=null, pmcid=null, year=2020, volume=27, issue=4, pageStart=442, pageEnd=445, url=null, language=null, rfNumber=[19], rfOrder=33, authorNames=陈春勇, 刘征, 李喜英, journalName=实用预防医学, refType=null, unstructuredReference=陈春勇，刘征，李喜英，等.郑州地区114例艾滋病合并肺结核双重感染患者临床特征及死亡影响因素分析[J].实用预防医学，2020，27（4）：442-445., articleTitle=郑州地区114例艾滋病合并肺结核双重感染患者临床特征及死亡影响因素分析, refAbstract=null), Reference(id=1324078259364831488, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, doi=null, pmid=null, pmcid=null, year=2020, volume=27, issue=4, pageStart=442, pageEnd=445, url=null, language=null, rfNumber=[19], rfOrder=34, authorNames=Chen CY, Liu Z, Li XY, journalName=Practical Preventive Medicine, refType=null, unstructuredReference=Chen CY, Liu Z, Li XY, et al. Clinical characteristics and factors influencing death in 114 patients co-infected with HIV/AIDS and pulmonary tuberculosis in Zhengzhou region[J]. Practical Preventive Medicine, 2020, 27(4): 442-445. (In Chinese), articleTitle=Clinical characteristics and factors influencing death in 114 patients co-infected with HIV/AIDS and pulmonary tuberculosis in Zhengzhou region, refAbstract=null)], funds=[Fund(id=1324078256466567389, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, awardId=20233201, language=CN, fundingSource=百色市科技计划项目(20233201), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324078250774896809, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, xref=1., ext=[AuthorCompanyExt(id=1324078250779091114, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, companyId=1324078250774896809, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health and Management, Youjiang Medical University for Nationalities, Baise, Guangxi 533000, China), AuthorCompanyExt(id=1324078250787479723, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, companyId=1324078250774896809, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.右江民族医学院 公共卫生学院，广西 百色 533000)]), AuthorCompany(id=1324078250858782892, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, xref=2., ext=[AuthorCompanyExt(id=1324078250867171501, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, companyId=1324078250858782892, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.百色市疾病预防控制中心，广西 百色 533000)])], figs=[ArticleFig(id=1324078254772068560, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, language=EN, label=Figure 1, caption=Survival curves of HIV-TB group and HIV / AIDS group, figureFileSmall=7/0fM7m/ZeOd8HMT8SEP2Q==, figureFileBig=Mu4jEb88LTUm6ZF3tItTrg==, tableContent=null), ArticleFig(id=1324078254847566033, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, language=CN, label=图1, caption=HIV-TB组与HIV/AIDS组生存曲线, figureFileSmall=7/0fM7m/ZeOd8HMT8SEP2Q==, figureFileBig=Mu4jEb88LTUm6ZF3tItTrg==, tableContent=null), ArticleFig(id=1324078255594152149, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, language=EN, label=Table 1, caption=

Death of cases of the two groups of research subjects ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量HIV/AIDS组HIV-TB组χ2值P值
病例数死亡人数病死率（%）病例数死亡人数病死率（%）
总体59418330.8159425142.2616.787<0.001
性别
男48116534.3048121945.5312.639<0.001
女1131815.931133228.325.0340.025
入组年龄（岁）
<453398625.3734314241.4019.688<0.001
≥452559738.0425110943.431.5210.217
婚姻
未婚1123934.821264938.890.4210.516
已婚有配偶39711428.7239016442.0515.315<0.001
离异或丧偶853035.29783848.723.0150.083
人群分类
农民38011931.3241716539.575.9040.015
非农民2146429.911778648.5914.297<0.001
文化程度
初中及以下49916232.4651222243.3612.733<0.001
初中以上952122.11822935.373.8180.051
是否接受抗病毒治疗
否625995.1662621003.0740.080
是53212423.3153218935.5319.124<0.001
首次CD4+计数（个/μl）
<20032210331.9932214844.5810.9570.001
≥2002768029.4116210339.315.8080.016
), ArticleFig(id=1324078255753535703, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, language=CN, label=表1, caption=

两组研究对象的死亡情况［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量HIV/AIDS组HIV-TB组χ2值P值
病例数死亡人数病死率（%）病例数死亡人数病死率（%）
总体59418330.8159425142.2616.787<0.001
性别
男48116534.3048121945.5312.639<0.001
女1131815.931133228.325.0340.025
入组年龄（岁）
<453398625.3734314241.4019.688<0.001
≥452559738.0425110943.431.5210.217
婚姻
未婚1123934.821264938.890.4210.516
已婚有配偶39711428.7239016442.0515.315<0.001
离异或丧偶853035.29783848.723.0150.083
人群分类
农民38011931.3241716539.575.9040.015
非农民2146429.911778648.5914.297<0.001
文化程度
初中及以下49916232.4651222243.3612.733<0.001
初中以上952122.11822935.373.8180.051
是否接受抗病毒治疗
否625995.1662621003.0740.080
是53212423.3153218935.5319.124<0.001
首次CD4+计数（个/μl）
<20032210331.9932214844.5810.9570.001
≥2002768029.4116210339.315.8080.016
), ArticleFig(id=1324078255996805336, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, language=EN, label=Table 2, caption=

The results of time-dependent Cox regression model analysis of survival influencing factors in 1 188 patients

, figureFileSmall=null, figureFileBig=null, tableContent=
变量aHR 值(95%CI）P 值
总体1.391(1.115~1.735)0.003
性别
男1
女0.571(0.423~0.770)<0.001
入组年龄（岁）
<451
≥451.701(1378~2.101)<0.001
婚姻
未婚1
已婚有配偶0.975(0.751~1.266)0.850
离异或丧偶1.155(0.826~1.616)0.400
人群分类
农民1
非农民0.908(0.733~1.126)0.380
文化程度
初中及以下1
初中以上0.809(0.593~0.104)0.181
是否接受抗病毒治疗
否1
是0.130(0.104~0.164)<0.001
首次CD4+计数（个/μl）
<2001
≥2000.548(0.448~0.672)<0.001
), ArticleFig(id=1324078256076497113, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, language=CN, label=表2, caption=

1 188例患者生存影响因素的伴时Cox回归模型分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量aHR 值(95%CI）P 值
总体1.391(1.115~1.735)0.003
性别
男1
女0.571(0.423~0.770)<0.001
入组年龄（岁）
<451
≥451.701(1378~2.101)<0.001
婚姻
未婚1
已婚有配偶0.975(0.751~1.266)0.850
离异或丧偶1.155(0.826~1.616)0.400
人群分类
农民1
非农民0.908(0.733~1.126)0.380
文化程度
初中及以下1
初中以上0.809(0.593~0.104)0.181
是否接受抗病毒治疗
否1
是0.130(0.104~0.164)<0.001
首次CD4+计数（个/μl）
<2001
≥2000.548(0.448~0.672)<0.001
), ArticleFig(id=1324078256172966107, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, language=EN, label=Table 3, caption=

The stratification results of time-dependent Cox regression model of survival influencing factors in 1 188 patients

, figureFileSmall=null, figureFileBig=null, tableContent=
变量多因素分析
aHR 值(95%CI）P 值
性别
男1.394(1.105~1.758)0.005
女1.147(0.550~2.393)0.714
入组年龄（岁）
<451.411(1.020~1.951)0.038
≥451.357(0.996~1.849)0.053
婚姻
未婚1.302(0.796~2.131)0.293
已婚有配偶1.222(0.930~1.605)0.150
离异或丧偶1.451(0.757~2.308)0.347
人群分类
农民1.557(1.198~2.024)0.001
非农民0.921(0.586~1.448)0.722
文化程度
初中及以下1.426(1.130~1.799)0.003
初中以上0.983(0.457~2.114)0.965
是否接受抗病毒治疗
否2.004(1.267~3.169)0.003
是1.252(0.967~1.621)0.088
首次CD4+计数（个/μl）
<2001.480(1.137~1.926)0.004
≥2001.001(0.644~1.553)0.998
), ArticleFig(id=1324078256290406620, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078249613074596, language=CN, label=表3, caption=

1 188例患者生存影响因素的伴时Cox回归模型分层分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量多因素分析
aHR 值(95%CI）P 值
性别
男1.394(1.105~1.758)0.005
女1.147(0.550~2.393)0.714
入组年龄（岁）
<451.411(1.020~1.951)0.038
≥451.357(0.996~1.849)0.053
婚姻
未婚1.302(0.796~2.131)0.293
已婚有配偶1.222(0.930~1.605)0.150
离异或丧偶1.451(0.757~2.308)0.347
人群分类
农民1.557(1.198~2.024)0.001
非农民0.921(0.586~1.448)0.722
文化程度
初中及以下1.426(1.130~1.799)0.003
初中以上0.983(0.457~2.114)0.965
是否接受抗病毒治疗
否2.004(1.267~3.169)0.003
是1.252(0.967~1.621)0.088
首次CD4+计数（个/μl）
<2001.480(1.137~1.926)0.004
≥2001.001(0.644~1.553)0.998
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基于伴时Cox回归模型的结核病对艾滋病患者的生存影响研究
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刘蕊 1 , 陈坚 1, 2 , 廖建英 1 , 何筱婷 2 , 黄安恒 2
现代预防医学 | 流行病与统计方法 2026,53(3): 424-428
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现代预防医学 |流行病与统计方法 2026 , 53 (3) : 424 -428
基于伴时Cox回归模型的结核病对艾滋病患者的生存影响研究
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刘蕊1, 陈坚1, 2 , 廖建英1, 何筱婷2, 黄安恒2
作者信息
  • 1.右江民族医学院 公共卫生学院，广西 百色 533000
  • 2.百色市疾病预防控制中心，广西 百色 533000
通讯作者:
陈坚，E-mail:
作者简介:

刘蕊(1998—)，女，硕士在读，研究方向：民族地区疾病控制与健康促进

Impact of tuberculosis on the survival of HIV/AIDS patients based on time-dependent Cox regression model
Rui LIU1, Jian CHEN1, 2 , Jian-ying LIAO1, Xiao-ting HE2, An-heng HUANG2
Affiliations
  • School of Public Health and Management, Youjiang Medical University for Nationalities, Baise, Guangxi 533000, China
出版时间: 2026-02-10 doi: 10.20043/j.cnki.MPM.202506488
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摘要
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目的

回顾性分析广西壮族自治区百色市2005—2019年人类免疫缺陷病毒/获得性免疫缺陷综合征（human immunodeficiency virus/acquired immunodeficiency syndrome，HIV/AIDS）患者感染结核病后的生存状况，为更好地开展HIV合并结核分技杆菌（HIV-tuberoulosis，HIV-TB）双重感染防控工作提供科学依据。

方法

采用回顾性动态队列研究，在艾滋病综合防治信息系统中下载历史数据库。选取2005—2019年确诊的HIV/AIDS患者，按照性别、入组年龄、确诊艾滋病时间、感染途径、是否接受抗病毒治疗及首次CD4+计数等条件，以确诊结核感染的双重感染者为HIV-TB组，根据匹配条件1∶1比例匹配非结核感染HIV/AIDS患者为HIV/AIDS组。使用Kaplan-Meier法绘制生存曲线，运用寿命表法估计累积生存率，利用伴时Cox回归模型进行生存影响因素分析。

结果

入组观察队列1 188例，HIV-TB组和HIV/AIDS组病例各594例。HIV-TB组和HIV/AIDS组死亡病例各251和183例，病死率分别为42.26%和30.81%，中位随访时间分别为108个月(IQR:70～150)和106个月(IQR:67～147)，中位生存时间分别为130个月(95% CI:108.283～152.411)和>180个月，第1、5、10和15年累积生存率分别为89.23%、72.87%、53.29%、40.65%和91.08%、80.60%、65.44%、56.40%。经多因素伴时Cox回归模型分析结果显示：HIV-TB组的死亡风险是HIV/AIDS组的1.391倍(95% CI:1.115～1.735)；其中男性、入组年龄<45岁、农民、文化程度为初中及以下、未接受抗病毒治疗和首次CD4+计数<200个/μl的HIV-TB患者死亡风险分别是HIV/AIDS患者的1.394(95% CI:1.105～1.758)、1.411(95% CI:1.020～1.951)、1.557(95% CI:1.198～2.024)、1.426(95% CI:1.130～1.799)、2.004(95% CI:1.267～3.169)和1.480倍(95% CI:1.137～1.926)。

结论

与HIV/AIDS患者相比，HIV-TB患者的生存时间明显较短，尤其是男性、年龄较小、文化程度低下、未接受抗病毒治疗以及免疫水平低者，需要针对性地开展宣传教育，加强高危人群健康监测管理，做到早发现、早诊断、早治疗，降低HIV-TB双重感染者的死亡风险，提升HIV-TB双重感染者的生存时间。

HIV/AIDS  /  HIV-TB  /  伴时Cox回归模型  /  生存分析
Objective

To retrospectively analyze the survival status of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients infected with tuberoulosis (TB) in Baise City from 2005 to 2019, and to provide a scientific basis for better prevention and control of HIV-tuberoulosis (HIV-TB) dual infection.

Methods

A retrospective dynamic cohort study was used to download the historical database in the AIDS comprehensive prevention and control information system. HIV/AIDS patients diagnosed from 2005 to 2019 were selected. According to the conditions of gender, age of enrollment,time of diagnosis of AIDS, route of infection, whether to receive antiviral therapy and first CD4+ count, the double infected patients diagnosed with tuberculosis infection were selected as the HIV-TB group, and the non-tuberculosis infected HIV/AIDS patients were matched according to the matching condition of 1:1 ratio as the HIV/AIDS group. The Kaplan-Meier method was used to draw the survival curve, the life table method was used to estimate the cumulative survival rate, and the time-dependent Cox regression model was used to analyze the influencing factors of survival.

Results

A total of 1 188 cases were enrolled in the observation cohort, with 594 cases in the HIV-TB group and 594 cases in the HIV/AIDS group. There were 251 and 183 deaths in HIV-TB group and HIV/AIDS group, respectively. The mortality rates were 42.26% and 30.81%,respectively. The median follow-up time was 108 (IQR: 70-150) months and 106 (IQR: 67-147) months, respectively. The median survival time was 130 (95% CI: 108.283-152.411) months and >180 months, respectively. The 1-, 5-, 10-, and 15-year cumulative survival rates were 89.23%, 72.87%, 53.29%, 40.65% and 91.08%, 80.60%, 65.44%, 56.40%, respectively. The results of multivariate time-dependent Cox regression model analysis showed that the risk of death in HIV-TB group was 1.391 times higher than that in HIV/AIDS group (95% CI: 1.115-1.735). Among males (HR=1.394, 95% CI: 1.105-1.758), participants aged <45 years (HR=1.411, 95% CI: 1.020-1.951), farmers (HR=1.557, 95% CI: 1.198-2.024), those with junior high school education or below (HR=1.426, 95% CI: 1.130-1.799), those not receiving antiviral therapy (HR=2.004, 95% CI: 1.267-3.169), and those with a first CD4+ count <200 cells/μL (HR=1.480, 95% CI: 1.137-1.926), HIV-TB patients had a higher risk of death than HIV/AIDS patients.

Conclusion

Compared with HIV/AIDS patients, the survival time of HIV-TB patients is significantly shorter, especially those who are male, younger, with low education level, without receiving antiviral therapy and with low immune level. It is necessary to carry out targeted publicity and education, strengthen health monitoring and management of high-risk groups, achieve early detection, early diagnosis and early treatment, reduce the risk of death of HIV-TB co-infected patients, and improve the survival time of HIV-TB co-infected patients.

HIV/AIDS  /  HIV-TB  /  Time-dependent Cox regression model  /  Survival analysis
刘蕊, 陈坚, 廖建英, 何筱婷, 黄安恒. 基于伴时Cox回归模型的结核病对艾滋病患者的生存影响研究. 现代预防医学, 2026 , 53 (3) : 424 -428 . DOI: 10.20043/j.cnki.MPM.202506488
Rui LIU, Jian CHEN, Jian-ying LIAO, Xiao-ting HE, An-heng HUANG. Impact of tuberculosis on the survival of HIV/AIDS patients based on time-dependent Cox regression model[J]. Modern Preventive Medicine, 2026 , 53 (3) : 424 -428 . DOI: 10.20043/j.cnki.MPM.202506488
正文
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人类免疫缺陷病毒/获得性免疫缺陷综合征（human immunodeficiency virus/acquired immunodeficiency syndrome，HIV/AIDS）患者因免疫功能缺陷及后续治疗不当可能继发多种机会性感染，结核病作为HIV/AIDS患者最为常见的机会性感染之一，仍是影响患者预后和生存质量的常见疾病[1-2]。同时结核病也是HIV/AIDS患者的主要死因之一[3]。根据世界卫生组织发布的《2024年全球结核病报告》中显示：全球结核病估算死亡125 万例，其中16.1万例为（占12.9%）HIV阳性患者，合并HIV感染的结核病患者死亡例数明显增加[4]。因此，如何早期识别HIV合并结核分技杆菌（HIV-tuberculosis，HIV-TB）双重感染的潜在危险因素，并且优化筛查和治疗策略，进而降低双重感染风险，最终改善患者预后、提高生活质量、延长生存时间，现已成为艾滋病临床干预中关注的重点问题[5-6]。本研究主要分析百色市2005—2019年HIV/AIDS患者，考虑到“确诊结核病”是随随访进程动态发生的伴时变量，其对患者生存的影响具有时间依赖性，传统Cox回归模型无法有效纳入此类时变信息，因此采用伴时Cox回归模型进行数据分析，结果如下。
1　对象与方法
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1.1　对象
资料来源于国家艾滋病防治基本信息系统历史数据库。选取2005—2019年确诊HIV/AIDS患者，提取其基本信息、治疗信息、首次CD4+计数以及是否患结核病等信息。纳入标准：（1）2005—2019年诊断为HIV/AIDS的患者；（2）诊断HIV/AIDS时年龄≥18岁；（3）患者至少完成1次随访观察；（4）研究对象的一般人口学特征、诊断日期、感染途径、治疗情况、首次CD4+计数数据完整。排除标准：（1）结核病感染在HIV/AIDS确诊之前，且超过6个月；（2）合并慢性病及恶性肿瘤者。匹配条件：性别、感染途径和治疗情况相同，年龄±2岁以内，确诊艾滋病时间±12个月以内，以及首次CD4+计数±50个/μl以内。按照性别、入组年龄、确诊艾滋病时间、感染途径、是否接受抗病毒治疗及首次CD4+计数等条件，以确诊结核感染的双重感染者为HIV-TB组，根据匹配条件1∶1比例匹配非结核感染HIV/AIDS患者为HIV/AIDS组。诊断标准：（1）HIV/AIDS患者：符合《艾滋病和艾滋病病毒感染诊断标准(WS 293—2019)》[7]的患者；（2）结核病患者：符合《肺结核诊断标准(WS 288—2017)》[8]的患者。
1.2　研究方法
采用回顾性动态队列研究，观察起点时间为患者诊断为HIV/AIDS日期，根据国家《艾滋病病毒感染者随访工作指南》要求[9]，患者每年由当地疾病预防控制机构至少完成一次随访并进行结核病筛查，观察截止时间为2023年12月31日。观察终点事件为研究对象因艾滋病相关疾病死亡，终点时间为死亡日期。删失事件为研究对象观察期间失访、观察期结束时仍存活或因非艾滋病相关疾病死亡，删失时间为末次随访日期或观察截止时间。观察时长为观察起点与终点时间或删失时间的差值，以月表示。在本研究中，因HIV/AIDS患者在随访过程中可能发生结核病感染，故将是否发生HIV-TB双重感染设置为伴时变量，将HIV-TB双重感染患者未确诊结核病感染前的状态纳入非结核感染HIV/AIDS时期观察，确诊结核病感染后的状态纳入HIV-TB双重感染时期观察。
1.3　统计分析
在Excel 2016软件中进行数据清理，通过SPSS 26.0软件进行统计分析。计数资料采用［n（%）］进行描述，率的比较用χ2检验。使用Kaplan-Meier法绘制生存曲线，对两组人群生存曲线的比较采用Log Rank检验，运用寿命表法估计HIV/AIDS患者的累积生存率，利用伴时Cox回归模型进行生存影响因素分析。先对总体数据进行分析，再根据变量构建亚组数据，采用分层分析的方法进行亚组数据分析；两次分析均将伴时变量与其他变量同时纳入多因素伴时Cox回归模型中。检验水准α=0.05。
2　结果
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2.1　基本情况
本研究入组观察队列共计1 188例，HIV-TB组和HIV/AIDS组病例各594例。入组病例平均年龄(43.86±12.73)岁；以男性、已婚有配偶、农民和初中及以下文化为主，分别占80.98%、66.25%、67.09%、85.10%。接受抗病毒治疗人数1 064人(89.56%)，首次CD4+计数<200个/μl的病例654例(55.05%)，≥200个/μl的病例534例(44.95%)。
截至2023年12月31日，1 188例研究对象共发生434例死亡，总病死率为36.53%；其中HIV-TB组和HIV/AIDS组死亡病例各251和183例，病死率分别为42.26%和30.81%。见表1。
2.2　生存状况
1 188例研究对象，HIV-TB组和HIV/AIDS组病例的中位随访时间分别为108个月(IQR:70～150)和106个月(IQR:67～147)，中位生存时间分别为130个月(95% CI:108.283～152.411)和>180个月，第1、5、10和15年累积生存率分别为89.23%、72.87%、53.29%、40.65%和91.08%、80.60%、65.44%、56.40%，经Log Rank检验，两组生存率差异有统计学意义(χ2=15.809，P<0.001)，HIV-TB患者生存率低于HIV/AIDS患者。见图1。
2.3　生存影响因素分析
根据变量构建亚组数据，设置伴时变量为是否HIV-TB双重感染。将伴时变量与其他变量同时纳入伴时Cox回归模型中，进行多因素分析。结果显示：总体来看，HIV-TB患者的死亡风险是HIV/AIDS患者的1.391倍(95% CI:1.115～1.735)，见表2；在男性人群中，HIV-TB患者的死亡风险是HIV/AIDS患者的1.394倍(95% CI:1.105～1.758)；在入组年龄<45岁人群中，HIV-TB患者的死亡风险是HIV/AIDS患者的1.411倍(95% CI:1.020～1.951)；在农民人群中，HIV-TB患者的死亡风险是HIV/AIDS患者的1.557倍(95% CI:1.198～2.024)；在文化程度为初中及以下人群中，HIV-TB患者的死亡风险是HIV/AIDS患者的1.426倍(95% CI:1.130～1.799)；在未接受抗病毒治疗人群中，HIV-TB患者的死亡风险是HIV/AIDS患者的2.004倍(95% CI:1.267～3.169)；在首次CD4+计数<200个/μl人群中，HIV-TB患者的死亡风险是HIV/AIDS患者的1.480倍(95% CI:1.137～1.926)。见表3。
3　讨论
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本研究结果显示，与HIV/AIDS患者相比，HIV-TB患者的病死率明显更高，生存时间较短，这与Whalen C、郑志刚[10-11]的研究一致。但HIV-TB病例病死率明显高于云南省[12]；中位生存时间与重庆市HIV/AIDS患者[13]相比，明显较短；第1、5、10和15年累积生存率低于武汉市HIV/AIDS患者[14]。考虑HIV/AIDS患者在合并感染结核病后，会造成自身免疫功能缺陷，加速病情恶化，从而增加死亡风险，导致生存率降低。应加强对HIV/AIDS患者的监测管理，尽早纳入治疗，从而降低结核病感染的风险，延长生存时间。
在本研究中，男性人群HIV-TB患者的死亡风险是HIV/AIDS患者的1.415倍。考虑男性的不良生活习惯或危险行为会增加死亡风险，例如抽烟、吸毒[15-16]等，另外男性具有健康意识较弱、疾病预防知识较少的特点，这均会增加男性HIV-TB患者的死亡风险；在入组年龄<45岁人群中，HIV-TB患者的死亡风险较高，考虑年龄越小，合并其他疾病的可能性越小，单一受结核感染影响越大；在农民以及文化程度为初中及以下人群中，HIV-TB患者的死亡风险均比HIV/AIDS患者高，此类人群社会经济地位较低、知识接受能力差、分散在农村、难以集中宣传，这就导致在感染后不能及时就医或在治疗过程中患者依从性差，增加死亡风险[3]；在未接受抗病毒治疗人群中，HIV-TB患者的死亡风险是HIV/AIDS患者的1.975倍，有研究显示[13]，CD4+T淋巴细胞数量和功能可以通过抗病毒治疗后逐步恢复，提示在做好结核筛查或治疗的基础上尽早进行抗病毒治疗,有利于延长其生存时间；在首次CD4+计数<200个/μl人群中，HIV-TB患者的死亡风险更高，CD4+T 细胞是机体细胞免疫中最为重要的免疫细胞之一，也是HIV病毒主要攻击的细胞，当CD4+T淋巴细胞水平比较低时，会使机体的防御机制遭受攻击和破坏，其他的病原体感染进展更为迅速。HIV复制可以驱动激活潜伏期的结核分枝杆菌，与此同时带来的不良反应和并发症更会加速患者死亡[17-19]。
综上所述，百色市HIV-TB患者的生存率较低，尤其是男性、年龄较小、文化程度低下、未接受抗病毒治疗以及免疫水平低者的死亡风险更高。因此，应持续加强对HIV-TB双重感染的防控力度，加大宣传教育，提升健康意识，重点关注高危人群，及早发现HIV-TB患者并进行规范化的抗病毒治疗，从而降低病死率，延长患者生存时间，提高生存质量。
基金
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  • 百色市科技计划项目(20233201)
文献
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参考文献 引证文献
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2026年第53卷第3期
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doi: 10.20043/j.cnki.MPM.202506488
  • 接收时间：2025-06-26
  • 首发时间：2026-11-02
  • 出版时间：2026-02-10
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  • 收稿日期：2025-06-26
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百色市科技计划项目(20233201)
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    1.右江民族医学院 公共卫生学院，广西 百色 533000
    2.百色市疾病预防控制中心，广西 百色 533000

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
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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