云南省玉溪市1995—2018年HIV感染/AIDS病例全死因及生存分析
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李顺祥

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R512.91

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云南省卫生和计划生育委员会医学学科带头人培养项目(D-201651)


All-causes of death and survival of HIV-infected/AIDS patients in Yuxi City, Yunnan Province, 1995-2018
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    摘要:

    目的 分析云南省玉溪市1995—2018年人类免疫缺陷病毒(HIV)感染者/获得性免疫缺陷综合征(艾滋病,AIDS)病例全死因,生存时间及其影响因素。方法 采用回顾性队列研究方法,利用寿命表法计算生存率,采用Cox比例风险模型分析生存时间影响因素。结果 4 445例HIV感染/AIDS病例纳入队列,随访时间中位数为5.2(IQR:2.1~9.1)年,其中1 054例死亡,机会性感染为主要死因,其次为吸毒过量、其他心血管疾病,全死因死亡率为4.00(95% CI:3.76~4.25)/100人年,中位生存时间为17.83(95% CI:15.81~19.86)年,第1、5、10、15、20年累计生存率分别为0.89、0.78、0.65、0.46、0.26。Cox多因素模型结果显示,男性死亡风险是女性的1.423倍,30~、40~、50~和≥60岁年龄组分别是15~岁年龄组的1.677、2.171、3.096、5.150倍,其他民族是汉族的1.170倍,离异或丧偶是未婚的1.214倍,异性性传播、注射吸毒传播和其他传播分别是男男同性性传播的1.769、3.326、2.532倍,样本来源为婚/孕/产检、监管场所、医疗机构检测和其他检测分别是主动咨询检测的0.575、0.432、1.413、0.591倍,现阶段病程为HIV感染者是AIDS患者的1.561倍,基线CD4+T细胞在200~、<200个/μL和不详组分别是≥500个/μL组的1.363、2.180、3.638倍,未接受抗病毒治疗(ART)是已接受ART的10.410倍。结论 HIV感染者/AIDS患者生存时间受多种因素影响,应加强早发现和早治疗工作,同时注重非艾滋病相关死因,给予相应干预措施,延长HIV感染/AIDS患者生存时间。

    Abstract:

    Objective To analyze all-causes of death, survival time and influencing factors of human immunodeficiency virus-infected/acquired immunodeficiency syndrome (HIV-infected/AIDS) patients in Yuxi City, Yunnan Province from 1995 to 2018. Methods Retrospective cohort study was conducted, survival rate was calculated by life table method, influencing factors for survival time was analyzed by Cox proportional hazard model. Results 4 445 HIV-infected/AIDS patients were included in the cohort, the median follow-up time was 5.2 years (IQR:2.1-9.1), 1 054 of whom died, opportunistic infection was the main cause of death, followed by drug overdose and other cardiovascular diseases, the all-cause mortality was 4.00 (95% CI:3.76-4.25)/100 person-years, median survival time was 17.83 years (95% CI:15.81-19.86), and cumulative survival rates at 1, 5, 10, 15 and 20 years were 0.89, 0.78, 0.65, 0.46 and 0.26, respectively. Cox multivariate model showed that the risks for death were as follows:men was 1.423-fold of women, 30-, 40-, 50-and ≥ 60 years old groups were 1.677-, 2.171-, 3.096-and 5.150-fold of 15-year groups, other ethnic groups was 1.170-fold of Han nationality, divorced or widowed people was 1.214-fold of unmarried people, heterosexual transmission, transmission of injecting drug use, and other transmission were 1.769-, 3.326-and 2.532-fold of men who had sexual with men respectively, the specimen sources of premarital/pregnancy/prenatal check-up, supervision place, medical institution detection and other examination were 0.575-, 0.432-, 1.413-and 0.591-fold of voluntary consultation examination respectively, at the present stage, the course of disease of HIV-infected person was 1.561-fold of AIDS patients, the baseline CD4+ cell levels of 200-, <200 cells/μL and unknown groups were 1.363-, 2.180-and 3.638-fold of ≥ 500 cells/μL group respectively, patients who didn't receive antiretroviral therapy (ART) was 10.410-fold of those who had received ART. Conclusion The survival time of HIV-infected/AIDS patients is affected by multiple factors, it is necessary to strengthen the early detection and treatment, pay attention to non-AIDS related death causes, and give corresponding intervention, so as to prolong the survival time of HIV-infected/AIDS patients.

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董文斌, 李世福, 赵金仙,等.云南省玉溪市1995—2018年HIV感染/AIDS病例全死因及生存分析[J]. 中国感染控制杂志,2020,19(11):958-965. DOI:10.12138/j. issn.1671-9638.20205763.
DONG Wen-bin, LI Shi-fu, ZHAO Jin-xian, et al. All-causes of death and survival of HIV-infected/AIDS patients in Yuxi City, Yunnan Province, 1995-2018[J]. Chin J Infect Control, 2020,19(11):958-965. DOI:10.12138/j. issn.1671-9638.20205763.

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  • 收稿日期:2019-09-03
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  • 在线发布日期: 2020-11-28
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