摘要
目的 了解邵阳市人类免疫缺陷病毒感染者/艾滋病(HIV/AIDS)患者的死亡风险及其相关影响因素。方法 采用回顾性队列研究方法,采用Kaplan-Meier生存分析和Cox比例风险回归模型分析1997—2024年邵阳市HIV/AIDS病例的生存状况和死亡风险。结果 研究纳入5 805例患者,观察期间有1 941例死亡,其中54.20%的死因为非艾滋病相关疾病,全因病死率为9.01/100人年。男性死亡风险是女性的1.447倍;不同HIV感染确诊年龄、文化程度患者的死亡风险比较,差异均有统计学意义(均P<0.05)。基线CD4^(+)T淋巴细胞计数在0~199组的患者死亡风险是≥500组的1.497倍(P<0.001),且该组病死率高于其他组;末次CD4^(+)T淋巴细胞计数越低的患者死亡风险更高(P<0.001)。未接受抗病毒治疗患者的病死率为36.37/100人年,高于接受治疗者的4.21/100人年,两者最大死亡风险比为6.578倍(P<0.001);相较于含INSTI方案组患者,含LPV/r方案、含NNRTI方案死亡风险分别为4.902、2.769(均P<0.001),其中含LPV/r方案组患者因心脑血管疾病死亡的比率高于含NNRTI方案组(11.79%VS 7.26%;χ^(2)=3.872,P=0.049)。结论 邵阳市HIV/AIDS患者面临较高的死亡风险。男性、高龄、低文化程度、未接受抗病毒治疗以及基线/末次CD4^(+)T淋巴细胞计数低都是增加死亡风险的重要因素。使用含有INSTI的治疗方案可以显著降低病死率。因此,早期发现病例,及时优化抗病毒治疗方案,并加强患者管理和依从性教育,对降低HIV/AIDS患者的死亡风险具有一定的临床参考价值。
Objective To understand the risk and related influencing factors of death of patients with infection of human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)in Shaoyang City.Methods The survival status and death risk of HIV/AIDS patients in Shaoyang City from 1997 to 2024 were analyzed by Kaplan-Meier survival analysis and Cox proportional hazards regression model of retrospective cohort study method.Results A total of 5805 patients were included in analysis,1941 died during the observation period,out of which 54.20%died from diseases irrelevant to AIDs,and the all-cause mortality was 9.01/100 person-year.The risk of death for males was 1.447 times of females.The comparison of death risk among patients with different ages of HIV infection diagnosis and educational levels showed statistically significant differences(all P<0.05).The death risk of patients with baseline CD4^(+)T lymphocyte count in the 0-199 group was 1.497 times higher than that in the≥500 group(P<0.001),and the mortality in this group was higher than those in other groups.Patients with lower last CD4^(+)T lymphocyte counts had a higher risk of death(P<0.001).The mortality of patients who did not receive antiviral treatment was 36.37/100 person-year,which was higher than 4.21/100 person-year of those who received treatment.The maximum ratio of death risk between the two was 6.578(P<0.001).Compared with patients in the INSTI-containing regimen group,the death risks of patients in LPV/r-containing and NNRTI-containing regimen groups were 4.902 and 2.769,respectively(both P<0.001),and patients in the LPV/r-containing regimen group had a higher percentage of deaths due to cardiovascular and cerebrovascular diseases than those in the NNRTI regimen group(11.79%vs 7.26%;χ^(2)=3.872,P=0.049).Conclusion HIV/AIDS patients in Shaoyang City face a high risk of death.Male,advanced age,low educational level,without receiving antiviral treatment,and low baseline/last CD4^(+)T lymphocyte count are all important factors that contribute to the increase of death risk.Receiving INSTI-containing treatment regimen can significantly reduce mortality.Therefore,early detecting cases,timely optimizing antiviral treatment regimen,as well as strengthening patient management and compliance education have certain clinical reference value for reducing the risk of death in HIV/AIDS patients.
作者
龙则灵
李朝晖
彭锋
LONG Zeling;LI Zhaohui;PENG Feng(Department of Infectious Diseases,The Central Hospital of Shaoyang,Shaoyang 422000,China;Department of STD/AIDS and Leprosy Prevention and Control,Shaoyang Center for Disease Control and Prevention,Shaoyang 422000,China;Department of Infectious Diseases,The Second Xiangya Hospital of Central South University,Changsha 410000,China)
出处
《中国感染控制杂志》
北大核心
2025年第9期1237-1243,共7页
Chinese Journal of Infection Control
