人类免疫缺陷病毒感染孕产妇所产婴儿死亡的影响因素分析

Influencing factors on the death of infants born to HIV infected mothers

目的了解我国获得性免疫缺陷综合征（AIDS）高流行地区人类免疫缺陷病毒（HIV）感染孕产妇所产婴儿死亡的影响因素。方法结合21904年建立的HIV感染孕产妇及所产婴儿随访研究队列，于2008年8～11月对我国4省7县区2004年1月至2007年11月HIV感染孕产妇所产婴儿的死亡状况及其影响因素进行调查。实际收集了498对HIV感染孕产妇及所产婴儿的相关信息。采用单因素和多因素Cox比例风险模型对HIV感染孕产妇所产婴儿死亡的影响因素进行分析。结果498名婴儿，总观察人年数为406．22人年，死亡45例，死亡密度为110．78／1000人年。单因素分析结果显示，母亲孕产期处于AIDS前期或发病期（RR=1．971，95％CI值：1．143～3．396）、孕产妇生存状况（RR=3．062，95％CI值：1．097～8．550）、经产妇（RR：0．517，95％CI值：0．278～0．961）、自然分娩（RR=0．561，95％C1值：0．345～0．910）、早产（RR=5．302，95％CI值：2．944～9．547）、低出生体重（RR=4．920，95％CI值：2．691～8．994）、母子预防性服用抗逆转录病毒药物（RR=0．227，95％CI值：0．121～0．428）及婴儿感染HIV（RR=5．870，95％CI值：3．232～10．660）等因素影响HIV感染孕产妇所产婴儿的死亡。进一步的多因素分析显示，处于AIDS前期或发病期的孕产妇较处于AIDS潜伏期者所产婴儿死亡危险增加（RR：6．99，95％CI值：1．92～25．64）；孕产期CD4＋T淋巴细胞计数低于200个／μl的孕产妇，所产婴儿发生死亡的危险增加（RR=2．05，95％CI值：1．01～4．15）；母子未预防性服用抗逆转录病毒药物增加婴儿死亡的危险（RR=6．17，95％CI值：1．62～23．26）；早产婴儿歹匕亡危险是足月产婴儿的2．87倍（95％CI值：1．12～7．35）；HIV感染婴儿死亡危险是非HIV感染婴儿的9．87倍（95％CI值：3．81～25．62）。结论提高HIV感染孕产妇自身免疫力，降低HIV母婴传播率及HIV感染孕产妇所产婴儿早产、低出生体重的发生率有助于降低婴儿死亡率。

Objective To understand the influencing factors on the death of infants born to HIV infected mothers in areas with high prevalence of HIV/AIDS in China. Methods Based on the follow-up cohort study targeting at HIV/AIDS infected pregnant women and their babies initiated in 2004, a survey on the death status and influencing factors on the infants born to HIV/AIDS infected mothers enrolled in this cohort from Jan. 2004 to Nov. 2007 was carried out during Aug. to Nov. 2008 in seven counties of four provinces in China. A total of 498 pairs of HlV-infected mothers and their infants were enrolled and their related information was collected. Single factor and multiple factors Cox model methods were adopted for data analysis. Results The total observed person-years of 498 infants was 406. 22, among which, 45 infants died,and the mortality density was 110.78 per 1000 child-year. A single factor Cox model showed, the pregnancy in pre-period of HIV/AIDS and HIV/AIDS period （ RR = 1. 971,95% CI： 1. 143 - 3. 396 ）, living status of the pregnancy （ RR = 3. 062,95% CI： 1. 097 - 8. 550 ）, multipara women （ RR = 0. 517,95% CI： 0. 278 - 0. 961 ）, natural childbirth （ RR = 0. 561,95% CI： 0. 345 - 0. 910 ）, premature labor （ RR = 5. 302, 95 % CI： 2. 944 - 9. 547 ）, low birth weight （ RR = 4. 920,95 % CI： 2. 691 - 8. 994 ）, mother-child pairs taking antiretroviral drugs（ RR =0. 227,95% CI：O. 121 - 0. 428 ） and infants infected HIV （ RR = 5. 870,95% CI： 3. 232 - 10. 660） could affect the infants death. The death of HIV-exposed infants was influenced by various factors. The death risk of infants born to HIV infected mothers who were in the danger of pre-period of HIV/ AIDS and HIV/AIDS period was greater than the infants delivered by HIV infected mothers who were in preclinical period of HIV/AIDS （RR = 6.99,95% CI： 1.92 -25.64）. The death risks were greater in the group that the women whose CD4 ＋ TLC count number lower than 200 cells/μl （ RR = 2.05,95% CI： 1.01 - 4. 15）. The infants whose mothers had no ARV treatment had higher possibility to die than the others（RR = 6. 17,95% CI： 1.62 -23.26）. The death risk of premature delivered infants was 2. 87 times of mature delivered infants （95% CI： 1.12 - 7.35 ）. The death risk of HIV/AIDS infected infants was 9. 87 times of the HIV/AIDS uninfected infants （ 95% CI： 3.81 - 25.62 ） . Conclusion Some measurements including improving HIV-infected pregnant women＇ s immunity, reducing mother to child transmission of HIV and premature birth, low birth weight are beneficial to reducing infant mortality.