运城市艾滋病免费抗病毒治疗病例生存分析

Survival analysis of HIV/AIDS cases receiving free antiretroviral therapy in Yuncheng of Shanxi Province

目的评估山西省运城市艾滋病免费抗病毒治疗的效果,分析影响治疗效果的主要因素。方法采用回顾性队列研究方法,选择2004年6月底至2009年12月底纳入国家免费抗病毒治疗系统的病例,收集资料,补充调查,采用SPSS 18.0统计分析。结果 602例抗病毒治疗病例中,存活490例(81.4%),死亡81例(13.5%),退出和转诊22例(3.7%),意外死亡9例(1.5%)。治疗后第3、6、12、24、36、48、60个月,累计生存率分别为0.93、0.91、0.89、0.87、0.86、0.85、0.84。CD4+T淋巴细胞计数治疗前平均值(123±98.6)个/μL,治疗后平均值(298±187.1)个/μL,治疗前后平均增加175个/μL(P=0.000)。病毒载量治疗前<最低检测限(LDL)占9.1%,治疗后<LDL占83.3%。应用Cox比例风险回归模型做多因素分析发现,治疗前CD4+T淋巴细胞计数水平、治疗前后CD4+T淋巴细胞变化水平、治疗后病毒载量水平3个变量的分组与生存时间差异分别有统计学意义。死亡危险比(HR)分别为7.46、7.53、8.66。结论抗病毒治疗取得了较好的治疗效果。

Objective To evaluate the effectiveness of free antiretroviral therapy （ART） and its influence on the survival of ART recipients. Method A retrospective cohort study was carried out in Yuneheng City, Shanxi Province among all qualified ART recipients who were aged 15 years above and engaged in the national free ART program from Jun 2004 to Dec 2009. Results A total of 602 treated cases were recruited in this study. The analysis showed that 490 （81.4%） cases survived, 81 cases （13.5%） died of AIDS related diseases, 22 cases （3.6%） withdrew from the program and 9 cases （1.5%） died of accidents. The cumulative survival rates were 0. 93, 0. 91, 0. 89, 0.87, 0.86, 0.85 and 0.84 at 3, 6, 12, 24, 36, 48 and 60 months respectively. The medians CD＋ T cell counts were 123±98.6/μL prior to the therapy and 298 ±187.1/μL post the therapy with an average increase of 175/μL （P=0. 000） ; 9.1% of the ART recipients had their viral loads below detection limit before the therapy and this percentage increased to 83.3 % after the therapy. In the Cox proportional hazard model, the univariate analysis showed that 7 factors were significantly associated with survival time, and 3 of them held true in the multivariate analysis. The hazard ratio was 7.46,7.53 and 8.66. Conclusion ART has been successfully implemented by significantly improving recipients＇ immune system and containing viral replication.