武汉市艾滋病患者生存时间及影响因素分析

Survival time and related factors among 469 AIDS cases in Wuhan city

目的探讨艾滋病(AIDS)患者的生存时间及其影响因素。方法采用回顾性队列研究方法,收集武汉市发现并确诊的469例AIDS患者的发病、死亡等信息及影响因素,用乘积极限法(Kaplan-Meier)描述其生存时间,用寿命表法分析其生存率,用Cox比例风险模型分析影响因素。结果死亡病例主要死于AIDS,平均观察时间为(23.54±26.99)个月,总死亡率为12.05/1 000人月,AIDS相关死亡率为9.51/1 000人月;截止观察终点,9年生存率为65.21%,平均生存时间82.85个月(95%CI=77.59～88.10);单因素分析显示,确诊时年龄、婚姻状况、文化程度、感染途径、治疗情况是AIDS患者平均生存时间的影响因素(P<0.01);多因素Cox回归模型表明,经注射毒品和经同性传播者死亡风险低于经输血/血制品途径传播者(HR=0.318,95%CI=0.132～0.762;HR=0.335,95%CI=0.115～0.969),高效抗反转录病毒治疗(HAART)能降低AIDS患者的死亡风险(HR=0.022,95%CI=0.011～0.043)。结论不同感染途径的AIDS患者生存时间不同,HAART是延长AIDS患者生存时间的有效手段之一,应进一步扩大HAART覆盖面,尽早进行治疗。

Objective To analyze the survival time and related factors of AIDS cases in Wuhan city,Hubei province. Methods A retrospective cohort study was conducted to analyze the survival time and related factors among 469 AIDS cases.Kaplan-Meier method was used to describe the survival distribution and life table was applied to calculate the survival proportion.Cox proportional hazard model was performed to identify the factors associated with survival. Results The deaths were mainly due to AIDS.For the 469 cases,the average observation time was 23.54±26.99 months.The total mortality was 12.05/1 000 person-months and AIDS related mortality was 9.51/1 000 person-months.The average survival time was 82.85 months（95% confidence interval [95%CI]=77.59-88.10 months）with a 9-year survival rate of 65.21% by the end of the observation.Univariate analysis presented a significant difference （P〈0.05） in average survival time of the AIDS patients based on age at diagnosis,education,transmission category,and under highly active antiretroviral therapy（HAART）.Results from multivariate Cox regression showed that injection drug users and men who have sex with men were at a lower risk of death after AIDS diagnosis（hazard ratio [HR]=0.318,95%CI=0.132-0.762; HR=0.335,95%CI=0.115-0.969）compared to those with infection route of blood transfusion or blood products.HAART reduced substantially the risk of death（HR=0.022,95%CI=0.011-0.043）. Conclusion The survival time of the AIDS patients varied in transmission categories.HAART is an effective approach to prolong survival of AIDS patients which should be more available and earlier to start.