中医药综合干预对农村地区HIV感染者死亡率的影响

Effects of TCM Comprehensive Intervention on Case Fatality Rate of HIV-Infected Persons in Rural Areas

目的探讨中医药综合治疗对农村地区人类免疫缺陷病毒(HIV)感染者死亡率的影响。方法以河南省某HIV感染高发区农村地区2004年10月纳入中医救治项目的 HIV感染者为中医治疗组,以未纳入中医救治项目、地理位置临近村庄的HIV感染者为非中医治疗组。通过中医药治疗艾滋病数据库和艾滋病综合防治数据信息系统收集研究对象的相关信息,记录截至2012年10月两组患者的死亡例数,并应用Cox比例风险模型分析影响HIV感染者死亡的因素。结果共纳入患者448例,中医治疗组103例,艾滋病相关死亡15例,死亡密度为2.12/100人年,累计死亡率14.6%;非中医治疗组345例,艾滋病相关死亡90例,死亡密度为3.94/100人年,累计死亡率26.1%,两组患者累计死亡率比较差异有统计学意义(P<0.05)。Cox比例风险模型单因素分析结果显示,非中医治疗组患者的死亡风险是中医治疗组患者的1.84倍(P<0.05);多因素分析结果显示,非中医治疗组患者的死亡风险是中医治疗组患者的1.90倍(P<0.05);此外,性别、年龄、婚姻状况和开始服用抗病毒药的时间也是HIV感染者死亡的影响因素(P<0.05)。结论中医药综合治疗可能降低HIV感染者的死亡率,但有待开展前瞻性研究给予客观评价。

Objective To study the effects of TCM comprehensive intervention on the case fatality rate （CFR） of human immunodeficicney virus （HIV） -infected persons in rural areas. Methods The HIV-infected persons in rural areas with a high incidence of HIV infection in 2004 were selected as the TCM treatment group. The TCM treatment project were selected as the non-TCM Henan Province included in TCM treatment project in October HIV-infected persons in neighboring rural areas not included in treatment group. The relevant information was collected through Database of TCM Treatment for AIDS and AIDS Prevention and Control Information System. The CFR till October 2012 in both groups were recorded. The factors affecting the CFR of HIV-infected persons were analyzed with Cox proportional hazards model. Results Totally 448 HIV-infected persons were included with 103 persons in the TCM treatment group and 345 persons in the non-TCM treatment group. There were 15 cases of AIDS-related deaths in the TCM treatment group, with a death density of 2. 12 per 100 person-years and a cumulative CFR of 14. 6%. There were 90 cases of AIDS-related deaths in the non-TCM treatment group, with a death density of 3.94 per 100 person- years and a cumulative CFR of 26. 1%. There was a significant difference between groups in the cumulative CFR （P 〈 0. 05 ）. Univariate analysis showed that the risk of death in the non-TCM treatment group was 1.84 times as that in the TCM treatment group （ P 〈 0. 05 ）. Multivariate analysis showed that the risk of death in the non-TCM treatment group was 1.90 times as that in the TCM treatment group （P 〈0. 05 ）. Furthermore, gender, age, marital status and time to start taking antiviral drugs were also the factors affecting the deaths of HIV-infected persons （ P 〈 0. 05 ）. Conclusion TCM comprehensive intervention may reduce CFR of HIV-infected persons but prospective studies need to be conducted to give an objective assessment.