广东省艾滋病感染者/患者的生存分析

Survival analysis of people living with HIV/AIDS in Guangdong Province

目的了解广东省是否需要治疗及治疗与否的艾滋病感染者/患者（HIV/AIDS）的生存时间,探讨影响HIV/AIDS生存时间的风险因素。方法采用回顾性队列研究。研究对象来自中国疾病预防控制信息系统/艾滋病综合防治信息系统/HIV/AIDS病例报告;纳入研究的对象为在2004年1月至2014年6月间报告的、现住址在广东省的、非港澳台及外籍的年龄在15岁以上的HIV/AIDS。采用乘积-极根法绘制4组生存曲线,用log-rank检验对多组生存曲线比较,多因素Cox比例风险模型对影响HIV/AIDS生存时间的风险因素进行分析。结果符合条件的HIV/AIDS病例共36 500例,最终纳入分析28 474例,男女性别比为3.54∶1,年龄以15-39岁为主（68.78%）,婚姻状况以已婚为主（44.02%）,传播途径以异性为主（55.33%）,需要治疗的占71.68%,已治疗的有53.50%。8年生存率由高到低依次是不需治已治组（88.68%）、需治已治组（79.07%）、不需治未治组（70.14%）及需治未治组（42.92%）。4组生存曲线差异具有统计学意义（P〈0.01）。多因素Cox比例风险模型结果显示,男性的死亡风险是女性的1.42倍,15岁以上的病例每增加10岁死亡风险增加0.60倍,异性传播的死亡风险是同性传播的5.66倍,注射毒品传播的死亡风险是同性传播的9.60倍,首次检测CD4^＋T细胞计数分组中,相对于〈200个/mm^3,200个/mm^3及以上各组的死亡风险由0.43倍逐渐降低到0.26倍。结论对HIV/AIDS病例进行治疗可以延长其生存时间,及早进行CD4＋T细胞计数检测以明确病程,为是否开始艾滋病抗病毒治疗提供依据。

Objective To explore survival time and it＇s influencing factors among people with HIV / AIDS whether needing or having accepted highly active antiretroviral therapy（ HAART） or not.Methods A retrospective cohort study was adopted. The subjects were obtained from Chinese national HIV / AIDS comprehensive control and prevention information system,presently living in Guangdong Province from January 2004 to June 2014,excluding less than 15 years old,Hong Kong,Macao,Taiwan,and foreign nationality. Survival curves of four groups were measured by productive-limit method. The difference of survival curves among all the groups were tested by log-rank. The risk factors affecting survival time of people with HIV / AIDS were analyzed by Cox proportional hazard model. Results A total of 28 474 cases were entered for analysis from 36 500 cases of HIV / AIDS who met the conditions. The sex ratio of male and female was 3. 54∶ 1. They were mainly at 15-39 years of age（ 68. 78%）. The marital status was mainly married（ 44. 02%） and the route of transmission was mainly heterosexual（ 55. 33%）. Among them,71. 68% needed HAART and 53. 50% had accepted it. The eight-year survive rates from high to low were 88. 68%,79. 07%,70. 14%,and 42. 92% for the four groups of Not-need-but-treated,Needand-treated,Not-need-and-not-treated,and Need-but-not-treated,respectively（ P〈0. 01）. In the Cox proportional hazard model,the risk of death was 1. 42 times in males compared with females,increased0. 60 time for every 10 years of age in the cases aged above 15 years,5. 66 times in heterosexual transmission compared with homosexual transmission,and 9. 60 times in transmission by drug injection compared with homosexual transmission. Compared with the group of〈 200 counts / mm^3 in the initial test of CD4＋T cells,the risk of death was decreased from 0. 43 gradually to 0. 26 time in the groups of ≥200 counts /mm^3. Conclusion HAART can extend the survival time of people living with HIV / AIDS. The test of CD4^＋T cell counts should be conducted as soon as possible to confirm the course and provide the information for initiating HAART.