四川省凉山州2008-2013年艾滋病患者生存时间及影响因素分析

Survival time and related influencing factors of AIDS patients in Liangshan prefecture, Sichuan province, during 2008-2013

目的 分析四川省凉山州2008-2013年艾滋病患者抗病毒治疗情况,探讨其生存时间及影响因素,为制订艾滋病综合防治策略提供科学依据.方法 采用回顾性队列研究方法,从国家艾滋病综合防治信息管理系统选取凉山州2008-2013年期间诊断的艾滋病患者,收集其基本人口学及感染、发病、治疗、死亡等相关信息,利用Cox比例风险回归模型分析可能影响因素.结果 8 321例艾滋病患者确诊艾滋病年龄范围18 - 87.5岁,平均（34.2±9.8）岁,死亡3 021例,接受抗病毒治疗（ART）患者3 721例.研究对象总病死率由2008年的43.9/100人年下降到2013年的20.7/100人年,治疗组病死率由2008年的27.3/100人年下降到2013年的5.1/100人年,未治疗组病死率维持在45.0/100人年至50.8/100人年;治疗比例逐年上升,由2008年的5.8％上升到2013年的54.5％.所有艾滋病患者中位生存时间为35.1个月,其中未治疗组为18.4个月;所有艾滋病患者生存时间与治疗、确诊艾滋病年龄以及感染HIV途径有关（P＜0.05）,未接受治疗患者的死亡风险是接受治疗者的5.78倍,但与性别、民族无关（P＞0.05）;治疗组艾滋病患者生存时间与性别、确诊艾滋病时年龄、民族、感染HIV途径、确诊艾滋病时CD4＋T细胞计数、治疗基线CD4＋T细胞计数和基线贫血有关（P＜0.05）;未治疗组艾滋病患者生存时间主要与确诊艾滋病年龄有关（P＜0.05）,与其余因素无关（P＞0.05）.结论 抗病毒治疗是影响艾滋病患者生存时间的重要因素,治疗时机对于治疗效果至关重要,治疗基线CD4＋T淋巴细胞计数水平是影响治疗效果的关键指标,提示加强CD4＋T淋巴细胞计数的检测与监测、及早发现和确证艾滋病患者、扩大抗病毒治疗覆盖面、选择合适的治疗时机是提高抗病毒治疗效果、降低病死率、延长艾滋病患者生存时间的重要途径。

Objective To investigate the survival time and affecting factors among AIDS patients under antiretroviral treatment,between 2008 and 2013 in Liangshan,Sichuan province.Methods Observational retrospective cohort study method was applied.AIDS patients were chosen from China＇ s national comprehensive prevention and control management system of AIDS in Liangshan,during 2008-2013.Related information on demographics,source of infection,pathogenesis,treatment and death was collected.Cox proportional hazards model was applied to analyze the factors that might affect the survival on patients.Results Among the 8 321 cases,ranging from 18 to 87.5 years old （mean age as 34.2 ± 9.8）,3 021 died and 3 721 patients had received HAART treatment.The total mortality rate dropped from 43.9/100 person-years to 20.7/100 person-years from 2008 to 2013.In the treatment group,mortality rate dropped from 27.3/100 person-years to 5.1/100 person-years,while in the untreated group it remained high-between （45.0-50.8）/100 person-years.Proportion for the treatment coverage increased gradually,from 5.8% in 2008 to 54.5% in 2013.Median survival time of all the AIDS patients was 35.1 months,but 18.4 months in the untreated group.Survival of all the AIDS patients was associated with factors as：treatment,age when AIDS diagnosis was made and route of HIV infection （P〈0.05）.The risk of death among untreated patients was 5.78 times to the treated ones,but did not seem to relate to gender or nationality （P〉0.05）.Survival of the treated group was associated with factors as gender,age when AIDS diagnosis was made,nationality,route of HIV infection,CD4 ＋ T cell count when AIDS diagnosis was made,CD4＋T cell count at treatment baseline,anemia at the treatment baseline （P〈 0.05）.Survival of the untreated group was mainly associated with age when AIDS was diagnosed （P〈 0.05） while other factors did not seem to be significantly related （P〉0.05）.Conclusion Antiretroviral therapy appeared an important factor that affecting the survival of AIDS patients,timely treatment and CD4 ＋T cell count provided at the baseline for treatment,were two key factors that affecting the outcome of treatment.Our findings pointed out that tactic factors as：strengthening the detection,monitoring on CD4 ＋T cell count,early diagnose and treatment,expanding the coverage of antiretroviral therapy,and appropriate timing for treatment etc.,were important ways to enhance the effects of treatment,so as to reduce the mortality rate and prolong the time of survival.