中老年HIV/AIDS患者基线状况与预后的相关性分析

The Relevance Research between Baseline Conditions of the Middle-aged and Elderly HIV/AIDS Patients and their Prognosis

目的评价已接受抗病毒治疗(ART)的中老年HIV感染者/AIDS患者(HIV/AIDS)的基线临床和实验室检测指标与其生存预后的相关性,探讨影响中老年HIV/AIDS患者长期预后的危险因素。方法对2 659例中老年HIV/AIDS患者的资料进行回顾性队列研究,研究时间段为1998年1月1日-2013年12月31日,根据是否发生艾滋病相关性死亡事件分为死亡组(269例)和非死亡组(2 390例),采用非条件Logistic回归分析筛选出影响中老年HIV/AIDS患者长期生存预后的危险因素。结果死亡组的男性比例(11.66%)高于女性组(6.29%)(P<0.01);WHO临床分期为Ⅳ期、Ⅲ期的病死率分别为12.81%和9.95%,明显高于Ⅱ期(5.71%)和Ⅰ期(4.25%)(P<0.01);基线CD4^+T淋巴细胞小于50/mm^3组的病死率达到16.36%,明显高于51~250/mm^3组(8.28%)和大于250/mm^3组(3.90%)(P<0.01);开始ART前的3个月内合并结核病以外的机会性感染组的病死率(13.10%)高于无机会性感染组(6.58%)(P<0.01);ART前1年内是否有结核病、不同婚姻状况和不同传播途径的病死率均无差别(P>0.05);HBs Ag阳性组和阴性组、Anti HCV阳性组和阴性组的病死率差异均无统计学意义(P>0.05);死亡组的肌酐、谷草转氨酶和谷丙转氨酶高于非死亡组(P<0.05);死亡组的总淋巴细胞、血小板、血红蛋白和甘油三酯低于非死亡组(P<0.05);死亡组的基线HIVRNA、尿素氮、总胆固醇、血清淀粉酶和总胆红素与非死亡组的差异无统计学意义(P>0.05)。非条件Logistic回归分析显示性别(OR=1.90,95%CI为1.27~2.83,P<0.01)、WHO临床分期(OR=1.26,95%CI为1.09~1.46,P<0.01)、基线CD4^+T淋巴细胞(OR=0.70,95%CI为0.54~0.90,P<0.01)和血红蛋白(OR=0.99,95%CI为0.98~1.00,P<0.01)是影响中老年HIV/AIDS患者长期预后的危险因素。结论对于50岁以上的已接受ART的中老年HIV/AIDS患者,性别、WHO临床分期、基线CD4^+T淋巴细胞和血红蛋白是影响其长期生存预后的危险因素。

Objective To evaluate the relevance between baseline conditions of the middle-aged and elderly human immune deficiency virus（ HIV）/acquired immune deficiency syndrome （AIDS） patients who have received Anti-Retroviral Therapy（ART） and their prognosis of survival and discuss the risk factors of survival prognosis for middle-aged and elderly HIV/AIDS patients. Methods Totally 2 659 middle-aged and elderly HIV/ AIDS patients were divided into death group（269cases） and non-death group（2 390 cases）. The independent risk factors of prognosis for middle-aged and elderly HIV/AIDS patients were screened by Unconditioned Logistic Regression Analysis. Results The proportion of male in death group was 11.66%, which was higher than that of non-death group（ 6. 29% ） （ P 〈 0. 01 ）. The fatality rates of World Health Organization （ WHO ）clinical stage for Ⅳand Ⅲ were 12. 81% and 9.95% , respectively, which were higher than that of WHO clinical stage Ⅱ （5.71%） and Ⅰ （4. 25% ） （P 〈0. 01 ）. The fatality rate of the group whose baseline CD4＋ T lymphocyte was less than 50/mm3 reached 16. 36% , which was higher than the group whose baseline CD4＋ T lymphocyte was 51 - 250/mm3 （8.28%） and more than 250 cells/mm3 （3.90%） （P 〈 0. 01 ）. The fatality rate of the group which had opportunistic infection （ nontuberculosis ） within 3 months before ART reached 13.10%, which was higher than that of the group which did not have opportunistic infection （6. 58% ） （ P 〈 0. 01 ）. There were no differences in the mortality rate between the groups of having and not having tuberculosis within 1 year before ART, different marital statuses, and different routes of transmission （ P 〉 0. 05 ）. There were no differences in the mortality rate between the groups of HBsAg positive and negative group, AntiHCV positive and negative group（ P 〉 0. 05 ）. Creatinine, aspertate aminotransferase and cereal third transaminase of the death group were bigger than those of non-death group （ P 〈 0. 05 ）. Total lymphocyte, platelet, hemoglobin and triglyceride of the death group were lower than that of non-death group （ P 〈 0.05 ）. There were no significant differences in baseline HIVRNA, urea nitrogen, total cholesterol, serum amylase and total bilirubin between the death and non-death group （ P 〉 0. 05 ）. Multi-factor unconditioned Logistic regression analysis revealed that gender （OR = 1.90, 95% CI 1.27 -2. 83, P 〈 0. 01 ）, WHO clinical stage （OR = 1.26, 95% CI 1.09 - 1.46, P 〈 0. 01 ）, baseline CD4＋ T lymphocyte （ OR = 0. 698, 95% CI0.54 -0.90,P 〈 0.01） and hemoglobin （OR= 0.99, 95%CI0.98 -1.00, P〈0.01） were prognostic risk factors for middle-aged and elderly HIV/AIDS patients. Conclusions The risk factors affecting the long-term survival prognosis are gender, WHO clinical stage, baseline CD4＋ T lymphocyte and hemoglobin for HIV/AIDS patients who are over 50 years-elderly.