贵州省接受抗病毒治疗艾滋病患者的生存因素分析

Survival factors of AIDS patients receiving antiretroviral therapy in Guizhou Province

目的了解贵州省人类免疫缺陷病毒(HIV)感染者和艾滋病(AIDS)患者接受抗逆转录病毒治疗后的生存时间及其影响因素。方法采用回顾性队列研究方法,分析贵州省2005—2016年接受抗病毒治疗的AIDS患者的生存时间,应用寿命表法计算生存概率,运用Cox比例风险回归模型分析其影响因素。结果共纳入分析15921例AIDS患者,开始治疗时的平均年龄为(42.13±14.40)岁,已婚/同居者占58.61%。治疗后患者的随访时间[中位数(P25~P75):15.96(6.00~33.00)]月。9.77%随访病例发生死亡,其中59.29%的死亡发生在开始治疗的12个月内;第1、5、10年的生存率分别为93.00%,82.00%和74.00%。Cox比例风险回归模型分析结果显示:女性患者死亡风险是男性的0.58倍(95%CI:0.49~0.68);随着年龄增高,患者死亡风险亦增高;基线CD4+T淋巴细胞计数越高,患者死亡风险越低;治疗前无疾病症状体征的患者死亡风险是有症状体征的0.70倍(95%CI:0.60~0.81)。结论贵州省AIDS患者抗病毒治疗情况整体较好,应高度关注死亡危险因素较高的患者,建议在扩增治疗患者的同时注重提高医疗水平和服务质量。

Objective To explore the survival time and its influencing factors of patients in Guizhou Province after they received antiretroviral therapy（ART） for treating human immunodeficiency virus （HIV） infection and acquired immunodeficiency syndrome （AIDS）. Methods A retrospective cohort analysis was conducted to analyze survival time of AIDS patients who received ART in Guizhou Province in 2005-2016, life table method was used to calculate the survival probability, Cox proportional hazards regression model was used to analyze the influencing factors of survival time. Results A total of 15 921 patients were included in the study, the median age at the beginning of therapy was（42.13 ± 14.40）years old, 58.61% of patients were married/housemate, The length of ART follow-up was （median[P2s - P：5]： 15.96[ 6.00 ±33. 00]） months. 9. 77% of the follow-up cases died, 59. 29% of the deaths occurred within 12 months of initiation of treatment; survival rates in the first, fifth, and tenth year were 93.00%, 82.00%, and 74.00% respectively. Cox proportional hazards regression model analysis showed that fe- male patients were 0.58 times more likely to die than male patients （95 % CI： O. 49- 0.68） ;the risk of death in- creased with increase of ages; the higher the baseline CD4＊ T lymphocyte count, the lower the risk of death; the risk of death in patients without symptoms or signs before therapy was 0. 70 times than those with symptoms orsigns（95% CI：O. 60 - 0.8l）. Conclusion The antiviral therapy of AIDS patients in Guizhou Province is generally well, patients with high risk actors for death should be paid high attention, it is suggested that medical level and service quality should he improved when patients are treated.