北京市1177例免费抗病毒治疗艾滋病病例生存情况及其影响因素分析

Survival and related factors of 1 177 HIV/AIDS patients with antiretrovirai therapy in Beijing

目的分析北京市1177例免费抗病毒治疗艾滋病病例的生存情况及其影响因素。方法采用回顾性队列研究方法，对艾滋病综合防治信息系统中2012年1月1日-12月31日期间开始治疗的病例进行随访观察。观察起点为研究对象开始进行抗病毒治疗时，观察终点为2015年12月31日。应用寿命表法计算生存率，应用乘积极限法计算平均生存时间，应用Cox比例风险模型分析生存时间的影响因素。结果共纳入研究对象1177例，平均生存时间47．45个月（95％CI47．18—47．72），总病死率为0．43／100人年（16／3728．42），治疗第1、2、3、4年的生存率分别为98．96％、98．69％、98．59％和98．59％。Cox比例风险模型分析结果显示：患者开始治疗时年龄≥50岁与15～29岁相比（HR=28．98，95％CI3．18～263．94）；传播途径为静脉注射吸毒与同性性传播相比（HR=22．60，95％CI5．07～100．78）；基线CD4＋T淋巴细胞计数0—50个／μL与〉200个／μL相比（HR=14．23，95％CI2．67—75．90），对研究对象生存时间的影响有统计学意义。结论北京市免费抗病毒治疗有效降低了艾滋病病例的病死率，延长了生存时间；开始治疗时年龄、传播途径、基线CD4＋T淋巴细胞计数是影响生存时间的危险因素。

Objective To analyze the survival time and related factors of 1 177 HIV patients receiving antiretroviral therapy in Beijing. Methods A retrospective cohort study was conducted to analyze the data that collected from the National HAART Reporting System during January 1, 2012 to December 31, 2015. Life table method was applied to calculate the survival proportion. Kaplan-Meier method was used to calculate the average survival time at the end of observation. Cox proportion hazard regression model was used to identify the factors related to survival time. Results A total of 1 177 cases were selected. The average survival time was 47.45 months （95%CI47.18-47.72）, and the overall mortality rate was 0.43 per 100 person-year. The survival rates at 1st, 2nd, 3rd and 4th year were 98.96%, 98.69%, 98.59% and 98.59%, respectively. Multivariate Cox regression analysis showed that patients＇ age （≥50 years） （HR=28.98, 95%CI 3.18-263.94）, transmission by intravenous drug use （HR=22.60, 95%CI 5.07-100.78） and baseline CD4＋ T cell count of 0-50/μL comparing to 〉200/μL （ITR=14.23, 95%CI 2.67-75.90）, at antiretroviral therapy initiation had significant effect on patients survival. Conclusions The antiretroviral therapy in Beijing reduced the mortality rate, prolonged the survival time, and was significantly effective. The related factors were transmission route, patients＇ age and CD4＋ T cell counts when antiretroviral therapy began.