艾滋病高流行地区TB/HIV双重感染住院患者流行病学特征及影响因素分析

Epidemiological characteristics and influencing factors of hospitalized patients with TB/HIV co-infection in high HIV/AIDS prevalence areas

目的了解艾滋病高流行地区结核菌/艾滋病病毒(TB/HIV)双重感染患者的流行病学特征及多次住院的影响因素。方法对四川省凉山彝族自治州布拖县人民医院2013-2017年医院信息管理系统中入院诊断为TB/HIV双重感染的653名患者进行流行病学特征分析,用非条件Logistic回归模型分析322名多次住院患者的影响因素。结果对布拖县人民医院2013-2017年间653名TB/HIV双重感染住院患者相关信息分析,人口学特征中性别(χ~2=15.482,P=0.004)、年龄(χ~2=18.472,P=0.018)、职业(χ~2=15.584,P=0.004)、婚姻状况(χ~2=25.858,P=0.001)、身体体质指数(BMI)(χ~2=45.396,P <0.001)、HIV不同传播途径之间(χ~2=25.643,P=0.001)存在差异。TB/HIV双重感染患者多次住院的影响因素为婚姻状况、BMI值和HIV传播途径,未婚者风险低于已婚[比值比(OR)=0.440,95%可信区间(CI):0.227~0.852];BMI正常或超重的患者多次住院风险高(OR值分别为1.828和2.657,95%CI分别为1.160~2.880和1.213~5.821);吸毒传播HIV者多次住院风险低于异性性传播(OR=0.527,95%CI:0.360~0.770)。结论加强艾滋病高流行地区高危人群的重点干预和精准防控,提升针对双重感染患者的筛查能力,坚持正确的治疗原则,提高患者依从性并减少再次入院。

Objective To understand the epidemiological characteristics of AIDS patients with tuberculosis infection and the influencing factors of multiple hospitalizations in high HIV prevalence areas. Methods The epidemiological characteristics of 653 patients diagnosed as TB/HIV co-infection were analyzed based on the data from the information management system of the people’s hospital of Butuo county, Liangshan Yi autonomous prefecture from 2013 to 2017. The influencing factors of 322 patients with multiple hospitalizations were analyzed by unconditional logistic regression model. Results Out of the 653 TB/HIV inpatients, there were differences in demographic characteristics in terms of gender(χ~2=15.482, P =0.004), age(χ~2=18.472, P =0.018), occupation(χ~2=15.584, P =0.004), marital status(χ~2=25.858, P =0.001), BMI(χ~2=45.396, P <0.001), and different transmission routes of HIV(χ~2=25.643, P =0.001). The influencing factors of multiple hospitalizations of TB/HIV co-infection patients were marital status, BMI value and route of AIDS transmission. The risk of unmarried persons was lower than that of the married(OR =0.440, 95% CI : 0.227-0.852). Patients with normal BMI or overweight had a high risk of multiple hospitalizations(OR =1.828 & 2.657, 95% CI :1.160-2.880 & 1.213-5.821) respectively. The risk of drug users with multiple hospitalizations was lower than that of those infected through heterosexual transmission(OR = 0.527 and 95% CI : 0.360-0.770). Conclusion To improve the quality of life and prognosis of the hospitalized patients, we should strengthen the behavior interventions for high-risk groups in high-epidemic areas, enhance the screening ability for patients with co-infection, adhere to the standard treatment, improve patient compliance and reduce re-hospitalizations.