人类免疫缺陷病毒感染/艾滋病患者169例的颈动脉超声检查特点及影响因素分析

Characteristics and influencing factors of carotid ultrasound in 169 patients with human immunodeficiency virus/acquired immunodeficiency syndrome

目的探讨人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染/艾滋病(acquired immunodeficiency syndrome,AIDS)患者出现颈动脉异常的发生情况和影响颈动脉异常发生的相关危险因素。方法选取2003年4月至2019年12月在北京协和医院感染内科AIDS门诊规律随诊,并于2015年7月至2019年12月完善颈动脉超声检查的169例HIV感染/AIDS患者,按年龄分为青年(≤44岁)和中老年(≥45岁),收集纳入患者的体格检查资料。统计学方法采用logistic回归分析和单样本t检验。结果169例HIV感染/AIDS患者中,颈动脉异常40例(23.7%),颈动脉无异常129例(76.3%)。中老年[比值比(odds ratio,OR)=3.85,95%可信区间(95%confidence interval,95%CI)1.54~9.65,P<0.01]、高血压(OR=6.24,95%CI 1.95~20.00,P<0.01)、高脂血症(OR=2.44,95%CI 1.00~5.93,P<0.05),以及人类白细胞抗原(human leucocyte antigen,HLA)-DR^(+)CD8^(+)/CD8^(+)增高(OR=1.03,95%CI 1.01~1.06,P<0.05)可增加发生颈动脉异常的风险。HIV感染/AIDS患者中Ⅰ组(20~30岁)、Ⅱ组(31~40岁)、Ⅲ组(41~50岁)的颈总动脉内中膜厚度(inner medium film thickness,IMT)分别为(0.0610±0.0012)、(0.0629±0.0014)、(0.0656±0.0026)cm,分别厚于对照组的(0.051±0.003)、(0.056±0.004)、(0.063±0.002)cm,差异均有统计学意义(t=5.119、4.775、1.739,均P<0.05)。HIV感染/AIDS患者中A组(30~44岁)、B组(45~59岁)的颈总动脉IMT分别为(0.0626±0.0011)、(0.0723±0.0034)cm,分别厚于对照组的(0.052±0.011)、(0.064±0.015)cm,差异均有统计学意义(t=9.520、3.012,均P<0.01)。结论相对年轻的HIV感染/AIDS患者较同龄HIV阴性人群发生颈动脉异常的概率更高,发生心血管疾病的风险可能更大。提示对于HIV感染/AIDS患者特别是青年患者,应早期进行颈动脉超声检查,尽早发现异常并进行干预和治疗。

Objective To investigate the occurrence of carotid artery abnormalities in human immunodeficiency virus(HIV)/acquired immunodeficiency syndrome(AIDS)patients and the related risk factors affecting the occurrence of carotid artery abnormalities.Methods A total of 169 regular follow-up outpatients with HIV/AIDS from April 2003 to December 2019 in Peking Union Medical College Hospital,whose carotid artery ultrasound examination were performed from July 2015 to December 2019 were included.The patients were divided into young(≤44 years old),middle-aged and elderly(≥45 years old)according to their ages,and the physical examination data of the included patients were collected.The statistical methods were logistic regression analysis and single sample t test.Results Among the 169 HIV/AIDS patients,40(23.7%)had abnormal carotid artery and 129(76.3%)had no abnormal carotid artery.Middle-aged and elderly people(odds ratio(OR)=3.85,95%confidence interval(95%CI)1.54-9.65,P<0.01),hypertension(OR=6.24,95%CI 1.95-20.00,P<0.01),hyperlipidemia(OR=2.44,95%CI 1.00-5.93,P<0.05),and elevated human leucocyte antigen(HLA)-DR^(+)CD8^(+)/CD8^(+)(OR=1.03,95%CI 1.01-1.06,P<0.05)were the risk factors for carotid artery abnormality.The common carotid artery inner medium film thickness(IMT)of patients in HIV/AIDS groupⅠ(20 to 30 years old),groupⅡ(31 to 40 years old),groupⅢ(41 to 50 years old)were(0.0610±0.0012),(0.0629±0.0014)and(0.0656±0.0026)cm,respectively,which were thicker than the control groups((0.051±0.003),(0.056±0.004)and(0.063±0.002)cm,respectively).The differences were all statistically significant(t=5.119,4.775 and 1.739,respectively,all P<0.05).The common carotid artery IMT of patients in HIV/AIDS group A(30 to 44 years old)and group B(45 to 59 years old)were(0.0626±0.0011)and(0.0723±0.0034)cm,respectively,which were thicker than the control groups((0.052±0.011)and(0.064±0.015)cm,respectively),the differences were both statistically significant(t=9.520 and 3.012,respectively,both P<0.01).Conclusion Younger HIV-positive people have a higher probability of abnormal carotid arteries and may be at greater risk of cardiovascular disease than HIV-negative people of the same age,suggesting that HIV-positive people,especially young people,should be examined early with ultrasound of the neck arteries to detect abnormalities and intervene as soon as possible.