1987~2020年福州市HIV/AIDS病例生存分析

Survival analysis on HIV/AIDS patients, Fuzhou city,1987-2020

目的了解福州市现住址HIV/AIDS病例生存时间及其影响因素。方法运用回顾性队列研究方法,对全国艾滋病综合防治数据信息系统中1987~2020年福州市现住址HIV/AIDS资料,采用寿命表法计算生存概率,采用乘积极限法(Kaplan-Meier法)计算研究对象的生存时间,Log-Rank法比较组间差异,用COX比例风险模型分析生存时间的影响因素。结果在4 449例HIV/AIDS病例中,全死因死亡690例,平均生存时间为20.17年(95%CI:19.52~20.82)。1、5、10、15年累积生存率为90.05%、83.88%、78.01%、73.54%。抗病毒治疗组生存时间23.29(95%CI:22.64~23.94)明显高于未治疗组2.50(95%CI:2.14~2.86)(P<0.01),后两个时期报告的HIV/AIDS死亡风险低于第一时期。COX多因素回归分析显示,年龄越大、初中及以下文化程度、异性传播、样本来源于医疗机构、病程阶段是艾滋病、未接受抗病毒治疗,是研究对象死亡的危险因素(P<0.01)。25~59和60岁以上组是0~24岁组的1.96倍(95%CI:1.39~2.77)和4.90倍(95%CI:3.39~7.09);高中及以上文化程度是初中及以下的0.63倍(95%CI:0.51~0.77);同性传播是异性传播途径的0.31倍(95%CI:0.22~0.43);来自重点人群、羁押人群是医疗机构发现的0.44倍(95%CI:0.35~0.56)、0.38倍(95%CI:0.23~0.64);疾病状态为艾滋病是病程为HIV的1.70倍(95%CI:1.39~2.07);治疗组是非治疗组的31.17倍(95%CI:25.61~37.94)。结论早发现、早治疗能降低HIV/AIDS患者死亡风险。

Objective To understand the survival time of HIV/AIDS cases in Fuzhou and its influencing factors. Methods A retrospective cohort study was used to analyze the HIV/AIDS data of Fuzhou city during 1987-2020 in the National AIDS Comprehensive Information System.Life table method was used to calculate the survival probability, and the product limit method(Kaplan-Meier method) was used to calculate the survival time of the research subjects.Log-Rank method was used to compare the differences between groups, and COX proportional risk model was used to analyze the influencing factors of survival time. Results Among 4 449 HIV/AIDS caces, 690 died of all causes.The mean survival time was 20.17 years(95%CI:19.52-20.82).The cumulative survival rates of the subjects at 1 st, 5 th, 10 th and 15 th year were 90.05%,83.88%,78.01% and 73.54%,respectively.The survival time of the antiviral treatment group was 23.29(95%CI:22.64-23.94) significantly higher than that of the untreated group 2.50(95%CI:2.14-2.86)(P<0.01),and the risk of HIV/AIDS death reported in the latter 2 periods was lower than that reported in the first period.Cox multivariate regression analysis showed that older age, education level of junior high school or below, heterosexual transmission, samples from medical institutions, course stage of AIDS,and no antiviral treatment were the risk factors for death(P<0.01).The death risk of 25 to 59 years old and over 60 years old were 1.96 times(95%CI:1.39-2.77) and 4.90 times(95%CI:3.39-7.09) as compared with 0 to 24 years old.High school education or above was 0.63 times lower than junior high school education or below(95%CI:0.51-0.77);the risk death of Homosexual transmission was 0.31 times lower than heterosexual transmission(95%CI:0.22-0.43).Those from key groups and those in custody were 0.44 times(95%CI:0.35-0.56) and 0.38 times(95%CI: 0.23-0.64) lower than those from medical institutions.The disease status of AIDS was 1.70 times than that of HIV(95%CI:1.39-2.07).The treatment group was 31.17 times higher than the non-treatment group(95%CI: 25.61-37.94). Conclusion Early detection and treatment can reduce the mortality risk of HIV/AIDS patients.