基于疾病风险评分匹配法分析中医药治疗对艾滋病患者死亡的影响

Impact of traditional Chinese medicine on mortality among AIDS patients based on disease risk score matching

目的 采用疾病风险评分和Cox脆弱模型分析中医药治疗对艾滋病患者死亡的影响因素。方法 使用艾滋病常规治疗数据库,以2010年5月至2016年5月转服二线cART的艾滋病患者为研究对象,随访10年。将参与中医项目中的艾滋病患者作为中医组,未参与中医项目的艾滋病患者作为非中医组,使用疾病风险评分方法将两组进行1∶1匹配后采用Cox脆弱模型分析中医药治疗对艾滋病患者死亡的影响。结果 符合纳入标准的艾滋病患者共2 954例,匹配后中医治疗组和非中医治疗组各610例,共1 220例。随访结束,中医组累计死亡72例,死亡密度1.46/100人年,非中医治疗组累计死亡105例,死亡密度为2.10/100人年,两组死亡密度差异有统计学意义(P<0.05)。Cox脆弱模型单因素分析结果显示,与非中医治疗组患者相比,中医治疗组患者的死亡风险更低;多因素分析结果显示男性、高年龄、单身/丧偶、文化程度低、HIV阳性时期<5年、CD4细胞计数低和血小板计数异常是艾滋病患者死亡的危险性因素。结论 经疾病风险评分匹配和Cox脆弱模型控制混杂因素后,仍然发现中医药治疗有助于降低艾滋病患者的死亡风险。

Objective This study aimed to analyze factors influencing mortality among AIDS patients who are treated with traditional Chinese medicine(TCM). Methods Utilizing data from the routine AIDS treatment database, this study focused on AIDS patients who transitioned to second-line combination antiretroviral therapy(cART) from May 2010to May 2016, with a follow-up period of 10 years. Patients involved in the TCM project were classified as the TCM group,while those not participating were considered the non-TCM group. After matching the groups at a 1: 1 ratio using the disease risk score method, the cox frailty model was applied to assess the impact of TCM on mortality. Results Of the 2 954 AIDS patients meeting the inclusion criteria, 610 were matched in both the TCM and non-TCM groups, totaling 1 220 patients. At the follow-up's end, the TCM group recorded 72 cumulative deaths, with a mortality density of 1.46 per 100 person-years, whereas the non-TCM group had 105 deaths, with a mortality density of 2.10 per 100 person-years. This significant difference in mortality density(P<0.05) highlights the potential benefit of TCM. Univariate analysis with the cox frailty model suggested a lower risk of death in the TCM group. Multivariate analysis identified several risk factors for mortality, including male gender, older age, being single or widowed, lower educational level, being HIVpositive for less than five years, low CD4+ T cell count, and abnormal platelet count. Conclusions After adjusting for confounders with disease risk score matching and the cox frailty model, TCM treatment appears to significantly reduce mortality risk among AIDS patients.