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艾滋病抗病毒治疗死亡患者的生存时间及相关因素分析
作者:郝连正 朱晓艳 王国永 林彬 钱跃升 陶小润 胡军 杨兴光 康殿民
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摘要:

目的  探析艾滋病抗病毒治疗死亡患者的生存时间及相关因素。方法  采用回顾性队列研究方法,通过中国疾病预防控制系统艾滋病综合防治信息系统收集2003年7月至2012年12月间山东省接受过艾滋病抗病毒治疗的死亡患者信息,采用Kaplan–Meier乘积极限法估算抗病毒治疗死亡患者的中位生存时间,比较不同年龄、性别、婚姻状况、感染途径、WHO临床分期、基线CD4T淋巴细胞水平、开始治疗距确认HIV感染的时间间隔组生存时间的差异,采用寿命表法和生存曲线描述其生存分布,采用Cox危险比例回归模型筛选艾滋病死亡的相关因素。结果  共收集142例艾滋病抗病毒治疗死亡患者为研究对象,其中艾滋病相关死亡125例(88.03%),艾滋病非相关死亡17例(11.97%);研究对象治疗中位生存时间为3.100(95%CI: 2.279~3.921)个月,接受治疗后的前3个月、3~6个月、6~12个月的累积生存率分别为(52±4)%、(33±4)%、(26±4)%。已婚或同居组治疗中位生存时间为2.670(95%CI: 1.470~3.870)个月,单身(未婚、离异、分居或丧偶)组为5.870 (95%CI: 2.617~9.123)个月;WHO临床分期Ⅰ期或Ⅱ期组治疗中位生存时间为5.870(95%CI: 3.989~7.751)个月,Ⅲ期或Ⅳ期为1.700(95%CI: 0.885~2.515)个月;基线CD4T淋巴细胞≤50个/μl组治疗中位生存时间为1.670(95%CI: 0.759~2.581)个月,51~199个/μl组为4.400(95%CI: 2.735~6.065)个月,≥200个/μl组为7.100(95%CI: 0.000~14.542)个月;不同婚姻状况、WHO临床分期、基线CD4T淋巴细胞水平组间生存时间差异均有统计学意义(P<0.05)。单身(未婚、离异、分居或丧偶)组死亡风险是已婚或同居组的0.641倍,WHO临床分期Ⅲ期或Ⅳ期患者的死亡风险是Ⅰ期或Ⅱ期患者的1.856倍,基线CD4T淋巴细胞为51~199个/μl组、≥200个/μl组患者的死亡风险分别是≤50个/μl组的0.582倍和0.551倍。结论  研究对象治疗后生存时间较短,死亡集中发生于开始治疗后的前6个月,随着时间延长,死亡速度减缓;已婚或同居、基线CD4T淋巴细胞水平低、WHO临床分期Ⅲ期或Ⅳ期是抗病毒治疗患者死亡的危险因素。

关键词:获得性免疫缺陷综合征;HIV;抗病毒治疗;生存时间;回顾性研究

Abstract:

Objective  To analyze survival time of AIDS death cases receiving Antiretroviral Therapy and related factors.Methods  A retrospective cohort study was carried out to collect the data on death cases receiving Antiretroviral Therapy by the National HIV/AIDS Comprehensive Response Information Management System. Kaplan-Meier was used to calculate the median survival time, and compare survival time among different groups of age, sex, marriage status, infectious routes, WHO clinical stage, baseline CD4+T cell counts, and interval time from the start of ART to HIV confirmation. Life table and survival curve were applied to describe survival distribution. Cox proportional hazard model was used to determine the factors associated with the survival time.Results  Among 142 AIDS death cases, 125 (88.03%) were related with AIDS and 17 (11.97%) were not. The total median survival time was 3.100 months (95%CI: 2.279-3.921). The cumulative survival rate was (52±4)%, (33±4)%, (26±4)% in the first 3 months, 3-6 months, and 6-12 months. The median survival time of married or cohabitation group was 2.670 months (95%CI: 1.470-3.870), and single (unmarried, divorced, separation, widowed) group was 5.870 months (95%CI: 2.617-9.123). The median survival time of WHO clinical stageⅠorⅡ group was 5.870 months (95%CI: 3.989-7.751), and WHO clinical stage Ⅲ or Ⅳ group was 1.700 months (95%CI: 0.885-2.515). The median survival time of baseline CD4+T cell counts≤50 /μl group was 1.670 months (95%CI: 0.759-2.581), and 51-199 /μl group was 4.400 months (95%CI: 2.735-6.065), and ≥200/μl group was 7.100 months (95%CI: 0.000-14.542). The survival time was significantly different among different baseline marital status groups, different WHO clinical stage groups, and different CD4+T cell counts groups. The mortality risk of Single (unmarried, divorced, separation, widowed) group was 0.641 times of the risk in married or cohabitation group. The mortality risk of WHO clinical stage Ⅲ or Ⅳ was 1.856 times of the risk in stage ⅠorⅡ. The mortality risk of baseline CD4+T cell counts 51-199 /μl group was 0.582 times of the risk in ≤50 /μl group, and ≥200 /μl group was 0.551 times of the risk in ≤50 /μl group.Conclusion  The total median survival time was relatively short. Most AIDS deaths happened in the first 3 months or 3-6 months after they received Antiretroviral Therapy, and the mortality trend slowed down in the following months. Married or cohabitation, low-baseline CD4+T cell counts, or WHO clinical stage Ⅲ or Ⅳ were found to be the risk factors associated with AIDS death cases receiving Antiretroviral Therapy.

Key words: Acquired immunodeficiency syndrome;HIV;Antiretroviral therapy;Survival time;Retrospective study

发表日期:2014/6

引用本文:

图/表:

  • 10.3760/cma.j.issn.0253-9624.2014.06.009.T001:表1 不同特征调查对象治疗后生存时间状况

    10.3760/cma.j.issn.0253-9624.2014.06.009.T001:表1 不同特征调查对象治疗后生存时间状况

  • 10.3760/cma.j.issn.0253-9624.2014.06.009.T002:表2 不同临床分期和基线CD4+T淋巴细胞计数水平调查对象治疗后生存时间比较

    10.3760/cma.j.issn.0253-9624.2014.06.009.T002:表2 不同临床分期和基线CD4+T淋巴细胞计数水平调查对象治疗后生存时间比较

  • 10.3760/cma.j.issn.0253-9624.2014.06.009.T003:表3 艾滋病抗病毒治疗死亡患者的生存分析

    10.3760/cma.j.issn.0253-9624.2014.06.009.T003:表3 艾滋病抗病毒治疗死亡患者的生存分析

  • 10.3760/cma.j.issn.0253-9624.2014.06.009.T004:表4 影响治疗后生存时间的多因素Cox回归分析结果

    10.3760/cma.j.issn.0253-9624.2014.06.009.T004:表4 影响治疗后生存时间的多因素Cox回归分析结果

参考文献:

[1]StaszewskiS, Morales–RamirezJ, TashimaKT, et al. Efavirenz plus zidovudine and lamivudine, efavirenz plus indinavir, and indinavir plus zidovudine and lamivudine in the treatment of HIV–1 infection in adults.Study 006 Team[J]. N Engl J Med, 1999, 341(25):1865–1873.
[2]GallantJE, StaszewskiS, PozniakAL, et al. Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral–naive patients: a 3–year randomized trial[J]. JAMA, 2004, 292(2):191–201.
[3]ZhangF, DouZ, YuL, et al. The effect of highly active antiretroviral therapy on mortality among HIV–infected former plasma donors in China[J]. Clin Infect Dis, 2008, 47(6):825–833.
[4]RossiSM, MalufEC, CarvalhoDS, et al. Impact of antiretroviral therapy under different treatment regimens[J]. Rev Panam Salud Publica, 2012, 32(2):117–123.
[5]中华医学会感染病学分会艾滋病学组. 艾滋病诊疗指南[J]. 中华传染病杂志, 2006, 24(2):133–144.
[6]郑锡文, 张家鹏, 王小善, 等. 云南省瑞丽市吸毒人群中艾滋病病毒感染自然史研究[J]. 中华流行病学杂志, 2000, 21(1):17–18.
[7]吕繁, 张丽芬, 王哲, 等. 中国中部地区两县既往有偿献血人群艾滋病回顾性队列研究[J]. 中华流行病学杂志, 2005, 26(5):311–313.
[8]UNAIDS Reference Group on Estimates, Modeling and Projections. Improved methods and assumptions for estimation of the HIV/AIDS epidemic and its impact: recommendations of the UNAIDS Reference Group on Estimates, Modeling and Projections[J]. AIDS, 2002, 16(9):w1–14.
[9]ZhangF, DouZ, MaY, et al. Five–year outcomes of the China National Free Antiretroviral Treatment Program[J]. Ann Intern Med, 2009, 151(4):241–251, W–52.
[10]Time from HIV–1 seroconversion to AIDS and death before widespread use of highly–active antiretroviral therapy: a collaborative re–analysis. Collaborative Group on AIDS Incubation and HIV Survival including the CASCADE EU Concerted Action. Concerted Action on SeroConversion to AIDS and Death in Europe[J]. Lancet, 2000, 355(9210):1131–1137.
[11]QuigleyM, MwingaA, HospM, et al. The effect of gender on HIV progression and mortality in a cohort of Zambian adults, followed for up to 7 years, Durban, South Africa, 2000[C]Durban:XIII international AIDS conference, 2000.
[12]PattanapanyasatK, ThakarMR. CD4+T cell count as a tool to monitor HIV progression & anti–retroviral therapy[J]. Indian J Med Res, 2005, 121(4):539–549.
[13]EggerM, MayM, ChêneG, et al. Prognosis of HIV–I infected patients starting highly active antiretroviral therapy:a collaborative analysis of prospective studies[J]. Lancet, 2002, 360(9327):119–129.
[14]SimmonsRD, CiancioBC, KallMM, et al. Ten–year mortality trends among persons diagnosed with HIV infection in England and Wales in the era of antiretroviral therapy: AIDS remains a silent killer[J]. HIV Med, 2013, 14(10):596–604.In press.
[15]KposowaAJ. Marital status and HIV/AIDS mortality:evidence from the US National Longitudinal Mortality Study[J]. Int J Infect Dis, 2013, 17(10):868–874.
[16]RosenfeldB, BreitbartW, GibsonC, et al. Desire for hastened death among patients with advanced AIDS[J]. Psychosomatics, 2006, 47(6):504–512.

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