桂西壮族地区艾滋病抗病毒治疗患者生存分析

Survival analysis of HIV/AIDS patients who received antiviral treatment in Western Guangxi Zhuang Region

摘要:

目的  了解桂西壮族地区艾滋病（AIDS）患者接受抗病毒治疗后的生存状况及其影响因素。方法  采取回顾性队列研究方法，选择1 495例2005~2013年首次在百色市接受抗病毒治疗的AIDS患者为研究对象，运用SPSS 21.0统计软件进行分析，寿命表法估计生存率，Kaplan-meier绘制生存曲线，多因素COX比例风险模型进行生存影响因素分析。结果  研究对象男女比例为1.68∶1.00，平均年龄（41.63±12.90）岁，以壮族、已婚/同居、农村居住患者为主，感染途径主要为异性性途径传播。患者接受抗病毒治疗后第12、24、36、48和60个月的累积生存率为93.22%、90.78%、88.64%、87.87%和87.15%，死亡主要集中于治疗的前6个月，其中0～3个月100人年病死率为11.63，4～6个月为7.50，9个月后稳定在5.00以下。患者治疗前后D4+ T淋巴细胞计数分别为（188.44±100.03）和（394.87±227.32）个/mm3，经抗病毒治疗后CD4+计数水平提高（Z =-28.082，P =0.000）。基线CD4+计数水平<50个/mm3（A组）、50～199个/mm3（B组）和200～350个/mm3（C组），3组生存率比较差异有统计学意义（P =0.000），A、B组患者相对于C组的死亡危险度分别为3.245（95%CI：1.940，5.428）和1.733（95%CI：1.088，2.762）。多因素COX比例风险模型分析结果显示，患者年龄、CD4+ T淋巴细胞计数水平、WHO临床分期、血红蛋白含量、血肌酐水平、谷草转氨酶水平、随访领药状态（是他人代领还是本人领取）、是否调整治疗方案等与生存时间存在统计学关联。结论  抗病毒治疗可改善AIDS患者的预后，及早发现AIDS并及时进行抗病毒治疗，及时处置机会性感染性疾病，提高治疗依从性，对延长患者生存时间有重要意义。

Abstract:

Objective To understand the survival status of HIV/AIDS patients received antiviral treatment in Western Guangxi Zhuang Region and its influencing factors. Methods Retrospective cohort study method was applied in this study. A total of 1,495 cases of HIV/AIDS patients who received antiviral treatment between 2005 and 2013 in Baise were chosen. The data were analyzed by SPSS 21.0 statistic software. Survival rate was estimated by life table. Survival curves were made from Kaplan-Meier. Influence factors of survival were analyzed by COX regression proportional hazard model. Results The male to female ratio was 1.68 : 1.00, and the average age was (41.63 ± 12.90) years. The patients were mainly of the Zhuang nationality, married/cohabiting, living in rural areas and infected through heterosexual sexual transmission. The cumulative survival rate of the patients who received antiretroviral therapy after 12, 24, 36, 48 and 60 months was 93.22%, 90.78%, 88.64%, 87.87% and 87.15%, respectively. The patients mainly died in the first 6months of treatment. The mortality of patients within three months was 11.63%, that from the 4th to 6th month was 7.50%, that after the 9th month was less than 5.00%. The average number of CD4+ T lymphocyte count was (188.44 ± 100.03) and (394.87 ± 227.32) cells/mm3 before and after treatment in the patients. CD4+ counts of the patients were significantly improved after treatment (Z = -28.082, P = 0.000). Differences in survival rate were statistically significant (P = 0.000) among the three groups classified according to the baseline level of CD4+ count, i.e. group A (< 50/mm3), group B (50-199/mm3) and group C (200-350/mm3). Compared with the group C, the death risk was 3.245 (95%CI: 1.940, 5.428) in the group A and 1.733 (95%CI: 1.088, 2.762) in the group B. Multivariate COX proportional hazards model analysis showed the survival time was in significant association with age, CD4+ T lymphocyte count, WHO clinical stage, hemoglobin, serum creatinine level, aspartate aminotransferase level, others or himself to get drugs at follow-up status and whether the therapy was replaced. Conclusions Antiviral therapy improves the outcome of the patients with HIV/AIDS. Early detection of HIV/AIDS and timely antiretroviral therapy, timely treatment of opportunistic infectious diseases and improvement of treatment compliance are of great significance to prolong the survival time of the patients.