贵港市HIV/AIDS病人生存时间及艾滋病相关死亡影响因素分析
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摘要
目的探讨影响贵港市艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)生存时间及艾滋病相关死亡的因素,为制定适合该市的艾滋病防治策略和措施提供依据。方法在艾滋病综合防治信息系统中收集1996—2017年贵港市HIV/AIDS病人的相关信息。采用回顾性队列研究的方法,运用寿命表法计算生存率,通过Log-Rank检验比较各因素不同水平生存时间的差异,用Kaplan-meier法进行单因素分析并绘制生存曲线,多因素分析采用COX比例风险回归模型。结果 13 948例HIV/AIDS病人中,发生艾滋病相关死亡1 663例(11.9%),艾滋病无关死亡2 528例(18.1%)。累计观察59 635.5人年,艾滋病相关死亡率为2.79/100人年。自2010年病死率呈逐年下降的趋势。平均生存时间为219.82个月[95%可信区间(CI):218.107～221.533]。确诊后1、5、10、15年的累计生存率分别为89%、86%、85%、85%。COX回归多因素分析显示,少数民族及来源于主动筛查的病人死亡风险较低,而男性、老年人(≥70岁)、疾病状态为AIDS、文化程度低、 CD4~+T淋巴细胞计数低(<200个/μL)、未接受抗病毒治疗的病人死亡风险较高。结论近几年来,贵港市HIV/AIDS病人的艾滋病相关死亡率逐年降低,应继续加强大众的宣传教育工作,尤其是强化重点人群对艾滋病的认识,不断提高检测的可及性及扩大抗病毒治疗的覆盖面。
Objective To explore the survival situation of HIV-infected individuals and AIDS patients and the factors of AIDS-related deaths in Guigang city, and provide scientific basis to formulate AIDS prevention and treatment strategies. Methods A retrospective cohort study was conducted among HIV/AIDS patients in Guigang from 1996 to 2017. Basic information was collected from the AIDS Prevention and Control Information System. The cumulative survival rate was calculated by using the life table method, and the differences in survival time between different groups were compared by Log-Rank test. The single factor analysis of survival time and the cumulative death curve were plotted by Kaplan-Meier method. Multivariate analysis was carried out by using Cox proportional hazards regression model. Results Among 13 948 HIV/AIDS patients, 1 663(11.9%) were AIDS-related deaths and 2 528(18.1%) were non-AIDS-related deaths. A total of 59 635.5 person-years were observed, and the AIDS-related death rate was 2.79/100 person-years. The mortality rate had been declining year by year since 2010. The average survival time was 219.82 months(95% CI: 218.107-221.533). Then the cumulative survival rates of the cases were 89%, 86%, 85%, and 85% at 1, 5, 10, and 15 years after diagnosis. The results of multivariate analysis showed that the ethnic minorities and patients receiving active screening had lower risks of death, while men, elderly patients(≥70 years old), and the patients at the disease status of AIDS, lower education levels(junior high school and below) and with low CD4 + T cell count(<200/μL), and no antiviral therapy had a higher mortality rate.Conclusion Though the AIDS-related death rate among HIV/AIDS patients in Guigang shows a decline year by year, it is necessary to further strengthen the public education, especially to enhance the awareness of AIDS knowledge among key groups, the accessibility of detection and the coverage of antiviral therapy.
Objective To explore the survival situation of HIV-infected individuals and AIDS patients and the factors of AIDS-related deaths in Guigang city, and provide scientific basis to formulate AIDS prevention and treatment strategies. Methods A retrospective cohort study was conducted among HIV/AIDS patients in Guigang from 1996 to 2017. Basic information was collected from the AIDS Prevention and Control Information System. The cumulative survival rate was calculated by using the life table method, and the differences in survival time between different groups were compared by Log-Rank test. The single factor analysis of survival time and the cumulative death curve were plotted by Kaplan-Meier method. Multivariate analysis was carried out by using Cox proportional hazards regression model. Results Among 13 948 HIV/AIDS patients, 1 663(11.9%) were AIDS-related deaths and 2 528(18.1%) were non-AIDS-related deaths. A total of 59 635.5 person-years were observed, and the AIDS-related death rate was 2.79/100 person-years. The mortality rate had been declining year by year since 2010. The average survival time was 219.82 months(95% CI: 218.107-221.533). Then the cumulative survival rates of the cases were 89%, 86%, 85%, and 85% at 1, 5, 10, and 15 years after diagnosis. The results of multivariate analysis showed that the ethnic minorities and patients receiving active screening had lower risks of death, while men, elderly patients(≥70 years old), and the patients at the disease status of AIDS, lower education levels(junior high school and below) and with low CD4 + T cell count(<200/μL), and no antiviral therapy had a higher mortality rate.Conclusion Though the AIDS-related death rate among HIV/AIDS patients in Guigang shows a decline year by year, it is necessary to further strengthen the public education, especially to enhance the awareness of AIDS knowledge among key groups, the accessibility of detection and the coverage of antiviral therapy.
引文
[1] 孙建云.建立艾滋病实验室安全防护制度,预防艾滋病的血源性传播[J].中国医药指南,2013,11(9):375-376.
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[4] 曹家艳,杨家奇,周彩霞,等.遵义市HIV/AIDS患者死亡率及其影响因素研究[J].中国皮肤性病学杂志,2016,30(9):918-921.
[5] 陈亮,张明雅,林勋,等.福建省HIV感染者/AIDS患者生存时间及影响因素分析[J].中国预防医学杂志,2016,17(2):134-138.
[6] 叶振淼,金茜,王大勇,等.1985—2016年浙江省温州市艾滋病病毒感染者/艾滋病患者生存时间及影响因素分析[J].疾病监测,2017,32(7):557-562.
[7] 黄东升,郑维斌,杨家芳,等.1990—2012年云南省保山市HIV/AIDS病例全因死亡率及其影响因素研究[J].中国卫生统计,2014,31(3):374-378.
[8] 覃雄林,覃春伟,李晓华,等.贵港市HIV/AIDS病人生存时间及影响因素分析[J].实用预防医学,2015,22(4):395-397.
[9] 伍芳辰.黔南州1997—2015年HIV/AIDS病人死亡因素分析[J].中国艾滋病性病,2017,23(3):264-266.
[10] 李斯斯,农全兴,徐永芳,等.广西南宁1999—2014年艾滋病感染者/患者生存状况分析[J].中国公共卫生,2015,31(12):1569-1573.
[11] 陈洪森,温金平,黄晓明,等.1999—2011年岑溪市艾滋病感染者及病人生存分析[J].实用预防医学,2013,20(6):681-683.
[12] Meng L,Tang W,Kai B,et al.Mortality among People Living with HIV and AIDS in China:Implications for Enhancing Linkage[J].Scientific reports,2016 (6):28005.
[13] Li M,Zhu Q,Zheng W,et al.A retrospective cohort study on the mortality of AIDS patients in Guangxi,China (2001-2011)[J].AIDS research and human retroviruses,2015,31(4):439-447.
[14] 葛宪民,唐振柱,李国坚,等.广西艾滋病防治警示性宣传教育模式探讨与应用[J].中国艾滋病性病,2017,23(11):1057-1061.
[15] 杨艳,周月姣,孟琴.广西第二轮全国艾滋病综合防治示范区艾滋病流行趋势分析[J].广西医学,2014,36(8):1123-1125.
[16] Dovel K,Yeatman S,Watkins S,et al.Men's heightened risk of AIDS-related death:the legacy of gendered HIV testing and treatment strategies[J].AIDS,2015,29(10):1123.
[17] 王维佳,张维义,端琼丽,等.云南省红河州艾滋病相关死亡影响因素分析[J].现代预防医学,2017,44(10):1874-1878.
[18] 伍芳辰.黔南州1997—2015年HIV/AIDS病人死亡因素分析[J].中国艾滋病性病,2017,23(3):264-266.
[19] 闫莉,肖培培,闫红静,等.HIV自我检测技术研究进展[J].中华预防医学杂志,2017,51(11):1053-1056.
[20] 玉艳红.HIV/AIDS中医证型与CD4+T淋巴细胞水平相关性的研究进展[J].广西医科大学学报,2014,31(2):333-335.
[21] 黄永红,潘祥奋,农启振,等.广西田东县18年来艾滋病人死亡影响因素研究[J].海峡预防医学杂志,2016,22(2):16-17.
[22] Zheng H,Wang L,Huang P,et al.Incidence and risk factors for AIDS-related mortality in HIV patients in China:a cross-sectional study[J].BMC Public Health,2014,14(1):831.
[23] 汤后林,李健,韩晶,等.2010年全国新报告HIV感染者/AIDS病例生存时间及其相关因素分析[J].中华流行病学杂志,2017,38(5):656-660.
[24] Song A,Zhou X,Chen P,et al.Variation of CD4-+T cell number at different baseline cell immunity levels after initiation of HARRT among HIV/AIDS patients[J].Journal of Public Health & Preventive Medicine,2017,28(4):25-28.
[2] 中国疾病预防控制中心性病艾滋病预防控制中心性病控制中心.2017年12月全国艾滋病性病疫情[J].中国艾滋病性病,2018,24(2):111.
[3] Li M,Tang W,Bu K,et al.Mortality among People Living with HIV and AIDS in China:Implications for Enhancing Linkage[J].Scientific reports,2016(6):28005.
[4] 曹家艳,杨家奇,周彩霞,等.遵义市HIV/AIDS患者死亡率及其影响因素研究[J].中国皮肤性病学杂志,2016,30(9):918-921.
[5] 陈亮,张明雅,林勋,等.福建省HIV感染者/AIDS患者生存时间及影响因素分析[J].中国预防医学杂志,2016,17(2):134-138.
[6] 叶振淼,金茜,王大勇,等.1985—2016年浙江省温州市艾滋病病毒感染者/艾滋病患者生存时间及影响因素分析[J].疾病监测,2017,32(7):557-562.
[7] 黄东升,郑维斌,杨家芳,等.1990—2012年云南省保山市HIV/AIDS病例全因死亡率及其影响因素研究[J].中国卫生统计,2014,31(3):374-378.
[8] 覃雄林,覃春伟,李晓华,等.贵港市HIV/AIDS病人生存时间及影响因素分析[J].实用预防医学,2015,22(4):395-397.
[9] 伍芳辰.黔南州1997—2015年HIV/AIDS病人死亡因素分析[J].中国艾滋病性病,2017,23(3):264-266.
[10] 李斯斯,农全兴,徐永芳,等.广西南宁1999—2014年艾滋病感染者/患者生存状况分析[J].中国公共卫生,2015,31(12):1569-1573.
[11] 陈洪森,温金平,黄晓明,等.1999—2011年岑溪市艾滋病感染者及病人生存分析[J].实用预防医学,2013,20(6):681-683.
[12] Meng L,Tang W,Kai B,et al.Mortality among People Living with HIV and AIDS in China:Implications for Enhancing Linkage[J].Scientific reports,2016 (6):28005.
[13] Li M,Zhu Q,Zheng W,et al.A retrospective cohort study on the mortality of AIDS patients in Guangxi,China (2001-2011)[J].AIDS research and human retroviruses,2015,31(4):439-447.
[14] 葛宪民,唐振柱,李国坚,等.广西艾滋病防治警示性宣传教育模式探讨与应用[J].中国艾滋病性病,2017,23(11):1057-1061.
[15] 杨艳,周月姣,孟琴.广西第二轮全国艾滋病综合防治示范区艾滋病流行趋势分析[J].广西医学,2014,36(8):1123-1125.
[16] Dovel K,Yeatman S,Watkins S,et al.Men's heightened risk of AIDS-related death:the legacy of gendered HIV testing and treatment strategies[J].AIDS,2015,29(10):1123.
[17] 王维佳,张维义,端琼丽,等.云南省红河州艾滋病相关死亡影响因素分析[J].现代预防医学,2017,44(10):1874-1878.
[18] 伍芳辰.黔南州1997—2015年HIV/AIDS病人死亡因素分析[J].中国艾滋病性病,2017,23(3):264-266.
[19] 闫莉,肖培培,闫红静,等.HIV自我检测技术研究进展[J].中华预防医学杂志,2017,51(11):1053-1056.
[20] 玉艳红.HIV/AIDS中医证型与CD4+T淋巴细胞水平相关性的研究进展[J].广西医科大学学报,2014,31(2):333-335.
[21] 黄永红,潘祥奋,农启振,等.广西田东县18年来艾滋病人死亡影响因素研究[J].海峡预防医学杂志,2016,22(2):16-17.
[22] Zheng H,Wang L,Huang P,et al.Incidence and risk factors for AIDS-related mortality in HIV patients in China:a cross-sectional study[J].BMC Public Health,2014,14(1):831.
[23] 汤后林,李健,韩晶,等.2010年全国新报告HIV感染者/AIDS病例生存时间及其相关因素分析[J].中华流行病学杂志,2017,38(5):656-660.
[24] Song A,Zhou X,Chen P,et al.Variation of CD4-+T cell number at different baseline cell immunity levels after initiation of HARRT among HIV/AIDS patients[J].Journal of Public Health & Preventive Medicine,2017,28(4):25-28.
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