摘要
目的评估艾滋病成人抗病毒治疗(ART)效果,并分析影响治疗效果的主要因素。方法采用回顾性队列研究方法,选择山西省2004年6月至2012年12月纳入国家免费抗病毒治疗系统病例,收集资料补充调查,使用SPSS 19.0软件进行统计分析,采用t检验和χ2检验,伴时Cox回归模型进行生存分析。结果 1 887例抗病毒治疗病例中存活156例(83.1%)、死亡255例(13.5%)、停药26例(1.4%)、转诊23例(1.2%)、失访15例(0.8%);治疗后第0.5、1.0、2.0、3.0、4.0、5.0、6.0、7.0、8.0年累计生存率分别为0.91%、0.89%、0.88%、0.86%、0.85%、0.82%、0.80%、0.79%、0.79%;CD4+T细胞从ART前的143.5个/μL平均增加205.3个/μL,治疗前后<100个/μL的比例由41.4%下降至7.8%、>350个/μL的比例由0.9%上升至46.7%。病毒载量治疗前小于最低检测限占18.2%,治疗后提高到89.1%;应用Cox比例风险回归模型做多因素分析发现,ART前CD4+T细胞计数、ART时年龄、ART前体质量指数3个变量的分组与生存时间差异分别有统计学意义。死亡危险比(HR)分别为4.05、3.68、3.44;对ART后CD4+T细胞计数、ART前后CD4+T细胞计数之差、ART后病毒载量编写程序生成3个伴时协变量,连同治疗前有统计学意义和专业意义的15个变量在内的18个变量进行多因素伴时Cox回归模型分析,最后仅有ART后CD4+T细胞计数与生存时间差异有统计学意义,HR为30.28。结论抗病毒治疗取得了较好的治疗效果,生存时间与ART后CD4+T细胞计数相关。
Objective To evaluate the effectiveness of free antiretroviral therapy（ART） in adults and the factors influence ART outcome. Methods A retrospective cohort study was conducted Shanxi province. All qualified ART recipients were enrolled in the national free ART program from June 2004 to December 2012. Statistical analysis was conducted by SPSS software （version 19.0）, use the t test and chi-square test, with Cox regression model for survival analysis. Results One thousand eight hundred and eighty-seven cases were included in the study. The rates for participants, who survived, who were deceased for acquired immune deficiency syndrome （AIDS） related diseases, who withdrawal from the treatment, who transferred to other hospital and who lost for follow-up were 83.1%, 13.5%, 1.4%, 1.2% and 0.8%, respectively. The cumulative survival rates were 0.91, 0.89, 0.88, 0.86, 0.85, 0.82, 0.80, 0.79 and 0.79 at 0.5, 1.0, 2.0, 3.0, 4.0, 5.0, 6.0, 7.0 and 8.0 years after treatment initiation, respectively. The medians of CD4＋T cell count were 143.5 cells/μL prior to treatment and 205.3 cells/μL post treatment. 18.2% of ART recipients had their viral loads below detection limit before therapy and this percentage increased to 89.1% after therapy. In the multivariate Cox proportional hazard model, CD4＋T cell count and BMI before treatment initiation, and the age start therapy were significantly associated with survival time. The Hazard ratio was 4.05, 3.44 and 3.68, respectively. Record the count of CD4＋T lymphocyte after antiretroviral treatment, the difference of CD4＋T lymphocyte count between before antiretroviral treatment and after, 3 covariates had been produced by the viral load program generates after antiretroviral treatment , 15 variables had been proved to be statistically and professional significance before antiretroviral treatment. Analysis above all variables based on multi factor time-dependent Cox regression model. There were statistical differences between the count of CD4＋T lymphocyte after
出处
《实用医技杂志》
2014年第12期1257-1260,共4页
Journal of Practical Medical Techniques
基金
"十二五"国家科技重大专项(2012ZX-10001-006)
关键词
艾滋病
抗病毒治疗
伴时Cox回归模型
生存分析
Acquired immune deficiency syndrome
Antiretroviral treatment
Time-dependent Cox model
