HIV感染者神经认知功能及可调控危险因素的现况研究

袁诗颖; 陈潇潇; 林海江; 石瑞紫; 李静; 徐璐璐; 乔世杰; 丁盈盈; 何纳

doi:10.16462/j.cnki.zhjbkz.2020.12.001

HIV感染者神经认知功能及可调控危险因素的现况研究

doi: 10.16462/j.cnki.zhjbkz.2020.12.001

1.
200032 上海，复旦大学公共卫生流行病学教研室，公共卫生安全教育部重点实验室
2.
318000 台州，台州市疾病预防控制中心

基金项目:

国家传染病防治科技重大专项 2018ZX10721102-004

上海市第五轮公共卫生三年行动计划 076478684Q/2020-00218

详细信息

通讯作者:
何纳，E-mail：nhe@fudan.edu.cn

中图分类号: R181.2
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出版历程
- 收稿日期: 2020-10-17
- 修回日期: 2020-11-06
- 刊出日期: 2020-12-10

Prevalence study of neurocognitive functions and modifiable risk factors in HIV-infected individuals

1.
Department of Public Health Epidemiology, Fudan University, Key Laboratory of Public Health and Safety Education, Shanghai 200032, China
2.
Taizhou Center for Disease Control and Prevention, Taizhou 318000, China

Funds:

China National Science and Technology Major Projects on Infectious Diseases 2018ZX10721102-004

The 5^th Public Health Action Plan of Shanghai Municipal Health Commission 076478684Q/2020-00218

More Information

Corresponding author: HE Na, E-mail: nhe@fudan.edu.cn

摘要

摘要: 目的了解可调控危险因素对人类免疫缺陷病毒(human immunodeficiency virus，HIV)感染者神经认知功能的影响。方法利用“HIV与衰老相关疾病前瞻性队列研究”队列2018-2019年基线调查数据，选取40岁及以上的中老年HIV感染者。采用广义线性模型(general liner model, GLM)分析包括心血管疾病危险因素和不良生活行为的可调控危险因素对感染者神经认知表现的影响。结果研究共纳入625例HIV感染者。心血管疾病危险因素及不良生活行为在中老年HIV感染者中报告比例较高。在不同年龄阶段，感染者各神经认知功能有不同程度的下降，整体上以60岁以后认知功能下降较明显。多因素回归分析模型分析显示，高血压是感染者定向力、记忆力、延迟回忆、语言功能和运动能力的危险因素，其他可调控危险因素如吸烟、饮酒、糖尿病和腹部肥胖等尚未发现统计学关联。此外，血压临床分级分析后发现，高血压前期和语言功能(β=-0.327, P=0.020)、定向力(β=-0.216, P=0.028)下降有关，即使未发展至高血压状态，高值血压仍会对神经认知功能产生负面影响。结论高血压和中老年HIV感染者神经认知功能下降相关，定向力及语言能力在高血压前期即可能受到不良影响。在日后HIV随访管理中要加大对高血压的防控力度，对高血压及早发现并进行规范化临床管理。
- 人类免疫缺陷病毒 /
- 神经认知功能 /
- 可调控危险因素
Abstract: Objective To investigate the effects of regulatory risk factors on neurocognitive function of human immunodeficiency virus infected persons. Methods Using the baseline survey data of the prospective cohort study of HIV and aging related diseases from 2018 to 2019, elderly HIV infected persons aged 40 and above were selected. A general linear model (GLM) was used to analyze the effects of regulatory risk factors including cardiovascular disease risk factors and bad life behavior on neurocognitive performance of infected persons. Results A total of 625 HIV infected persons were included in the study. Cardiovascular disease risk factors and bad life behavior were reported in the elderly HIV infected patients. At different age stages, the neurocognitive function of infected persons decreased to different degrees, and the cognitive function decreased significantly after 60 years of age. Multivariate regression analysis model showed that hypertension was a risk factor for orientation, memory, delayed recall, language function and exercise ability of infected persons, and other regulatory risk factors such as smoking, alcohol consumption, diabetes and abdominal obesity had not been statistically correlated. Moreover, after clinical grading analysis of blood pressure, it found that prehypertension was associated with decreased language function (β=-0.327, P=0.020), orientation force (β=-0.216, P=0. 028). Even if it did not develop to hypertension state, high-value blood pressure have a negative effect on neurocognitive function. Conclusions Hypertension is associated with the decline of neurocognitive function in middle-aged and elderly HIV patients, and orientation and language ability may be adversely affected in the early stage of hypertension. During HIV follow-up management in the future, we should strengthen the prevention and control of hypertension, early detection of hypertension and standardized clinical management.
- HIV /
- Neurocognitive functioning /
- Modifiable risk factors

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图 1 不同年龄组HIV感染者神经认知功能得分比较

Figure 1. Comparison of neurocognitive function scores of HIV infected persons in different age groups

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表 1 浙江省台州市HIV感染者一般人口学特征及传统危险因素现状[n(%)]

Table 1. General demographic characteristics and status of traditional risk factors of HIV infected persons in Taizhou City, Zhejiang Province[n(%)]

特征	HIV感染者年龄(岁)				χ²值	P值
特征	40~	50~	60~	≥70	χ²值	P值
性别					7.39	0.060
男	156(79.2)	153(75.0)	109(73.2)	66(88.0)
女	41(20.8)	51(25.0)	40(26.9)	9(12.0)
文化程度					92.57	< 0.001
小学及以下	12(6.1)	25(12.3)	47(31.5)	24(32.0)
初中	74(37.6)	81(39.7)	78(52.4)	34(45.3)
高中及以上	111(56.4)	98(48.0)	24(16.1)	17(33.7)
抑郁	64(32.5)	63(30.9)	52(34.9)	31(41.3)	2.91	0.406
失眠	39(19.8)	56(27.5)	54(36.2)	34(45.3)	21.71	< 0.001
神经认知损伤	9(4.6)	21(10.3)	37(24.8)	35(46.7)	83.83	< 0.001
传统危险因素
BMI(kg/m²)					4.39	0.623
< 18.5	11(5.6)	14(6.9)	8(5.4)	8(10.7)
18.5~	121(61.4)	126(61.8)	97(65.1)	49(65.3)
≥24	65(32.3)	64(31.4)	44(29.5)	18(24.0)
腹型肥胖	107(54.6)	108(52.9)	85(57.01)	39(52.0)	0.77	0.856
规律锻炼	71(36.0)	83(40.7)	60(40.3)	29(38.7)	1.07	0.784
吸烟					58.12	< 0.001
从不	115(58.4)	115(56.4)	73(49.0)	25(33.3)
过去	17(8.6)	31(15.2)	25(16.8)	35(46.7)
现在	65(33.0)	58(28.4)	51(34.2)	15(20.0)
饮酒					7.09	0.313
从不	181(91.9)	185(91.6)	129(87.8)	71(94.7)
轻/中度	9(4.6)	13(6.4)	13(8.8)	1(1.3)
重度	7(3.6)	4(2.0)	5(3.4)	3(4.0)
血脂异常症	100(52.6)	105(53.6)	72(50.0)	37(50.0)	0.57	0.903
糖尿病	6(3.1)	11(5.4)	13(8.7)	8(10.7)	7.93	0.047
高血压	12(6.1)	40(19.6)	42(28.2)	34(45.3)	59.02	< 0.001
HIV特定因素
HIV阳性诊断时间(年)					15.50	0.017
0~	143(72.6)	167(81.9)	130(87.3)	60(80.0)
1~	21(10.7)	12(5.9)	7(4.7)	9(12.0)
≥3	33(16.8)	25(12.3)	12(8.1)	6(8.0)
cART时间(年)					7.29	0.295
未接受ART	66(37.7)	84(45.9)	57(41.6)	29(42.7)
< 3	85(48.6)	79(43.2)	71(51.8)	34(50.0)
≥3	24(13.7)	20(11.0)	9(6.6)	5(7.4)
CD4细胞计数最低值＜200个/μl	83(44.2)	91(46.0)	63(43.4)	43(57.3)	4.50	0.212
当前CD4细胞计数(个/μl)					22.15	0.001
< 200	31(18.9)	33(20.4)	19(16.1)	17(30.4)
200~	38(23.2)	64(40.0)	43(36.4)	23(41.1)
≥350	95(57.9)	65(40.1)	56(47.5)	16(28.6)
依法韦仑用药史^a	76(38.6)	70(34.3)	61(41.0)	30(40.0)	1.88	0.598
注：^a表示感染者中治疗方案包含依法韦仑(Efavirenz, EFV)所占比例。

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表 2 HIV感染者中可调控危险因素与神经认知功能域关联分析

Table 2. Associations between modifiable risk factors and neurocognitive domains among HIV infected individuals

特征	定向力^a	记忆力^a	注意和计算力^a	延迟回忆^a	语言功能^a	运动能力^a
BMI(kg/m²)
18.5~	0.076	0.106	0.282	0.011	0.143	0.061
≥24	-0.025	0.115	0.343	-0.063	0.176	0.044
无规律锻炼	0.011	0.066	-0.231	0.083	-0.075	0.057
吸烟
过去吸烟	-0.120	-0.040	-0.126	-0.184	-0.109	0.065
现在吸烟	-0.063	-0.034	0.019	-0.025	-0.189	-0.033
饮酒
轻/中度饮酒	0.192	0.228	0.136	0.017	-0.135	0.143
重度饮酒	0.280	-0.014	-0.110	-0.123	0.242	-0.107
血脂异常症	0.051	0.147	0.155	0.170^c	0.054	0.065
腹部肥胖	-0.071	0.013	0.090	-0.003	-0.103	0.033
糖尿病	-0.425^c	-0.125	-0.293	-0.094	-0.188	-0.051
高血压	-0.256^c	-0.297^b	-0.300	-0.220^c	-0.526^b	-0.250^c
注：^a值为GLM中各功能域值，校正年龄、性别、教育程度、抑郁、失眠及HIV特定因素。^b值为P＜0.01, ^c值为P＜0.05。

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表 3 不同血压等级与HIV感染者神经认知功能关联分析

Table 3. Associations between hypertension grades and neurocognitive domains among HIV infected individuals

血压临床分级	定向力^a	记忆力^a	注意和计算力^a	延迟回忆^a	语言功能^a	运动能力^a
正常血压高值	-0.216^c	-0.049	-0.146	-0.087	-0.327^c	0.059
轻度高血压(Ⅰ级)	-0.178	-0.146	-0.423^c	-0.194	-0.378^c	-0.029
中重度高血压(Ⅱ/Ⅲ级)	-0.528^c	-0.115	-0.679	0.082	-0.944^b	-0.197
注：^a值为GLM中各功能域β值，校正年龄、性别、教育程度、抑郁、失眠及HIV特定因素。^b值为P＜0.01，^c值为P＜0.05。

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