成都市50岁及以上HIV/AIDS抗病毒治疗后生存分析

施雅莹; 周敏; 吴学庆; 何世娇; 刘芳; 朱彦锋

doi:10.16462/j.cnki.zhjbkz.2020.12.007

成都市50岁及以上HIV/AIDS抗病毒治疗后生存分析

doi: 10.16462/j.cnki.zhjbkz.2020.12.007

1.
610041 成都，成都市疾病预防控制中心性病艾滋病防制科
2.
110001 沈阳，中国医科大学公共卫生学院
3.
610500 成都，成都医学院公共卫生学院

详细信息

通讯作者:
朱彦锋，E-mail：cmc_zhuyanfeng@163.com

中图分类号: R512.91
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出版历程
- 收稿日期: 2019-11-12
- 修回日期: 2020-03-02
- 刊出日期: 2020-12-10

Analysis of survival of HIV/AIDS aged 50 years and above in Chengdu after antiretroviral therapy

1.
Department of STD/AIDS Control and Prevention, Chengdu Center for Disease Control and Prevention, Chengdu 610041, China
2.
School of Public Health, China Medical university, Shenyang 110001, China
3.
School of Public Health, Chengdu Medical College, Chengdu 610041, China

More Information

Corresponding author: ZHU Yan-feng, E-mail: cmc_zhuyanfeng@163.com

摘要

摘要: 目的了解成都市50岁及以上艾滋病病毒感染者和艾滋病病人(HIV/AIDS)在接受抗病毒治疗后的生存情况，探讨50岁及以上HIV/AIDS抗病毒治疗后生存的影响因素，为制定50岁及以上HIV/AIDS治疗政策提供依据。方法选择成都市2010-2018年新报告的50岁及以上接受抗病毒治疗的HIV/AIDS，采用寿命表法描述生存情况，通过多因素Cox风险回归模型对可能的影响因素进行分层并进行生存分析。结果治疗后20个月内累计生存率从0.97下降到0.91，截至观察终点时间9年累计生存率为0.82。多因素分析显示：女性发生死亡危险是男性的0.689倍；70岁及以上发生死亡危险是50~岁的4.037倍；未婚和离异丧偶发生死亡危险是已婚的1.909倍和1.269倍；大专及以上发生死亡危险是文盲的0.403倍；首次CD4⁺T细胞检测值>500个/mm³发生死亡危险是 < 100个/mm³的0.318倍。结论成都市50岁及以上HIV/AIDS抗病毒治疗后的生存率较高，性别、年龄、文化程度、婚姻状况、首次CD4⁺T细胞检测值是影响50岁及以上HIV/AIDS病人生存的因素，应根据本地区实际情况，制定相应的治疗措施与宣传手段。
- 艾滋病病毒感染者/艾滋病病人 /
- 抗病毒治疗 /
- 生存分析
Abstract: Objective To understand the survival of HIV/AIDS aged 50 years and above in Chengdu after receiving antiretroviral therapy(ART), and to explore the factors affecting the survival of HIV/AIDS aged 50 years and above after ART, so as to provide the basis for the health authorities at all levels to formulate the treatment policy for HIV/AIDS aged 50 years and above. Methods The HIV/AIDS aged 50 years and above who were receiving ART in Chengdu from 2010 to 2018 were selected. Life-table method was used to describe the survival situation. Survival analysis method was used to stratify the study subjects according to the factors by the Cox risk regression model. Results The cumulative survival rate decreased from 0.97 to 0.91 within 20 months after treatment, and the cumulative survival rate was 0.82 at 9 years up to the end point of observation. Cox multivariate analysis showed that the risk of death in women was 0.689 times than in men. The aged 70 years and above was 4.037 times than the aged from 50 to 54 years old. Spinsterhood and divorced were 1.909 and 1.269 times than married. The college and above was 0.403 times than illiteracy. The first CD4⁺T cell test value of >500 /mm³ was 0.318 times higher than < 100 /mm³. Conclusions The survival rate of AIDS patients aged 50 years and above after ART is high. The factors such as age, education level and marital status affect the survival of AIDS patients aged 50 years and above. Corresponding treatment measures and publicity means should be developed according to the actual situation in Chengdu.
- HIV/AIDS /
- Antiviral therapy /
- Survival analysis

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图 1 成都市2010-2018年50岁及以上HIV/AIDS病例接受抗病毒治疗后的生存曲线

Figure 1. Survival curve of reported HIV infection with the men over 50 years old receiving ART in Chengdu City from 2010 to 2018

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表 1 成都市2010-2018年新报告的50岁及以上HIV/AIDS病例的基本情况

Table 1. Basic information of reported HIV infection with the men over 50 years old in Chengdu City from 2010 to 2018

特征	人数(例)	构成比(%)
性别
男	6 622	71.99
女	2 576	28.01
年龄(岁)
50~	2 357	25.63
55~	1 716	18.66
60~	2 115	22.99
65~	1 477	16.06
≥70	1 533	16.67
文化程度
文盲	805	8.75
小学	4 394	47.77
中学	3 708	40.31
大专及以上	291	3.16
婚姻状况
未婚	292	3.17
已婚有配偶	6 000	65.23
离异或丧偶	2 866	31.16
不详	40	0.43
首次CD4⁺T检测值(个/mm³)
≤100	1 855	20.38
101~	2 254	24.77
201~	2 254	24.77
301~	1 417	15.57
401~	699	7.68
>500	621	6.82

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表 2 成都市2010-2018年50岁及以上HIV/AIDS病例接受抗病毒治疗后的生存情况

Table 2. Survival situation of reported HIV infection with the men over 50 years old receiving ART in Chengdu from 2010 to 2018

期初时间(月)	期初人数	截尾人数	校正期初人数	死亡人数	死亡概率	生存概率	累积生存率	累积生存率的标准误	概率密度
0~	9 198	955	8 720.500	288	0.03	0.97	0.97	0.00	0.007
5~	7 955	1 102	7 404.000	144	0.02	0.98	0.95	0.00	0.004
10~	6 709	745	6 336.500	141	0.02	0.98	0.93	0.00	0.004
15~	5 823	877	5 384.500	100	0.02	0.98	0.91	0.00	0.003
20~	4 846	731	4 480.500	67	0.01	0.99	0.90	0.00	0.003
25~	4 048	597	3 749.500	55	0.01	0.99	0.88	0.00	0.003
30~	3 396	568	3 112.000	39	0.01	0.99	0.87	0.00	0.002
35~	2 789	413	2 582.500	29	0.01	0.99	0.86	0.00	0.002
40~	2 347	443	2 125.500	21	0.01	0.99	0.85	0.00	0.002
45~	1 883	349	1 708.500	22	0.01	0.99	0.84	0.01	0.002
50~	1 512	282	1 371.000	11	0.01	0.99	0.84	0.01	0.001
55~	1 219	271	1 083.500	6	0.01	0.99	0.83	0.01	0.001
60~	942	169	857.500	7	0.01	0.99	0.82	0.01	0.001
65~	766	195	668.500	4	0.01	0.99	0.82	0.01	0.001
70~	567	156	489.000	1	0.00	1.00	0.82	0.01	0.000
75~	410	119	350.500	0	0.00	1.00	0.82	0.01	0.000
80~	291	98	242.000	0	0.00	1.00	0.82	0.01	0.000
85~	193	65	160.500	0	0.00	1.00	0.82	0.01	0.000
90~	128	60	98.000	0	0.00	1.00	0.82	0.01	0.000
95~	68	32	52.000	0	0.00	1.00	0.82	0.01	0.000
100~	36	24	24.000	0	0.00	1.00	0.82	0.01	0.000
≥105	12	12	6.000	0	0.00	1.00	0.82	0.01	0.000

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表 3 成都市2010-2018年接受抗病毒治疗50岁及以上HIV/AIDS病例Cox比例风险回归模型分析结果

Table 3. Cox proportional hazard regression model analyses with the men over 50 years old receiving ART in Chengdu from 2010 to 2018

类别	β	s_x	Wald值	HR(95% CI)值	P值
性别
男				1.000
女	-0.372	0.090	16.993	0.689(0.578~0.823)	< 0.001
年龄组(岁)
50~				1.000
55~	0.537	0.124	18.686	1.711(1.341~2.182)	< 0.001
60~	0.394	0.124	10.139	1.482(1.163~1.889)	0.001
65~	0.789	0.124	40.211	2.200(1.724~2.808)	< 0.001
≥70	1.396	0.115	147.211	4.037(3.223~5.058)	< 0.001
婚姻状况
已婚有配偶				1.000
未婚	0.647	0.162	15.996	1.909(1.391~2.621)	< 0.001
离异或丧偶	0.238	0.070	11.472	1.269(1.106~1.457)	0.001
文化程度
文盲				1.000
小学	-0.070	0.111	0.401	0.932(0.750~1.159)	0.527
中学	-0.234	0.118	3.902	0.791(0.627~0.998)	0.048
大专及以上	-0.908	0.265	11.692	0.403(0.240~0.679)	0.001
首次CD4⁺T细胞(个/mm³)
≤100				1.000
101~	-0.800	0.088	83.071	0.449(0.378~0.534)	< 0.001
201~	-0.974	0.095	104.648	0.378(0.313~0.455)	< 0.001
301~	-1.057	0.116	82.464	0.347(0.277~0.436)	< 0.001
401~	-0.919	0.154	35.532	0.399(0.295~0.540)	< 0.001
＞500	-1.146	0.182	39.411	0.318(0.222~0.455)	< 0.001

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