Study on latent transition of sexual behavior patterns based on human papilloma viruses infection of men who have sex with men
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摘要:
目的 探讨基于人乳头瘤病毒(human papilloma viruses, HPV)感染男男性行为人群(men who have sex with men, MSM)性行为模式随时间发展变化趋势，为性行为干预措施提供依据。 方法 在“MSM乙型肝炎病毒感染对人乳头瘤病毒持续感染的影响”动态队列，对研究对象进行间隔6个月随访，对基线与第一次随访时人口学特征、性行为相关特征进行问卷调查及HPV检测。通过潜在转变分析(latent transition analysis, LTA)对基线性行为模式进行潜在分类并观察其在第1次随访时变化趋势。 结果 LTA将MSM人群性行为模式分为性行为低风险、中风险及高风险组3个潜在类别。基线至第1次随访，性行为低风险组保持低风险状态的概率为99.49%，转变为中风险状态的概率为0.51%；性行为中风险组保持为中风险状态的概率为74.88%，转变为低风险状态的概率为22.33%，转变为高风险状态的概率为2.79%，性行为高风险组保持于高风险状态的概率为100.00%。 结论 MSM人群性行为模式总体趋于稳定，后期应对高风险人群采取干预措施促进其性行为风险向低风险转变。 Abstract:Objective To explore the trend of the development of sexual behavior patterns of men who have sex with men(MSM) based on human papilloma viruses(HPV) infection over time, so as to provide evidence for sexual behavior intervention. Methods In dynamic cohort of "effects of hepatitis B virus infection on persistent infection of human papillomavirus in men who have sex with men", the participants were followed up every 6 months, and the demographic characteristics and sexual behaviors of the participants were collected at baseline and the first visit. HPV test was also completed 2 times. The latent transition analysis(LTA) was used to classify the potential states of the sexual behavior patterns at baseline and observe the trend of each potential category over time. Results MSM sexual behavior patterns were divided into three potential categories: sexual behavior low risk group, medium risk group and high risk group by LTA method. Over time, the probability of a low-risk group with a low-risk status at first visit was 99.49%, and the probability of transitioning to a medium-risk state was 0.51%; the probability that the risk group in the sexual behavior remained in the medium-risk state was 74.88%, and the probability of transition to the low-risk state was 22.33%, the probability of transitioning to a high-risk state was 2.79%; and the probability that a high-risk group of sexual behavior remained at high-risk state was 100.00%. Conclusions Sexual behavior patterns of MSM tend to be stable in general, and intervention measures should be taken in high-risk groups in the future period to promote the transition of their sexual behavior risk to low-risk. -
表 1 基线MSM不同性行为特征下HPV感染情况分析[n(%)]
Table 1. HPV infection status by different sexual behaviors of MSM at baseline [n(%)]
变量 例数 HPV感染 HPV未感染 χ2 P值 自我认知性取向 3.159 0.076 同性恋 451 213(47.23) 238(52.77) 异性及其他 134 75(55.97) 59(44.03) 近6个月性行为对象 5.212 0.022 仅为男性 454 212(46.70) 242(53.30) 男性、女性皆有 131 76(58.02) 55(41.98) 近6个月是否发生同性肛交性行为 5.664 0.017 有 466 241(51.72) 225(48.28) 无 119 47(39.50) 72(60.50) 同性肛交是否使用安全套 0.191 0.662 使用 469 233(49.68) 236(50.32) 不使用 116 55(47.41) 61(52.59) 同性性行为角色 4.734 0.030 以“1”为主a 307 138(44.95) 169(55.05) 以“0”为主b 278 150(53.96) 128(46.04) 近6个月是否发生同性商业性行为 4.246 0.039 有 58 36(62.07) 22(37.93) 无 527 252(47.82) 275(52.18) 毒品使用c 11.241 0.001 无 419 188(44.87) 231(55.13) 有 166 100(60.24) 66(39.76) 近6个月是否在浴室中寻找性伴 2.671 0.102 有 43 43(58.11) 31(41.89) 无 428 245(47.95) 266(52.05) 性病史 0.538 0.463 有 74 24(54.55) 20(45.45) 无 511 264(48.80) 277(51.20) 近6个月性伴数目 3.078 0.079 ≤2 390 182(46.67) 208(53.33) ＞2 195 106(54.36) 89(45.64) 注：a表现为男性角色的一方；b表现为女性角色的一方；c表示使用摇头丸、冰毒、K粉、鸦片、大麻、海洛因、麻古、杜冷丁、吗啡及Rush poppers。 
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表 2 不同潜在类别数LTA模型拟合效果
Table 2. Fitting effect of different latent classes with LTA model
潜类别数 似然比χ2 AIC值 BIC值 Df值 G2值 2 -5 178.81 3 644.60 3 736.40 262 122 3 602.60 3 -5 085.04 3 485.07 3 638.07 262 108 3 415.07 4 -5 030.44 3 407.87 3 630.82 262 092 3 305.87 5 -4 925.76 3 234.50 3 536.14 262 074 3 096.50 6 -4 882.28 3 187.53 3 576.61 262 054 3 009.53
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表 3 不同性行为风险潜在类别组条件概率(%)
Table 3. Probability of latent class by sexual risk(%)
变量 潜类别 1(低风险组) 2(中风险组) 3(高风险组) 自我认知性取向 同性恋 96.01 39.52 95.50 异性及其他 3.99 60.48 4.50 近6个月性行为对象 仅为男性 98.23 36.22 96.71 男性、女性皆有 1.77 63.78 3.29 近6个月是否发生同性肛交行为 有 70.06 74.65 95.79 无 29.94 25.35 4.21 同性肛交时是否使用安全套 有 73.43 76.85 80.87 无 26.57 23.15 19.13 同性性行为角色 以“1”为主 51.85 34.45 55.70 以“0”为主 48.15 65.55 44.30 近6个月是否发生同性商业性行为 有 1.21 16.21 8.98 无 98.79 83.79 91.02 毒品使用 无 89.50 75.26 33.76 有 10.50 24.74 66.24 近6个月是否在浴室中寻找性伴 有 7.45 20.89 21.42 无 92.55 79.11 78.58 近6个月性伴数目 ≤2 85.10 72.37 48.32 ＞2 14.90 27.63 51.68
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表 4 不同性行为风险类别在基线与第1次随访时间点时间点的转变概率(%)
Table 4. Transition probability by sexual behavior risk classes at baseline and first visit(%)
类别 性行为低风险组1 性行为中风险组2 性行为高风险组3 性行为低风险组1 99.49 0.51 0.00 性行为中风险组2 22.33 74.88 2.79 性行为高风险组3 0.00 0.00 100.00
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表 5 性行为中风险组向低风险组转变人群性行为差异[n(%)]
Table 5. Differences in sexual behavior of medium-risk group transition to low-risk group [n(%)]
变量 例数(n) 1a 2b χ2值 P值 自我认知性取向 57.686 ＜0.001 同性恋 102 52(51.00) 50(49.00) 异性及其他 81 0(00.00) 81(100.00) 近6个月性行为对象 68.777 ＜0.001 仅为男性 94 52(55.30) 42(44.70) 男性、女性皆有 89 0(0.00) 89(100.00) 近6个月是否发生同性商业性行为 5.098 0.024 有 12 0(0.00) 12(100.00) 无 171 52(30.40) 119(69.60) 注：a表示T2时间点中风险组向低风险组转变; b表示T2时间点仍保持在中风险组。
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