浙江省台州市HIV阳性和阴性衰弱者衰弱特征的聚类分析

李静; 袁诗颖; 陈潇潇; 林海江; 何纳; 丁盈盈

doi:10.16462/j.cnki.zhjbkz.2021.06.015

浙江省台州市HIV阳性和阴性衰弱者衰弱特征的聚类分析

doi: 10.16462/j.cnki.zhjbkz.2021.06.015

1.
200032 上海，复旦大学公共卫生学院流行病学教研室，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:

国家自然科学基金 81872671

国家科技重大传染病项目 2018ZX10721102-004

详细信息

通讯作者:
丁盈盈，E-mail: dingyy@fudan.edu.cn

中图分类号: R181
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出版历程
- 收稿日期: 2020-08-24
- 修回日期: 2020-10-25
- 刊出日期: 2021-06-10

Frailty subtypes among people living with HIV and HIV-negative individuals in Taizhou, Zhejiang: a cluster analysis

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

Funds:

National Natural Science Foundation of China 81872671

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

More Information

Corresponding author: DING Ying-ying, E-mail: dingyy@fudan.edu.cn

摘要

摘要: 目的识别HIV阳性和阴性衰弱者衰弱类型并探索其分布和流行病学特征差异，以便为HIV阳性衰弱者采取的干预提供依据。方法选取2017年2月-2020年1月台州市“HIV与衰老相关疾病前瞻性队列研究”(the comparative HIV and aging research in Taizhou cohort, CHART)基线数据中符合Fried衰弱表型标准的HIV阳性和阴性衰弱者，对五项衰弱问题进行潜类别聚类分析。结果 83例HIV阳性衰弱者和101例阴性衰弱者被聚成三类(第一类：低体力活动、疲惫和握力差为特点的无力状，即无力组；第二类：以低步速为突出特点的五项功能差，即低步速组；第三类：体重减少和轻度无力状，即消瘦组)。HIV阳性衰弱者在低步速组中占比较高，为54.2%，阴性衰弱者在无力组中占比较高，为35.6%。HIV阳性衰弱者低步速组现在吸烟比例高于消瘦组(χ² =10.889, P=0.004)，无力组现在吸烟比例高于消瘦组(χ² =7.909, P=0.019)，消瘦组偏瘦比例高于无力组(χ² =9.309, P=0.009)。阴性衰弱者无力组≥60岁比例高于消瘦组(χ² =10.502, P=0.001)，睡眠障碍患病率低于消瘦组(χ² =6.541, P=0.011)；低步速组≥60岁比例高于消瘦组(χ² =6.232, P=0.013)。结论 HIV阳性和阴性衰弱者衰弱类型构成不同，HIV阳性衰弱者表现为以低步速为突出特点的五项功能差。应结合其特征进行干预。
- 艾滋病 /
- 衰弱 /
- 睡眠障碍 /
- 抑郁症状 /
- 共病
Abstract: Objective To identify the frailty subtypes and investigate their differences in distribution and epidemiological characteristics between people living with HIV (PLWH) and HIV-negative individuals, to provide evidence for conducting intervention on frail PLWH. Methods PLWH and HIV-negative individuals who met the Fried's frailty phenotype criteria were selected from the baseline survey of the comparative HIV and aging research in Taizhou cohort (CHART) from February 2017 to January 2020. Latent cluster analysis was conducted to identify the frailty subtypes based on five Fried frailty components. Results Among 83 frail PLWH and 101 frail HIV-negative individuals included, three frailty clusters were identified. Cluster 1 was characterized by weakness with low physical activity, exhaustion and weak grip strength, which was defined as weakness group; cluster 2 was characterized by 5 poor items with slow walking pace as prominent feature, which was defined as slow walking pace group; cluster 3 was characterized by weight loss and mild weakness, which was defined as emaciation group. Proportion of frail PLWH was the highest in slow walking pace group (54.2%), but proportion of frail HIV-negative individuals was the highest in weakness group(35.6%). Frail PLWH in slow walking pace group were more likely to be current smokers compared with those in emaciation group(χ² =10.889, P=0.004). Frail PLWH in weakness group were more likely to be current smokers compared with those in emaciation group(χ² =7.909, P=0.019). Frail PLWH in emaciation group were more likely to be underweight compared to those in weakness group(χ² =9.309, P=0.009). Frail HIV-negative individuals in weakness group were more likely to be aged over 60 years old compared to those in emaciation group(χ² =10.502, P=0.001), but less likely to have sleep disorders than those in emaciation group(χ² =6.541, P=0.011). Frail HIV-negative individuals in slow walking pace group were more likely to be aged over 60 years old compared to those in emaciation group(χ² =6.232, P=0.013). Conclusions Distribution of frailty subtypes are different between frail PLWH and HIV-negative individuals. Frail PLWH have more frailty subtype characterized by 5 poor components with slow walking pace as the prominent feature. Screening and intervention should be actively carried out considering frailty subtypes and their characteristics in PLWH.
- AIDS /
- Frailty /
- Sleep disorders /
- Depressive symptoms /
- Comorbidity

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图 1 2017年2月-2020年1月浙江省台州市3种衰弱类型发生概率雷达图

Figure 1. Radar map of occurrence probability of 3 frailty subtypes in Taizhou, Zhejiang Province fron February 2017 to January 2020

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表 1 2017年2月-2020年1月浙江省台州市HIV阳性和阴性衰弱者的衰弱表型基本特征差异[n(%)]

Table 1. The basic characteristics of frailty subtypes among frail people living with HIV and HIV-negative individuals in Taizhou, Zhejiang Province fron February 2017 to January 2020 [n(%)]

变量	HIV阳性衰弱者						HIV阴性衰弱者
变量	合计 (n=83)	无力组 (n=19)	低步速组 (n=45)	消瘦组 (n=19)	χ²/F/H值	P值	合计 (n=83)	无力组 (n=19)	低步速组 (n=45)	消瘦组 (n=19)	χ²/F/H值	P值
年龄组(岁)					7.357	0.025^a					12.907	0.002^a
< 60	39(47.0)	12(63.2)	15(33.3)	12(63.2)			25(24.7)	4(11.1)	5(16.7)	16(45.7)
≥60	44(53.0)	7(36.8)	30(66.7)	7(36.8)			76(75.3)	32(88.9)	25(83.3)	19(54.3)
年龄 [M (P₂₅, P₇₅), 岁]	62.4 (45.5, 70.0)	51.5 (32.4, 64.4)	67.3 (55.7, 75.3)	54.0 (37.9, 66.2)	17.597	< 0.001 ^b	69.8 (60.0, 76.1)	72.8 (65.7, 77.1)	72.2 (65.6, 80.1)	60.3 (51.0, 71.3)	13.624	0.001^a
性别					0.320	0.936					0.051	0.975
女	18(21.7)	4(21.0)	9(20.0)	5(26.3)			25(24.7)	9(25.0)	7(23.3)	9(25.7)
男	65(78.3)	15(79.0)	36(80.0)	14(73.7)			76(75.3)	27(75.0)	23(76.7)	26(74.3)
文化程度					3.075	0.215					0.601	0.741
文盲/小学	54(65.1)	10(52.6)	33(73.3)	11(57.9)			79(78.2)	29(80.6)	22(73.3)	28(80.0)
初中及以上	29(34.9)	9(47.4)	12(26.7)	8(42.1)			22(21.8)	7(19.4)	8(26.7)	7(20.0)
BMI (kg/m²)					9.292	0.041^a					3.589	0.485
< 18.5	23(27.7)	1(5.3)	13(28.9)	9(47.4)			5(5.0)	0(0.0)	3(10.0)	2(5.7)
18.5~ < 24.0	46(55.4)	15(78.9)	24(53.3)	7(36.8)			45(44.5)	17(47.2)	13(43.3)	15(42.9)
≥24.0	14(16.9)	3(15.8)	8(17.8)	3(15.8)			51(50.5)	19(52.8)	14(46.7)	18(51.4)
腰臀比					0.107	0.948					4.011	0.135
正常	46(55.4)	11(57.9)	25(55.6)	10(52.6)			29(28.7)	6(16.7)	11(36.7)	12(34.3)
超标	37(44.6)	8(42.1)	20(44.4)	9(47.4)			72(71.3)	30(83.3)	19(63.3)	23(65.7)
吸烟					11.689	0.016 ^a					2.670	0.615
从不	38(45.8)	7(36.8)	16(35.6)	15(79.0)			56(55.5)	17(47.2)	18(60.0)	21(60.0)
以前吸	25(30.1)	7(36.8)	17(37.8)	1(5.3)			23(22.8)	8(22.2)	7(23.3)	8(22.9)
现在吸	20(24.1)	5(26.4)	12(26.6)	3(15.7)			22(21.7)	11(30.6)	5(16.7)	6(17.1)
睡眠障碍					0.991	0.609					6.559	0.038 ^a
否	33(39.8)	9(47.4)	18(40.0)	6(31.6)			42(41.6)	20(55.6)	13(43.3)	9(25.7)
是	50(60.2)	10(52.6)	27(60.0)	13(68.4)			59(58.4)	16(44.4)	17(56.7)	26(74.3)
抑郁症状得分 [M (P₂₅, P₇₅)]	18.0 (14.0, 21.0)	18.0 (14.0, 20.0)	17.0 (14.0, 20.0)	20.0 (15.0, 24.0)	1.110	0.334	14.0 (11.0, 18.0)	12.5 (10.5, 16.5)	14.0 (11.0, 16.0)	17.0 (14.0, 21.0)	10.610	0.005 ^b
共病数量(种)					3.060	0.559					6.061	0.195
0	38(45.8)	10(52.6)	18(40.0)	10(52.6)			16(15.8)	9(25.0)	1(3.3)	6(17.1)
1	26(31.3)	7(36.8)	14(31.1)	5(26.3)			35(34.7)	12(33.3)	12(40.0)	11(31.4)
≥2	19(22.9)	2(10.6)	13(28.9)	4(21.1)			50(49.5)	15(41.7)	17(56.7)	18(51.5)
HIV诊断时间(年)					2.232	0.317
< 3	67(80.7)	14(73.7)	39(86.7)	14(73.7)
≥3	16(19.3)	5(26.3)	6(13.3)	5(26.3)
抗病毒治疗时间(年)					7.554	0.113
未治疗	27(32.5)	4(21.1)	20(44.4)	3(15.8)
< 3	42(50.6)	10(52.6)	19(42.2)	13(68.4)
≥3	14(16.9)	5(26.3)	6(13.4)	3(15.8)
当前CD4⁺T淋巴细胞计数(个/μl)					3.107	0.212
< 200	52(62.7)	15(79.0)	27(60.0)	10(52.6)
≥200	31(37.3)	4(21.0)	18(40.0)	9(47.4)
当前HIV病毒载量(copies/ml)(n=48)					6.493	0.045^a
< 200	30(62.5)	10(83.3)	12(46.2)	8(80.0)
≥200	18(37.5)	2(16.7)	14(53.8)	2(20.0)
注：^a表示P < 0.05;^b表示P < 0.001。

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表 2 2017年2月-2020年1月浙江省台州市HIV阳性和阴性衰弱者的衰弱类型分布

Table 2. The distribution of frailty subtypes among frail people living with HIV and HIV-negative individuals in Taizhou, Zhejiang Province fron February 2017 to January 2020

HIV感染状态	无力组	低步速组	消瘦组	χ²值	P值
HIV(+)	19 (22.9)	45 (54.2)	19 (22.9)	11.343	0.003 ^a
HIV(-)	36 (35.6)	30 (29.7)	35 (34.7)
合计	55 (29.9)	75 (40.8)	54 (29.3)
注：^a表示P < 0.05。

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