Analysis on the characteristics of HIV-infected maternal and their babies in Guangdong Province
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摘要:
目的 了解广东省人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染孕产妇及所生婴儿特征，为预防HIV母婴传播(mother-to-child transmission, MTCT)综合干预服务提供参考依据。 方法 利用国家预防MTCT信息管理系统监测数据，收集2006-2017年广东省HIV感染孕产妇及所生婴儿一般资料和接受预防HIV MTCT服务相关资料，比较HIV感染再生育孕产妇及所生婴儿与初次生育孕产妇及所生婴儿的差异。 结果 2 094例HIV感染孕产妇数中，再生育孕产妇占比61.70%，平均年龄为(30.2±5.3)岁，文化程度以初中/高中为主(54.18%)；与初次生育孕产妇相比，再生育孕产妇HIV初检孕周较晚[28.0(14.0, 39.0) vs 17.0(12.0, 28.3)，周]，产时/产后确诊占比高(41.18% vs 10.10%)，性伴HIV感染状态普遍不详(54.57% vs 41.52%)，接受抗病毒治疗比例不高(62.77% vs 87.41%)，治疗开始时期晚(产时/产后开始治疗占比19.24% vs 6.28%)，所生婴儿接受预防性治疗的比例不高(82.35% vs 91.90%)，混合喂养占比较稍高(6.94% vs 3.42%)。 结论 广东省HIV感染孕产妇预防HIV MTCT服务利用度不高，加强HIV感染孕产妇的健康意识，提升医务人员对HIV感染孕产妇及所生婴儿的关注，特别是再生育孕产妇，有助于推进广东省预防HIV MTCT项目工作。 Abstract:Objective To investigate the characteristics of HIV-infected maternal and their babies in Guangdong Province, and to improve services on prevention of HIV mother-to-child transmission (MTCT). Methods Exporting monitoring data from national information management system for prevention MTCT, the general information and the relevant data about HIV prevention MTCT services from HIV-infected pregnant women and their babies in Guangdong Province from 2006 to 2017 were collected to compare the differences between different parities maternal. Results Among the 2 094 HIV-infected pregnant women, 61.70% were re-pregnant women, whose average age were (30.2±5.3) years old, the education level was mainly in junior high/senior high school (54.18%). Compared with the first-time pregnant maternal, re-pregnant maternal were tend to screening on later gestational age [28.0(14.0, 39.0) vs 21.0 (13.0, 38.0), weeks], with a high proportion of confirmed time during intrapartum/postpartum (41.18% vs 10.10%), HIV infection status of sexual partner was unknown (54.57% vs 41.52%), generally, the proportion of anti-viral treatment was not high (62.77% vs 87.41%), treatment begins late (intrapartum/postpartum started treatment accounted for 19.24% vs 6.28%). The preventive treatment rate of their infants were not high (82.35% vs 91.90%), while mixed feeding rate was higher (6.94% vs 3.42%). Conclusions The utilization of HIV MTCT in prevention of HIV-infected maternal in Guangdong was not high. Strengthening the health awareness of HIV-infected maternal, and enhancing the attention of medical staff to HIV-infected maternal and their babies, espesially among those re-pregnant women, are helpful to promote the work of prevention of HIV MTCT project in Guangdong Province. -
Key words:
- Human immunodeficiency virus /
- Maternal /
- Mother-to-child transmission
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表 1 2006-2017年广东省HIV感染孕产妇一般特征分析[n(%)]
Table 1. Analysis of general characteristics of HIV-infected maternal in Guangdong from 2006 to 2017 [n(%)]
变量 合计 初次生育 再生育 t/χ2值 P值 年龄[岁，x±s] 29.0±5.4 27.0±4.9 30.2±5.3 13.95 ＜0.001 年龄分组(岁) 80.98 ＜0.001 ＜20 52(2.48) 33(4.11) 19(1.47) 20~ 1 696(80.88) 706(88.03) 990(76.63) ≥35 346(16.52) 63(7.86) 283(21.90) 民族 9.64 0.002 汉族 1819(86.87) 720(89.78) 1 099(85.06) 其他 275(13.13) 82(10.22) 193(14.94) 文化程度 95.99 ＜0.001 小学及以下 354(16.90) 75(9.35) 279(21.59) 初中/高中 1 499(71.59) 603(52.99) 896(54.18) 大学及以上 128(6.11) 88(10.97) 40(3.10) 不详 113(5.40) 36(4.49) 77(5.96) 职业 28.64 ＜0.001 农民 222(10.60) 55(6.86) 167(12.93) 无业/待业 1 139(54.39) 423(52.74) 716(55.42) 其他 733(35.01) 324(40.40) 409(31.65) 婚姻状况 13.17 ＜0.001 已婚 1 742(83.19) 637(79.43) 1 105(85.53) 未婚/离异 352(16.81) 165(20.57) 187(14.47) 
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表 2 2006-2017年广东省HIV感染孕产妇临床特征分析
Table 2. nalysis of clinical characteristics of HIV-infected maternal in Guangdong from 2006 to 2017 [n(%)]
变量 合计 初次生育 再生育 t/χ2值 P值 初检孕周[周，M(P25, P75)] 21.0(13.0, 38.0) 17.0(12.0, 28.3) 28.0(14.0, 39.0) 10.53 ＜0.001 确认感染时期 254.93 ＜0.001 婚前 118(5.64) 60(7.48) 58(4.49) 孕期 994(47.47) 521(64.96) 473(36.61) 产时/产后 613(29.27) 81(10.10) 532(41.18) 其他 369(17.62) 140(17.46) 229(17.72) 性伴HIV感染 35.22 ＜0.001 未感染 620(29.61) 285(35.54) 335(25.93) 感染 436(20.82) 184(22.94) 252(19.50) 不详 1 038(49.57) 333(41.52) 705(54.57) 抗病毒治疗 150.60 ＜0.001 未治疗 560(26.74) 95(11.84) 465(35.99) 治疗 1 512(72.21) 701(87.41) 811(62.77) 不详 22(1.05) 6(0.75) 16(1.24) 开始治疗时期 55.01 ＜0.001 孕期 1 312(86.77) 657(93.72) 655(80.76) 产时/产后 200(13.23) 44(6.28) 156(19.24) 孕期治疗孕周(周)a 15.75 ＜0.001 ＜14 380(28.96) 160(24.35) 220(33.59) 14~ 593(45.20) 327(49.77) 266(40.61) ≥28 339(25.84) 170(25.88) 169(25.80) 孕次(次) 892.91 ＜0.001 1 430(20.53) 430(53.62) 0(0.00) 2 798(38.11) 224(27.93) 574(44.43) ≥3 866(41.36) 148(18.45) 718(55.57) 分娩方式 98.15 ＜0.001 阴道产 979(46.75) 265(33.04) 714(55.26) 剖宫产 1 115(53.25) 537(66.96) 578(44.74) 分娩地点 78.82 ＜0.001 市级及以上助产机构 1 001(47.81) 451(56.23) 550(42.57) 县(区)级助产机构 757(36.15) 291(36.28) 466(36.07) 乡(街道)级助产机构 306(14.61) 54(6.73) 252(19.50) 家中/其他 30(1.43) 6(0.38) 24(1.16) 注：a孕期治疗孕周：HIV感染孕产妇孕期治疗分组根据孕周划分为孕早期(＜14周)、孕中期(14~周)、孕晚期(≥28)[6]。
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表 3 2006-2017年广东省HIV感染孕产妇所生婴儿特征分析[n(%)]
Table 3. Analysis of clinical characteristics of infants born to HIV-infected maternal in Guangdong from 2006 to 2017[n(%)]
变量 合计 初次生育 再生育 t/χ2值 P值 体重[kg，x±s] 2.9±0.5 2.9±0.5 3.0±0.5 3.43 0.001 身长[cm，x±s] 48.8±3.3 48.7±3.0 48.8±3.5 0.62 0.539 儿童预防性治疗 37.48 ＜0.001 治疗 1 801(86.01) 737(91.90) 1064(82.35) 未治疗 215(10.27) 47(5.86) 168(13.00) 不详 78(3.72) 18(2.24) 60(4.65) 喂养方式a 6.90 0.032 母乳喂养 14(1.19) 6(1.21) 8(1.18) 人工喂养 1 096(93.36) 474(95.37) 622(91.88) 混合喂养 64(5.45) 17(3.42) 47(6.94) 注：a喂养方式：获得1 174名婴儿的喂养方式信息，其中再生育孕产妇所生婴儿677名。
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[1] The Joint United Nations Programme on HIV and AIDS (UNAIDS). UNAIDS data 2018[EB/OL]. (2018-04-03)[2020-02-28]. http://www.unaids.org/en/resources/documents/2018/unaids-data-2018. [2] 庄柯, 桂希恩, 骆嘉拉, 等.艾滋病高发农村儿童人类免疫缺陷病毒感染与艾滋病关系[J].中华儿科杂志, 2003, 41(8):30-33. DOI: 10.3760/j.issn:0578-1310.2003.08.008.Zhuang K, Gui XE, Luo JL, et al. A survey of children with HIV/AIDS in highly epidemic villages of AIDS[J]. Chin J Pediatr, 2003, 41(8):30-33. DOI: 10.3760/j.issn:0578-1310.2003.08.008. [3] 胡崇高, 邱丽倩, 徐玮, 等.浙江省HIV感染再生育孕产妇特征及妊娠结局分析[J].预防医学, 2017, 29(6):579-582. DOI:10.19485/j.cnki.issn 1007-093 1.201 7.06.009.Hu CG, Qiu LQ, Xu W, et al. An analysis on the demographic charactistics and pregnant outcomes of the reproductive women with HIV infection[J]. Prev Med, 2017, 29(6):579-582. DOI: 10.19485/j.cnki.issn 1007-093 1.201 7.06.009. [4] Kreitchmann R, Megazzini K, Melo VH, et al. Repeat pregnancy in women with HIV infection in Latin America and the Caribbean[J]. AIDS Care, 2015, 27(10):1289-1297. DOI: 10.1080/09540121.2015.1050987. [5] Floridia M, Tamburrini E, Masuelli G, et al. Rate, correlates and outcomes of repeat pregnancy in HIV-infected women[J]. HIV Medicine, 2017, 18(6):440-443. DOI: 10.1111/hiv.12473. [6] 王泽华.妇产科学(第5版)[M].北京:人民卫生出版社, 2004.Wang ZH. Obstetrics and Gynecology (5th Edition)[M]. Beijing:People's Medical Publishing House, 2004. [7] Bangsberg DR, Hecht FM, Charlebois ED, et al. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population[J]. AIDS, 2000, 14(4):357-366. DOI: 10.1097/00002030-200003100-00008. [8] 关灵灵.新疆艾滋病母婴传播现状与影响因素分析[D].兰州: 兰州大学, 2017.Guang LL. Analysis on the status and influencing factors of mother to child transmission of HIV/AIDS[D]. Lanzhou: Lanzhou University, 2017. [9] 徐海港, 胡洋, 张欢, 等. 2012-2016年江西省HIV感染孕产妇母婴传播阻断干预情况分析[J].中国健康教育, 2018, 34(4):363-366. DOI:10.16168/j.cnki.issn.1002-9982.2018.04.018.Xu HG, Hu Y, Zhang H, et al. Situation analysis of HIV-infected pregnant woman and intervention for prevention of mother-to-child transmission in Jiangxi from 2012 to 2016[J]. Chin J Health Education, 2018, 34(4):363-366. DOI: 10.19757/j.cnki.issn1674-7763.2017.05.004. [10] 刘冬梅, 庞俊, 韦淑珍, 等.不同孕期HIV/AIDS孕妇接受抗病毒治疗的效果评估[J].中华全科医学, 2013, 11(7):1061-1062. DOI: 10.16766/j.cnki.issn.1674-4152.2013.07.037.Liu DM, Pang J, Wei SZ, et al. Effect evaluation of HIV/AIDS pregnant women of different pregnancy receiving antiviral treatment[J]. Chinese Journal of General Practice, 2013, 11(7):1061-1062. DOI: 10.16766/j.cnki.issn.1674-4152.2013.07.037. [11] 李映, 谢小花, 黄越华, 等.广西945例HIV阳性孕产妇母婴传播综合干预措施利用情况[J].中国艾滋病性病, 2015, 21(8):664-667. DOI: 10.13419/j.cnki.aids.2015.08.05.Li Y, Xie XH, Huang YH, et al. Effect of applications of comprehensive PMTCT intervention services for 945 HIV-infected pregnant women in Guangxi[J]. Chin J AIDS STD, 2015, 21(8):664-667. DOI: 10.13419/j.cnki.aids.2015.08.05. [12] 周丹红, 许建飞, 杨罗旗.台州市2012-2016年预防艾滋病母婴传播情况分析[J].中国乡村医药. 2018, 25(15):51-52. http://kns.cnki.net/KCMS/detail/detail.aspx?dbcode=CJFD&filename=XCYY201815030Zhou DH, Xu JF, Yang LQ. Analysis of prevention of mother-to-child transmission of AIDS in Taizhou from 2012 to 2016[J]. Chinese Journal of Rural Medicine and Pharmacy. 2018, 25(15):51-52. http://kns.cnki.net/KCMS/detail/detail.aspx?dbcode=CJFD&filename=XCYY201815030 [13] 覃清华, 周小潇, 谢小花.我国HIV感染孕产妇应用抗病毒药物情况及依从性研究进展[J].中国健康教育, 2018, 34(11):62-64. DOI: 10.16168/j.cnki.issn.1002-9982.2018.11.013.Qin QH, Zhou XX, Xie XH, Research advance in antiviral drug use compliance among HIV positive pregnant women in China[J]. Chin J Health Education, 2018, 34(11):62-64. DOI: 10.16168/j.cnki.issn.1002-9982.2018.11.013. [14] 王潇滟, 王爱玲, 王芳, 等.高流行地区HIV感染产妇配偶HIV检测情况及影响因素分析[J].中国艾滋病性病, 2015(6):493-496. DOI:10.13419/j.cnki.aids.2015.06.13. Wang XY, Wang AL, Wang F, et al. Partner's HIV testing and influence factors of HIV infected maternities in some high prealence areas of China[J]. Chin J AIDS STD, 2015(6):493-496. DOI: 10.13419/j.cnki.aids.2015.06.13. [15] 中华人民共和国国家卫生健康委员会.国家卫生计生委办公厅关于全面开展预防艾滋病、梅毒和乙肝母婴传播工作的通知[EB/OL]. (2015-06-16)[2020-02-28]. http://www.nhc.gov.cn/fys/s3581/201506/4f2123fa955a44afa75a75da2ad35d6e.shtml.National Health Commission of The People's Republic of China. Notice of the General Office of the National Health and Family Planning Commission on the over-comprehensive prevention of mother-to-child transmission of HIV, syphilis and Hepatitis B[EB/OL]. (2015-06-16)[2020-02-28]. http://www.nhc.gov.cn/fys/s3581/201506/4f2123fa955a44afa75a75da2ad35d6e.shtml. [16] 张璐, 方利文, 王临虹, 等.我国部分地区HIV感染产妇分娩方式及变化趋势[J].中国妇幼健康研究, 2012, 3(1):47-49. DOI: 10.3969/j.issn.1673-5293.2012.01.016.Zhang L, Fang LW, Wang LH, et al. Delivery mode of HIV infected pregnant women and the change trend in some regions of China[J]. Chinese Journal of Woman and Child Health Research, 2012, 23(1):47-49. DOI: 10.3969/j.issn.1673-5293.2012.01.016. [17] 陈彩云, 韩柳, 冯彩霞, 等.艾滋病病毒母婴传播影响因素的Logistic回归分析[J].中国热带医学, 2018, 18(8):68-71.Chen CY, Han L, Feng CX, et al. Logistic regression analysis of factors affecting mother to child transmission of human immunodeficiency virus[J]. China Tropical Medicine, 2018, 18(8):68-71. [18] 高洁, 吴颖岚, 邹颖, 等. 2012-2016年湖南省艾滋病感染孕产妇综合干预措施利用情况分析[J].中国妇幼卫生杂志, 2017(5):18-22. DOI: 10.19757/j.cnki.issn1674-7763.2017.05.004.Gao J, Wu YL, Zou Y, et al. Analysis of the applications effect of comprehensive PMTCT intervention services for HIV-infected pregnant women in Hunan Province in 2012-2016[J]. Chinese Journal of Women and Children Health, 2017(5):18-22. DOI: 10.19757/j.cnki.issn1674-7763.2017.05.004. [19] 王凤英, 艾比拜·买买提明, 李莉, 等. 2011-2012年新疆HIV母婴阻断的现况调查[J].疾病预防控制通报, 2014(3):8-9. DOI: 10.13215/j.cnki.jbyfkztb.1310014.Wang FY, Aibibi MMT, Li L, et al. Cross-sectional investigation on mother-infant block of HIV in Xinjiang, 2011-2012[J]. Endemic Diseases Bulletin, 2014(3):8-9. DOI: 10.13215/j.cnki.jbyfkztb.1310014. [20] 王临虹, 王爱玲, 方利文, 等.艾滋病母婴传播的流行状况与预防[J].中国妇幼保健, 2005, 3(20):92-94. DOI: 10.3969/j.issn.1001-4411.2005.03.053.Wang LH, Wang AL, Fang LW, et al. Epidemic situation and prevention of mother-to-child transmission of AIDS[J]. Maternal and Child Health Care of China, 2005, 3(20):92-94. DOI: 10.3969/j.issn.1001-4411.2005.03.053. -
