本文選題：HIV普遍檢測(cè)　切入點(diǎn)：居民健康體檢　出處：《浙江大學(xué)》2014年博士論文

【摘要】：第一部分結(jié)合居民健康體檢的社區(qū)艾滋病抗體普遍檢測(cè)研究 背景： 是否艾滋病普遍檢測(cè)的爭(zhēng)議已經(jīng)持續(xù)了25年之久,2012年美國(guó)預(yù)防服務(wù)工作組(USPSTF)發(fā)布指南性文件,強(qiáng)烈建議在所有成人中開(kāi)展普遍HIV抗體檢測(cè)。暗娼等橋梁人群的作用,使中國(guó)艾滋病從高危、重點(diǎn)人群向普通人群擴(kuò)散,由于潛伏期長(zhǎng)、無(wú)癥狀,使艾滋病的主動(dòng)發(fā)現(xiàn)更為困難,當(dāng)前疫情監(jiān)測(cè)體系難以完全觸及普通人群,急需探索普通人群的全民HIV抗體篩查策略,及早發(fā)現(xiàn)傳染病、及時(shí)控制傳染源、減少傳播和降低感染率。 目的： 探索結(jié)合浙江省現(xiàn)行的居民健康體檢工程的HIV抗體普遍篩查策略,發(fā)現(xiàn)潛在陽(yáng)性人群,及時(shí)掌握區(qū)域人群艾滋病感染率、分布及其相關(guān)風(fēng)險(xiǎn)因素,為摸清艾滋病流行率打下基礎(chǔ)。 方法： 2010年6月到2012年5月,采用分層多階段整群抽樣策略,結(jié)合健康體檢,完成社區(qū)居民HIV抗體普遍檢測(cè),并收集人口學(xué)、抗體檢測(cè)結(jié)果。用SPSS18.0進(jìn)行數(shù)據(jù)清洗和分析,一般信息用描述性分析,參照2000年中國(guó)人口標(biāo)準(zhǔn)結(jié)構(gòu)標(biāo)化感染率,不同感染率之間比較用卡方檢驗(yàn),相關(guān)影響因素用Logistic回歸分析。結(jié)果： 在1113030納入檢測(cè)人群中,確診HIV陽(yáng)性310例,感染率為3.45/10000,其中男性為5.62/10000,女性為1.17/10000,相對(duì)于男性人群,女性人群的艾滋病感染風(fēng)險(xiǎn)相對(duì)較低(ARR,0.16,p0.001)。不同年齡層的艾滋病感染率也具有顯著差異,25-34歲年齡層感染率最高為9.30/10000,相比對(duì)15歲人群,其他年齡組人群的艾滋病感染風(fēng)險(xiǎn)均較高(ARR范圍從2.49-25.69),尤其是25-34與35-44年齡組人群高(ARR,25.69,p0.001和ARR18.48,p0.001),在老年人群中發(fā)現(xiàn)55-64歲和65歲以上年齡組人群的艾滋病感染率分別為2.04/10000和0.78/10000。在中等GDP地區(qū),25-44歲,男性人群感染率高。310例陽(yáng)性人群中203為既往診斷陽(yáng)性病例,107例為本次普遍檢測(cè)新診斷出病例,本次普遍檢測(cè)貢獻(xiàn)率達(dá)34.52%。相比于本地戶(hù)籍陽(yáng)性人群,非本地戶(hù)籍具有具有如下特點(diǎn)：平均年齡小10歲、未婚比例高、文化程度低等。結(jié)論： 1)本研究通過(guò)在浙江省居民健康體檢基礎(chǔ)上增加HIV抗體檢測(cè),成功的在大規(guī)模人群(111萬(wàn))完成HIV抗體普遍檢測(cè)； 2)基于分層多階段整群抽樣策略,在111萬(wàn)人群中,診斷陽(yáng)性310例,艾滋病感染率為3.45/10000,尚屬低流行區(qū),同時(shí)率的分布將為后續(xù)疫情監(jiān)測(cè)、干預(yù)研究提供基礎(chǔ)資料； 3)診斷的310例陽(yáng)性中,107例(34.52%)為新診斷病例,普遍檢測(cè)有助于發(fā)現(xiàn)潛在陽(yáng)性人群。 第二部分基于社區(qū)的艾滋病強(qiáng)化隨訪效果研究 背景： 高效抗逆轉(zhuǎn)錄病毒治療(HAART)對(duì)減少艾滋病病人死亡和提高病人生活質(zhì)量發(fā)揮了極其重要的作用,但較差的服藥依從性使HAART的療效大打折扣。因此,開(kāi)展有效病人管理探索,以期較好的完成病人隨訪管理指標(biāo),加強(qiáng)接受抗病毒治療病人的服藥督促、社會(huì)心理支持,提高治療效果,有利于降低病死率。 目的： 本研究旨在建立基于社區(qū)的抗病毒治療隨訪干預(yù)措施,評(píng)估不同隨訪管理模式下接受HAART患者的用藥依從性情況、隨訪指標(biāo)體系和治療效果。了解HAART人群依從性狀況和相關(guān)影響因素,從而在降低病死率方面進(jìn)行探索。 方法： 2012年3月到2013年6月,強(qiáng)化隨訪組建立的社區(qū)-疾控-專(zhuān)科醫(yī)院的“三位一體”陽(yáng)性隨訪管理措施,常規(guī)隨訪組以當(dāng)前的“疾控”隨訪為主要模式。評(píng)估12個(gè)月后依從性變化、隨訪管理指標(biāo)變化以及治療效果。采用SPSS18.0進(jìn)行數(shù)據(jù)分析,運(yùn)用描述統(tǒng)計(jì)、卡方檢驗(yàn)、Logistic回歸、t檢驗(yàn)等統(tǒng)計(jì)方法。 結(jié)果： 在強(qiáng)化隨訪組和常規(guī)隨訪組各納入165例和84例,強(qiáng)化隨訪組的依從性從83.03%提高到91.52%,常規(guī)隨訪組依從性從82.14%提高到83.33%,兩者有顯著性差異(χ2=3.733,P=0.045),綜合比較前后依從性變化情況,發(fā)現(xiàn)強(qiáng)化隨訪組變好比例為16.36%,常規(guī)隨訪組為7.14%,有統(tǒng)計(jì)學(xué)差異性(χ2=4.117,P=0.042)。對(duì)HAART人群中的關(guān)鍵指標(biāo)分析發(fā)現(xiàn),相比于常規(guī)隨訪組,強(qiáng)化隨訪組在堅(jiān)持治療比例、完成7次隨訪比例、CD4檢測(cè)比例、病毒載量檢測(cè)比例等主要指標(biāo)的完成情況均優(yōu)于常規(guī)隨訪組。在免疫學(xué)指標(biāo)觀察中,強(qiáng)化隨訪組和常規(guī)隨訪組CD4+T細(xì)胞計(jì)數(shù)均顯著上升(t=-3.028,P=0.003；t=-2.327,P=0.022)；強(qiáng)化隨訪組活化系統(tǒng)表達(dá)(CD8+CD38+)比例37.38±8.68下降到34.40±11.53,具有顯著性差異(t=1.987,P=0.048)；強(qiáng)化隨訪組IL7-CD127系統(tǒng)(CD4+CD127+)比例從23.22±7.11上升到27.69±11.72,具有顯著性差異(t=-3.237,P=0.001)；常規(guī)隨訪組均沒(méi)有顯著性差異。 結(jié)論： 1)經(jīng)12個(gè)月隨訪,強(qiáng)化隨訪組依從性的改善顯著優(yōu)于常規(guī)隨訪組(χ2=4.117,P=0.042)； 2)相比于常規(guī)隨訪組,強(qiáng)化隨訪組堅(jiān)持治療比例、完成7次隨訪比例、CD4檢測(cè)比例、病毒載量檢測(cè)比例等主要指標(biāo)的完成情況均優(yōu)于常規(guī)隨訪組； 3)經(jīng)過(guò)12個(gè)月的治療,兩組研究對(duì)象的CD4+T細(xì)胞數(shù)均能顯著提高,然而強(qiáng)化隨訪組在免疫活化和IL7-CD127系統(tǒng)的免疫恢復(fù)情況顯著優(yōu)于常規(guī)隨訪組。 第三部分艾滋病陽(yáng)性的老年人群流行病學(xué)與病死率分析 背景： 隨著人口老齡化的到來(lái),預(yù)期壽命的提高和生活質(zhì)量的改善,使得該人群性活躍程度出現(xiàn)了極大的變化,中國(guó)老年人感染病例快速增長(zhǎng)的趨勢(shì),但這個(gè)人群的流行、發(fā)病、死亡特點(diǎn)仍不清楚。 目的： 系統(tǒng)回顧分析老年艾滋病感染者病人流行特征,比較死亡原因及病死率,掌握浙江省老年感染人群特征,為針對(duì)性防治提供依據(jù)。 方法： 根據(jù)浙江省疫情分布和流行病學(xué)因素,收集2000年1月1日-2012年12月30日?qǐng)?bào)告的1115例艾滋病陽(yáng)性病例,其中196例為老年(≥50歲),應(yīng)用SPSS18.0進(jìn)行數(shù)據(jù)分析,采用卡方檢驗(yàn)、生存分析方法。 結(jié)果： 發(fā)現(xiàn)≥50歲組占整個(gè)艾滋病陽(yáng)性的比例成逐年上升的趨勢(shì),特別是在2000年后,從0上升到2012年的22.45%,性傳播為主,占82.65%。相對(duì)與50歲組,50歲組診斷時(shí)CD4數(shù)值顯著低(291.64vs.363.63p0.05).更多的人發(fā)現(xiàn)即處于發(fā)病狀態(tài)(51.02%vs.34.06%p0.05)。生存分析估計(jì)≥50歲組存活時(shí)間為11.54±0.49年；50歲組為13.85±0.46年,兩組之間Log Rank (Mantel-Cox)檢驗(yàn)卡方值為3.83,兩者有顯著差異性(P0.05)。 結(jié)論： 1)老年病例發(fā)現(xiàn)數(shù)逐年上升,性傳播為主,老年群體艾滋病問(wèn)題不容忽視； 2)老年陽(yáng)性人群估計(jì)生存時(shí)間為11.54±0.49年,不能及時(shí)早期診斷和本身的基礎(chǔ)疾病,可能是該人群估計(jì)存活時(shí)間短、病死率高的主要原因； 3)加強(qiáng)對(duì)老年人探索主動(dòng)篩查策略或擴(kuò)大監(jiān)測(cè)體系的年齡譜,以便及時(shí)發(fā)現(xiàn)老年病人,及時(shí)治療,降低老年艾滋病人病死率。
[Abstract]:Study on the universal detection of community AIDS antibody in the first part in combination with residents ' health examination

Background :

It is highly recommended that universal HIV antibody detection be carried out in all adults . It is highly recommended that universal HIV antibody detection be carried out in all adults . It is highly recommended that HIV antibody detection be carried out in all adults . As the latent period is long and asymptomatic , the active discovery of AIDS is more difficult . The current epidemic situation monitoring system is difficult to reach the general population . It is urgent to explore the universal HIV antibody screening strategy of the general population . It is urgent to detect infectious diseases in time , control the source of infection in time , reduce the transmission and reduce the infection rate .

Purpose :

To explore the universal screening strategy of HIV antibody in the current residents ' health check - up project in Zhejiang Province , find out the potential positive population , grasp the HIV infection rate , distribution and relevant risk factors of the regional population in time , and lay the foundation for finding out the prevalence rate of AIDS .

Method :

From June 2010 to May 2012 , a stratified multi - stage cluster sampling strategy was adopted to carry out general detection of HIV antibodies in community residents and to collect population and antibody detection results .

Among the 1113030 patients , 310 HIV - positive patients were diagnosed , with an infection rate of 3.45 / 10000 , with a male of 5.62 / 10000 and a female 1.17 / 10000 , with a relatively low risk of HIV infection in the female population compared to the male population ( ARR , 0.16 , p0.001 ) . Among the elderly population , the prevalence of HIV infection was 2.04 / 10000 and 0.78 / 10000 . Among the elderly population , the prevalence of HIV infection was 2.04 / 10000 and 0.78 / 10000 respectively . Among the elderly population , the prevalence of HIV infection was 2.04 / 10000 and 0.78 / 10000 respectively .

1 ) HIV antibody test was carried out on the basis of health examination of residents in Zhejiang Province , and the universal detection of HIV antibody was completed in large - scale population ( 111 million ) .


2 ) Based on stratified multi - stage cluster sampling strategy , among 111 000 people , 310 cases were diagnosed positive , the infection rate of AIDS was 3.45 / 10000 , still belonged to low epidemic area , and the distribution of the rate will provide basic information for follow - up epidemic monitoring and intervention study ;


3 ) Of the 310 positive cases , 107 cases ( 34.52 % ) were newly diagnosed cases .

The Second Part Based on Community - based AIDS Intensive Follow - up Effect

Background :

High - efficiency anti - retroviral therapy ( HAART ) plays a very important role in reducing the death of patients with AIDS and improving the quality of life of patients . However , the poor drug compliance makes HAART ' s curative effect very low . Therefore , effective patient management exploration is carried out with a view to better completing the patient ' s follow - up management index , strengthening the administration supervision and social psychological support of patients receiving anti - virus treatment , improving the treatment effect , and being beneficial to reducing the mortality rate .

Purpose :

The purpose of this study was to establish a community - based follow - up intervention to evaluate the compliance of patients with HAART in different follow - up management modes , follow - up index system and treatment effect .

Method :

From March 2012 to June 2013 , the " three - in - one " follow - up management of the community - disease control - specialist hospital established in the follow - up group was strengthened . The routine follow - up group was followed up as the main mode with the current " disease control " follow - up . The data were analyzed by SPSS 18.0 , and the statistical methods such as descriptive statistics , chi - square test , Logistic regression , t - test were applied .

Results :

In the intensive follow - up group and routine follow - up group , 165 cases and 84 cases were included , the compliance of the intensive follow - up group was increased from 83.03 % to 91.52 % , and the compliance of routine follow - up group increased from 82.14 % to 83.33 % . According to the analysis of key indexes in HAART population , compared with the routine follow - up group , the completion of the main indexes such as the proportion of follow - up , the proportion of CD4 , the proportion of CD4 and the proportion of viral load were better than those of the conventional follow - up group . In the observation of immunology , the number of CD4 + T cells in the intensive follow - up group and the conventional follow - up group increased significantly ( t = - 3.028 , P = 0.003 ;
t=-2.327,P=0.022)錛，

本文編號(hào)：1729786