本文選題：艾滋病 + 抗反轉錄病毒治療��； 參考：《復旦大學》2014年碩士論文

【摘要】：研究目的：評價上海地區(qū)接受國家免費高效抗反轉錄病毒治療(HAART)的治療效果及其相關影響因素；探討國內治療方案及治療時機與延長艾滋病病人生存時間、生存質量的關系,為制定更加合理的治療方案和決策支持提供科學依據,進一步遏制艾滋病在我國的蔓延。研究方法：采用回顧性隊列研究方法,對上海地區(qū)自2005年9月30日至2008年12月31日納入國家免費抗病毒治療艾滋病患者的臨床資料、細胞免疫、病毒學應答、藥物的不良反應及生存情況進行綜合評估。觀察終點時間為2012年12月底。本次數據錄入與分析,分別采用EpiData和SPSS 17.0統(tǒng)計軟件。研究結果：本次研究共納)-410例患者,其中男321例、女89例,平均年齡(42.1±12.4)歲。其中以20-49歲的中青年為主(71.7%),已婚或同居者236例(57.6%)：感染途徑以性傳播為主,異性傳播占52.2%,同性傳播占22.4%；在接受本次治療前,3.7%的病例接受過中藥治療,19.5%的病例接受過抗病毒治療。本研究病例納入治療時多數已進入艾滋病晚期,75.9%病例的CD4+T淋巴細胞計數200個/μl治療前平均CD4+T淋巴細胞計數為(121.1±111.8)個/μl。平均隨訪治療時間為(59.4±1.3)個月。隨著治療時間的延長,患者體內病毒載量得到很好的抑制。在HAART第12、24、36、48、60及72個月時病毒完全抑制率分別為23.4%,64.4%,73.4%,86.7%,87.2%及84%；患者的CD4+T細胞計數呈現不同程度的增長,治療后各個隨訪時間點的CD4+T淋巴細胞計數平均水平隨著治療時間的推移呈上升趨勢,治療后第3、6、12、24、36、48、60、72月份患者CD4+T淋巴細胞平均計數分別為199、220、264、310、345、373、386、395個/μl,與基線平均水平相比均具有顯著性意義(P0.001)。而且,患者中CD4+T淋巴細胞計數200個/μl的比例隨著抗病毒治療時間的推移呈下降趨勢,第3、6、12、18、24、36、48、60、72月份病人中CD4+T細胞計數200個/μl的百分比與基線比較均具有顯著性意義(P0.001)。截止至研究終點,失訪13例,轉診8例,因艾滋相關死亡31例,1例自殺,仍有357例患者繼續(xù)接受ART。死亡病例平均年齡為52.2歲,平均治療時間為5.1個月(2天-29個月)。在接受抗病毒治療后第1、2、3、4、5、6、7年,生存率分別為0.93、0.92、0.92、0.92、0.92、0.92、0.92。應用Cox比例風險回歸模型單因素分析,發(fā)現年齡(44歲組、44-59歲組和60歲組)和基線CD4+T淋巴細胞計數(=100個/μl組和100個/μl組)與生存時間有統(tǒng)計學意義(P0.05)。多因素Cox比例風險回歸模型分析發(fā)現：在控制了年齡、性別、婚姻狀況等因素的潛在混雜作用影響后,基線CD4+T淋巴細胞計數與其生存時間之間存在統(tǒng)計學關聯�；�CD4+T淋巴細胞計數=100個/μl組死于艾滋病相關疾病的風險較基線CD4+T淋巴細胞計數100個/μl組的艾滋病患者低(HR=0.21,95%CI：0.15-0.78)在本研究過程中,71.2%的患者出現抗病毒藥物相關不良反應,以惡心嘔吐、胃納減少等消化道癥狀為主,大多數藥物不良反應比較輕微,經對癥治療后緩解,其中125例次患者因藥物不良反應更改治療方案。研究結論：上海地區(qū)艾滋病人通過接受免費抗病毒治療,使體內HIV病毒復制得到有效抑制,同時免疫功能也得到提高。在降低艾滋病病人的病死率,延長病人的生存時間,取得了良好的治療效果；在長期的治療隨訪過程中發(fā)現藥物的不良反應是更換治療方案的主要原因,要加強對各種抗病毒藥物不良反應的監(jiān)測,提供相應的治療策略,提高病人依從性,減少換藥的人次和頻度,在有限的藥物選擇范圍內達到最佳的治療效果。
[Abstract]:Objective: To evaluate the therapeutic effect of national free high performance antiretroviral therapy (HAART) in Shanghai and its related factors, and to explore the relationship between the domestic treatment plan and the time of treatment and the survival time of AIDS patients and the quality of life, and provide a scientific basis for making more reasonable treatment schemes and decision support. To further curb the spread of AIDS in China. Methods of retrospective cohort study, a comprehensive assessment of the clinical data, cellular immunity, virological response, adverse drug reactions and survival of the national free antiviral treatment of AIDS patients from September 30, 2005 to December 31, 2008 in Shanghai was evaluated. The end of the study was the end of December 2012. EpiData and SPSS 17 statistical software were used for the data entry and analysis. The results of the study were included in this study. The results were included in this study. In this study, there were 321 males and 89 females with the average age of (42.1 + 12.4) years old. Among them, the middle and young people were 20-49 years old (71.7%), and 236 cases (57.6%) were married or cohabitation (57.6%): the infection pathway was found. Sexually transmitted transmission, heterosexual transmission accounted for 52.2%, homosexual transmission accounted for 22.4%; before receiving this treatment, 3.7% of the cases received traditional Chinese medicine and 19.5% of the cases received antiviral treatment. Most of the cases included in the treatment of this study had entered the advanced AIDS, the 75.9% cases of CD4+T lymphocytic count 200 / Mu l before the average CD4+T lymphocyte The average time of follow-up treatment was (121.1 + 111.8) / mu L. (59.4 + 1.3) months. With the prolonged treatment time, the viral load in the patient was well suppressed. The total inhibition rate of the virus was 23.4%, 64.4%, 73.4%, 86.7%, 87.2% and 84% respectively at the time of 12,24,36,48,60 and 72 months of HAART; the CD4+T cell count of the patients presented different processes. The average level of CD4+T lymphocyte counts increased with the time of treatment, and the average count of CD4+T lymphocytes in patients after treatment was 199220264310345373386395 / U L respectively after treatment (P), compared with the baseline average level (P). 0.001). Moreover, the proportion of CD4+T lymphocyte counts of 200 / u l decreased with the time of antiviral therapy, and the percentage of CD4+T cell counts of 200 / u l in month 3,6,12,18,24,36,48,60,72 was significant (P0.001). 31 cases of related death, 1 cases of suicidal, and 357 patients who continued to accept ART. death, the average age was 52.2 years, the average time of treatment was 5.1 months (2 days -29 months). In the 1,2,3,4,5,6,7 year after the treatment of antiviral treatment, the survival rate was the single factor analysis of the Cox proportional risk regression model of the 0.93,0.92,0.92,0.92,0.92,0.92,0.92. application, respectively. The present age (44 year old group, 44-59 year old group and 60 year old group) and the baseline CD4+T lymphocyte count (=100 / mu l group and 100 / L Group) and survival time were statistically significant (P0.05). Multiple factor Cox proportional risk regression model analysis found that the baseline CD4+T lymphocyte after controlling the potential confounding of factors such as age, sex, marital status and so on. There was a statistical correlation between the count and the survival time. The baseline CD4+T lymphocyte count =100 / u l group died of AIDS related diseases at a lower baseline CD4+T lymphocyte count of 100 / u l groups of AIDS patients (HR=0.21,95%CI:0.15-0.78) in this study, and in this study, the adverse reactions associated with antiviral drugs were found. The main symptoms of digestive tract were nausea and vomiting and reduction of gastric intake. Most of the drug adverse reactions were mild and were relieved after symptomatic treatment. 125 of them changed the treatment program due to adverse drug reactions. The study concluded that the AIDS patients in Shanghai area were treated with free disease resistant treatment to effectively inhibit the replication of HIV virus in the body. The immune function is also improved. In reducing the mortality rate of AIDS patients and prolonging the patient's survival time, a good therapeutic effect has been obtained. In the long-term follow-up process, the adverse reaction of the drug is found to be the main reason for the replacement of the treatment plan, and the monitoring of adverse drug reactions of various antiviral drugs should be strengthened and the corresponding treatment should be provided. The treatment strategy improves patient compliance, reduces the number and frequency of dressing change, and achieves the best therapeutic effect within the limited range of drug selection.
【學位授予單位】：復旦大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R512.91

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相關期刊論文 前2條

1 鄭毓芳;劉莉;張仁芳;沈銀忠;齊唐凱;王江蓉;盧洪洲;;上海地區(qū)艾滋病患者初始一線抗反轉錄病毒治療藥物更換原因的比較研究[J];中國感染與化療雜志;2012年01期

2 周琳;吳瓊海;沈偉偉;丁盈盈;林海江;何納;;浙江省臺州市接受抗病毒治療的艾滋病患者生存分析[J];中華疾病控制雜志;2013年12期

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