【摘要】：目的探索我國(guó)不同年齡成人艾滋病病毒感染者(感染者)在抗病毒治療36個(gè)月內(nèi)的病毒學(xué)效果和免疫學(xué)效果,并分析其他影響因素,為我國(guó)成人艾滋病抗病毒治療工作提供參考。方法利用國(guó)家抗病毒治療數(shù)據(jù)庫(kù)中成人艾滋病病毒感染者的部分相關(guān)數(shù)據(jù)資料進(jìn)行回顧性隊(duì)列研究。在2010年1月1日-2012年12月31日期間初次接受治療且基線CD4/CD8比值1的成人感染者作為研究對(duì)象,并按照基線年齡將其分為3組:18～49歲(參照組)、50～59歲以及≥60歲組。隨訪研究對(duì)象至治療36個(gè)月。通過(guò)Logistic模型分析不同年齡組感染者病毒抑制失敗率的差異。通過(guò)混合效應(yīng)線性模型分析不同年齡組感染者CD4+T淋巴細(xì)胞(CD4)應(yīng)答特點(diǎn)及差異。通過(guò)Kaplan-Meier法分析不同年齡組感染者發(fā)生免疫學(xué)失敗的情況,并應(yīng)用Cox模型分析差異。結(jié)果1.確定5331例成人艾滋病病毒感染者為研究對(duì)象,其中18～49歲組4187(78.5%)例、50～59 歲組 632(11.9%)例和≥60 歲組 512(9.6%)例。50～59 歲組發(fā)生病毒抑制失敗的風(fēng)險(xiǎn)是18～49歲組的1.11倍(95%CI:0.80-1.52),≥60歲組發(fā)生病毒抑制失敗的風(fēng)險(xiǎn)是18～49歲組的1.25倍(95%CI:0.87-1.79)。50～59歲組CD4計(jì)數(shù)比18～49歲組平均低16個(gè)/mm3(P.001),≥60歲組比18～49歲組平均低26個(gè)/mm3(P.001)。50～59歲組發(fā)生免疫學(xué)失敗的風(fēng)險(xiǎn)是18～49歲組的1.44倍(95%CI:0.85-2.42),≥60歲組發(fā)生免疫學(xué)失敗的風(fēng)險(xiǎn)是18～49歲組的1.92倍(95%CI:1.15-3.19)。2。在不同特征的感染者中,與18～49歲組相比,50～59歲組和≥60歲組病毒抑制失敗的風(fēng)險(xiǎn)不具有統(tǒng)計(jì)學(xué)意義(P.005)。3.女性、開(kāi)始治療方案含TDF以及病毒抑制失敗的感染者中,50～59歲組與18-49歲組在治療36個(gè)月中CD4計(jì)數(shù)水平相似(P.005),≥60歲組與18～49歲組在治療36個(gè)月中CD4計(jì)數(shù)水平也相似(P.005)。4.基線CD4計(jì)數(shù)200個(gè)/mm3,男性,已婚或同居,基線CD4/CD8L比值0.30,開(kāi)始治療方案含AZT/d4T以及保持病毒抑制的感染者中,與18～49歲組相比,≥60歲組發(fā)生免疫學(xué)失敗的風(fēng)險(xiǎn)均具有統(tǒng)計(jì)學(xué)意義,對(duì)應(yīng)的aHR值(95%CI)及P值見(jiàn)表16。在不同特征的感染者中,50～59歲組發(fā)生免疫學(xué)失敗的風(fēng)險(xiǎn)也不具有統(tǒng)計(jì)學(xué)意義(P.005)。結(jié)論通過(guò)對(duì)三所省級(jí)傳染病�？漆t(yī)院的艾滋病病毒感染者分析發(fā)現(xiàn),治療36個(gè)月中:1.年齡對(duì)成人感染者的病毒學(xué)效果無(wú)顯著影響。2.混合效應(yīng)線性模型分析表明50～59歲和≥60歲感染者CD4計(jì)數(shù)低于18～49歲感染者。3.≥60歲感染者發(fā)生免疫學(xué)失敗的風(fēng)險(xiǎn)高于18～49歲感染者。
文內(nèi)圖片：
圖片說(shuō)明：圖3.3個(gè)年齡組在36個(gè)月內(nèi)不同治療時(shí)間的〔氏校正均數(shù)
[Abstract]:Objective To explore the virological and immunological effects of HIV-infected people living with AIDS in our country for 36 months, and to analyze the other factors to provide reference for the anti-virus treatment of adult AIDS in our country. Methods A retrospective cohort study was carried out using some relevant data from the national anti-virus treatment database for adult HIV-infected persons. Adult patients who received initial treatment and baseline CD4/ CD8 ratio 1 were treated as subjects for the first time during the period from 1 January 2010 to 31 December 2012, and were divided into three groups according to the baseline age:18-49 years (reference group),50-59 years of age and 60-year-old. Follow-up study subjects to treatment for 36 months. Logistic model was used to analyze the difference of the failure rate of the virus in different age groups. The response characteristics and differences of CD4 + T lymphocytes (CD4) in different age groups were analyzed by a mixed-effect linear model. A Kaplan-Meier method was used to analyze the immunological failure of patients with different age groups and to use the Cox model to analyze the difference. Results 1. A total of 5,331 adult HIV-infected persons were identified as subjects, of which 4187 (78.5%),632 (11.9%) and 512 (9.6%) in the 60-year-old group were aged between 18 and 49, and the risk of a viral inhibition failure in the 50-59-year-old group was 1.11-fold (95% CI: 0.80-1.52) in the 18-49-year-old group. The risk of viral inhibition failure in the 60-year-old group was 1.25-fold (95% CI: 0.87-1.79) in the 18-49-year-old group. The CD4 count in the 50-59-year-old group was 16/ mm3 (P.001) lower than that in the 18-49-year-old group (P.001). The risk of immunological failure in the 50-59-year-old group was 1.44-fold (95% CI: 0.85-2.42) in the 18-49-year-old group. The risk of immunological failure in the 60-year-old group was 1.92-fold (95% CI: 1.15-3.19) in the 18-49-year-old group. In those infected with different characteristics, the risk of viral inhibition failure in the 50-59-year-old group and the 60-year-old group was not statistically significant (P.005) compared to the 18-49-year-old group. The number of CD4 counts in the 50-59-year-old group and the 18-49-year-old group was similar to that of the 18-49-year-old group in the 36-month period of treatment (P.005), and the CD4 count was also similar between the 60-year-old group and the 18-49-year-old group in the 36-month period (P.005). At baseline CD4 count of 200/ mm3, male, married or cohabiting, baseline CD4/ CD8L ratio 0.30, initiation of treatment with AZT/ d4T and the maintenance of viral inhibition, the risk of immunological failure in the 60-year-old group was statistically significant compared to the 18 to 49-year-old group, The corresponding aHR values (95% CI) and P values are shown in Table 16. The risk of immunological failure in the 50 to 59-year-old group was not statistically significant among those with different characteristics (P.005). Conclusion The analysis of the HIV-infected patients in the three provincial infectious disease specialized hospital found that the treatment for 36 months:1. Age had no significant effect on the virologic effect of adult patients. The linear model of the mixed effect analysis showed that the CD4 counts of those infected with 50-59 and 60-year-old were lower than those in the age of 18-49 years. The risk of immunological failure of the 60-year-old is higher than that of the 18-49-year-old.
【學(xué)位授予單位】：中國(guó)疾病預(yù)防控制中心
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R512.91

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