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目的评价已接受抗病毒治疗(ART)的中老年HIV感染者/AIDS患者(HIV/AIDS)的基线临床和实验室检测指标与其生存预后的相关性,探讨影响中老年HIV/AIDS患者长期预后的危险因素。方法对2 659例中老年HIV/AIDS患者的资料进行回顾性队列研究,研究时间段为1998年1月1日-2013年12月31日,根据是否发生艾滋病相关性死亡事件分为死亡组(269例)和非死亡组(2 390例),采用非条件Logistic回归分析筛选出影响中老年HIV/AIDS患者长期生存预后的危险因素。结果死亡组的男性比例(11.66%)高于女性组(6.29%)(P<0.01);WHO临床分期为Ⅳ期、Ⅲ期的病死率分别为12.81%和9.95%,明显高于Ⅱ期(5.71%)和Ⅰ期(4.25%)(P<0.01);基线CD4~+T淋巴细胞小于50/mm~3组的病死率达到16.36%,明显高于51~250/mm~3组(8.28%)和大于250/mm~3组(3.90%)(P<0.01);开始ART前的3个月内合并结核病以外的机会性感染组的病死率(13.10%)高于无机会性感染组(6.58%)(P<0.01);ART前1年内是否有结核病、不同婚姻状况和不同传播途径的病死率均无差别(P>0.05);HBs Ag阳性组和阴性组、Anti HCV阳性组和阴性组的病死率差异均无统计学意义(P>0.05);死亡组的肌酐、谷草转氨酶和谷丙转氨酶高于非死亡组(P<0.05);死亡组的总淋巴细胞、血小板、血红蛋白和甘油三酯低于非死亡组(P<0.05);死亡组的基线HIVRNA、尿素氮、总胆固醇、血清淀粉酶和总胆红素与非死亡组的差异无统计学意义(P>0.05)。非条件Logistic回归分析显示性别(OR=1.90,95%CI为1.27~2.83,P<0.01)、WHO临床分期(OR=1.26,95%CI为1.09~1.46,P<0.01)、基线CD4~+T淋巴细胞(OR=0.70,95%CI为0.54~0.90,P<0.01)和血红蛋白(OR=0.99,95%CI为0.98~1.00,P<0.01)是影响中老年HIV/AIDS患者长期预后的危险因素。结论对于50岁以上的已接受ART的中老年HIV/AIDS患者,性别、WHO临床分期、基线CD4~+T淋巴细胞和血红蛋白是影响其长期生存预后的危险因素。
Objective To evaluate the correlation between baseline clinical and laboratory test indicators of elderly HIV / AIDS patients (HIV / AIDS) who have received ART and their survival and prognosis to explore the long-term prognosis of middle-aged and elderly patients with HIV / AIDS Risk factors. Methods A retrospective cohort study was conducted on the data of 2 659 middle-aged and elderly people with HIV / AIDS. The study period was from January 1, 1998 to December 31, 2013. According to the incidence of AIDS-related deaths, the patients were divided into death group 269 cases) and non-death cases (2390 cases). Non-conditional logistic regression analysis was used to screen out the risk factors that affect the long-term survival and prognosis of middle-aged and elderly patients with HIV / AIDS. Results The death rate in the dead group was 11.66% higher than that in the female group (6.29%) (P <0.01). The WHO clinical stage was stage IV and stage III with a mortality rate of 12.81% and 9.95% 5.71%) and stage Ⅰ (4.25%) (P <0.01). The mortality of baseline CD4 ~ + T lymphocytes in the group of less than 50 / mm ~ 3 reached 16.36%, which was significantly higher than that in the group of 51 ~ 250 / %) And more than 250 / mm ~ 3 (3.90%) (P <0.01). The mortality of opportunistic infections except tuberculosis (13.10%) within 3 months before starting ART was higher than those without opportunistic infections (6.58%) (P <0.01). There was no difference in the incidence of tuberculosis within one year before ART, and there was no significant difference in mortality rates among different marital status and different routes of transmission (P> 0.05). HBs Ag positive and negative groups, (P> 0.05). The creatinine, aspartate aminotransferase and glutamic-pyruvic transaminase in the death group were higher than those in the non-death group (P <0.05). The death rate of total lymphocyte, platelet, hemoglobin and Triglyceride was lower than non-death group (P <0.05). There were no significant differences in baseline HIV RNA, urea nitrogen, total cholesterol, serum amylase, total bilirubin and non-death group in death group (P> 0.05). Non-conditional logistic regression analysis showed that gender (OR = 1.90, 95% CI 1.27-2.83, P <0.01), WHO staging (OR = 1.26, 95% CI 1.09-1.46, P <0.01) T lymphocyte (OR = 0.70, 95% CI 0.54 ~ 0.90, P <0.01) and hemoglobin (OR = 0.99, 95% CI 0.98-1.00, P <0.01) Risk factors. Conclusions Sex, WHO clinical stage, baseline CD4 ~ + T lymphocytes and hemoglobin are risk factors for long-term survival and prognosis in ART patients with HIV / AIDS who have received ART over 50 years of age.