辽宁省2003-2015年7255例艾滋病抗病毒治疗患者的生存分析

目的 探讨艾滋病（acquired immunodeficiency syndrome，AIDS）患者高效抗逆转录病毒治疗（highly active antiretroviral therapy，HAART）后的生存率及其影响因素。方法 采用回顾性队列研究方法，收集辽宁省2003-2015年7 255例接受HAART的人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染者和AIDS患者的相关信息，用寿命表法分析其生存率，用Cox回归模型分析生存时间的影响因素。结果 共收集7 255例HIV/AIDS为研究对象，HAART后1、3、5年的累积生存率分别为97%、95%、93%，6～12年的累积生存率均为92%；其中HAART后艾滋病相关死亡269例，总病死率为1.99/100人年；Cox回归模型多因素分析显示，年龄30～59岁（HR=0.330，95%CI:0.203～0.538）、>59岁组（HR=0.569，95%CI:0.395～0.820）与<30岁组相比死亡风险低；文化程度初中（HR=0.503，95%CI:0.324～0.780）、高中及中专（HR=0.284，95%CI:0.200～0.405）、大专及以上组（HR=0.254，95%CI:0.169～0.381）与小学及以下组相比死亡风险低，感染途径为异性传播组与同性传播组相比死亡风险低（HR=0.540，95%CI:0.383～0.763）；基线CD4+T淋巴细胞计数≥200个/μl组与<50个/μl组相比死亡风险低（HR=0.316，95%CI:0.201～0.499）；BMI≥24.0 kg/m2组与<18.5 kg/m2组相比死亡风险低（HR=0.459，95%CI:0.344～0.611）。结论 辽宁省艾滋病抗病毒治疗效果稳定，5年生存率水平较高。疾病早期进行规范治疗是降低患者死亡风险、提高生存率的有效措施。

The survival analysis in 7 255 AIDS patients on antiretroviral therapy in Liaoning Province in 2003-2015

Objective To analyze the survival rates of AIDS cases receiving Highly Active Antiretroviral Therapy (HAART) and related factors. Methods A retrospective cohort study was conducted to analyze the related factors among 7 255 HIV/AIDS patients who had been treated with HAART in Liaoning province from 2003 to 2015. The life table method was used for survival rate analysis, and Cox proportional hazard model was performed to identify the factors associated with survival time. Results Among 7 225 HIV/AIDS patients, the 1, 3, 5 and 6-12 year actuarial survival rates were 97%, 95%, 93% and 92% respectively after HAART. There were 269 cases of HIV/AIDS related death after HAART, and the total case fatality ratio was 1.99/100. As to mortality risk, the group aged from 30 to 59 years(HR=0.330,95%CI:0.203-0.538) and older than 59 years (HR=0.569,95%CI:0.395-0.820) were lower than the group aged younger than 30 years; the group educated as middle school (HR=0.503,95% CI:0.324-0.780), high school, technical secondary school (HR=0.284,95% CI:0.200-0.405), junior college and much higher(HR=0.254,95% CI:0.169-0.381) were lower than the groups educated as primary school and much lower. Meanwhile the mortality rate was related to the pathway of infection:the rate of the heterosexual transmission group was lower than that of the homosexual transmission group (HR=0.540, 95%CI:0.383-0.763), the rate of the group which the baseline CD4+T cell counts ≥200 μl was lower than that of <50 μl (HR=0.316,95% CI:0.201-0.499), and the rate of the group that BMI ≥24.0 kg/m2 was also lower than that of <18.5 kg/m2 (HR=0.459,95% CI:0.344-0.611). Conclusions The antiretroviral therapy of HIV/AIDS patients in Liaoning province are effective and stable, and have high 5-year survival rate; the early standard treatment is effective measure to reduce the mortality risk and improve the survival rate.