HIV感染者神经认知功能及可调控危险因素的现况研究

  目的  了解可调控危险因素对人类免疫缺陷病毒(human immunodeficiency virus，HIV)感染者神经认知功能的影响。  方法  利用“HIV与衰老相关疾病前瞻性队列研究”队列2018-2019年基线调查数据，选取40岁及以上的中老年HIV感染者。采用广义线性模型(general liner model, GLM)分析包括心血管疾病危险因素和不良生活行为的可调控危险因素对感染者神经认知表现的影响。  结果  研究共纳入625例HIV感染者。心血管疾病危险因素及不良生活行为在中老年HIV感染者中报告比例较高。在不同年龄阶段，感染者各神经认知功能有不同程度的下降，整体上以60岁以后认知功能下降较明显。多因素回归分析模型分析显示，高血压是感染者定向力、记忆力、延迟回忆、语言功能和运动能力的危险因素，其他可调控危险因素如吸烟、饮酒、糖尿病和腹部肥胖等尚未发现统计学关联。此外，血压临床分级分析后发现，高血压前期和语言功能(β=-0.327, P=0.020)、定向力(β=-0.216, P=0.028)下降有关，即使未发展至高血压状态，高值血压仍会对神经认知功能产生负面影响。  结论  高血压和中老年HIV感染者神经认知功能下降相关，定向力及语言能力在高血压前期即可能受到不良影响。在日后HIV随访管理中要加大对高血压的防控力度，对高血压及早发现并进行规范化临床管理。

Prevalence study of neurocognitive functions and modifiable risk factors in HIV-infected individuals

  Objective  To investigate the effects of regulatory risk factors on neurocognitive function of human immunodeficiency virus infected persons.  Methods  Using the baseline survey data of the prospective cohort study of HIV and aging related diseases from 2018 to 2019, elderly HIV infected persons aged 40 and above were selected. A general linear model (GLM) was used to analyze the effects of regulatory risk factors including cardiovascular disease risk factors and bad life behavior on neurocognitive performance of infected persons.  Results  A total of 625 HIV infected persons were included in the study. Cardiovascular disease risk factors and bad life behavior were reported in the elderly HIV infected patients. At different age stages, the neurocognitive function of infected persons decreased to different degrees, and the cognitive function decreased significantly after 60 years of age. Multivariate regression analysis model showed that hypertension was a risk factor for orientation, memory, delayed recall, language function and exercise ability of infected persons, and other regulatory risk factors such as smoking, alcohol consumption, diabetes and abdominal obesity had not been statistically correlated. Moreover, after clinical grading analysis of blood pressure, it found that prehypertension was associated with decreased language function (β=-0.327, P=0.020), orientation force (β=-0.216, P=0. 028). Even if it did not develop to hypertension state, high-value blood pressure have a negative effect on neurocognitive function.  Conclusions  Hypertension is associated with the decline of neurocognitive function in middle-aged and elderly HIV patients, and orientation and language ability may be adversely affected in the early stage of hypertension. During HIV follow-up management in the future, we should strengthen the prevention and control of hypertension, early detection of hypertension and standardized clinical management.