HIV感染/AIDS者结核感染的影响因素分析

目的 分析HIV感染/AIDS者结核感染情况及其影响因素。方法 于2017年1—7月采用随机整群抽样的方法,抽取江苏省常州地区3家社区医院,以其10年累计登记的HIV感染/AIDS者作为研究对象,最终纳入475例,平均年龄(44.44±13.85)岁,其中,男378例(79.58%),女97例(20.42%);HIV感染者273例(57.47%),AIDS患者202例(42.53%)。收集研究对象的社会人口学信息及临床相关信息;采集研究对象外周静脉血,检测HIV病毒载量,并选取CD4 ⁺T细胞计数>200个/μl者采用QuantiFERON ^®-TB Gold (QFT)检测结核感染情况;分析研究对象结核感染情况,并采用多因素非条件logistic回归分析结核感染的影响因素。结果 研究对象中CD4 ⁺T细胞计数>200个/μl者有429例,结核感染率为10.02%(43/429)。单因素分析显示,CD4 ⁺T细胞计数>200个/μl者中有结核病接触史者结核感染率(30.30%,10/33)高于无接触史者(8.33%,33/396);CD4 ⁺T细胞计数>500个/μl者结核感染率(13.15%,33/251)高于CD4 ⁺T细胞计数为200~500个/μl者(5.62%,10/178),差异均有统计学意义(χ ²分别为16.30、6.55,P值均<0.05)。进一步的非条件logistic回归分析显示,CD4 ⁺T细胞计数>200个/μl的HIV感染/AIDS者中,有结核病患者接触史者结核感染风险是无接触史者的4.61倍调整OR值(95%CI值)为4.61(2.00~10.63)];CD4 ⁺T细胞计数>500个/μl的HIV感染/AIDS者结核感染风险是CD4 ⁺T细胞计数200~500个/μl者的2.47倍调整OR值(95%CI值)为2.47(1.17~5.21)]。结论 免疫水平低下的HIV感染/AIDS者结核感染检出率低;结核病患者接触史、免疫水平是HIV感染/AIDS者结核感染的重要影响因素。

Analysis of influencing factors of Mycobacterium tuberculosis infection in HIV/AIDS patients

Objective To analyze the MTB infection and its influencing factors in HIV/AIDS patients. Methods From January to July 2017, 3 community hospitals were selected by a random cluster sampling method in Changzhou, in which HIV/AIDS patients by the 10-year cumulative registration were used as the research subjects. As a result, a total of 475 subjects were included, with an average age (44.44±13.85) years, including 378 males (79.58%) and 97 females (20.42%); 273 HIV-infected patients (57.47%) and 202 AIDS patients (42.53%). The sociodemographic information and clinically relevant information of the subjects were collected. Peripheral venous blood from subjects was tested for HIV viral load, then the subjects with CD4 ⁺ T cell counts>200 cells/μl were selected for MTB infection detection using QuantiFERON ^®-TB Gold (QFT). The MTB infection status of the subjects was analyzed and influencing factors of MTB infection were analyzed by multivariate non-conditional logistic regression. Results There were 429 subjects with CD4 ⁺ T cell counts>200 cells/μl, and the MTB infection rate was 10.02% (43/429). Univariate analysis showed that the MTB infection rate of subjects with CD4 ⁺ T cell counts>200 cells/μl who had a history of tuberculosis exposure was higher than that of subjects without history of tuberculosis exposure (30.30%(10/33) vs. 8.33% (33/396); χ ²=16.30, P<0.05); and the MTB infection rate of subjects with CD4 ⁺ T cell counts >500 cells/μl was higher than that of subjects with CD4 ⁺ T cell counts from 200 to 500 cells/μl (13.15% (33/251) vs. 5.62% (10/178); χ ²=6.55, P<0.05). Further unconditional logistic regression analysis showed that among HIV/AIDS patients with CD4 ⁺ T cell counts>200 cells/μl, the risk of MTB infection in the subjects with history of tuberculosis exposure was 4.61 times of subjects without history of tuberculosis exposure (adjusted OR=4.61, 95%CI=2.00-10.63); and the MTB infection risk of HIV/AIDS patients with CD4 ⁺ T cell counts>500 cells/μl was 2.47 times of the HIV/AIDS patients with CD4 ⁺ T cell counts from 200 to 500 cells/μl (adjusted OR=2.47, 95%CI=1.17-5.21). Conclusion The detection rate of MTB infection is low in HIV/AIDS patients with low immune level. The history of tuberculosis exposure and immune level are important influencing factors of MTB infection in HIV/AIDS patients.