1989至2020年北京市东城区1 076例人类免疫缺陷病毒感染者/获得性免疫缺陷综合征患者生存时间及影响因素

目的探讨北京市东城区人类免疫缺陷病毒感染者/获得性免疫缺陷综合征（HIV/AIDS）患者生存时间及影响因素。 方法采用回顾性队列研究方法，在中国艾滋病综合防治信息系统中收集1989年1月1日~2020年12月31日北京市东城区HIV/AIDS患者共1 076例的临床资料，应用寿命表法分析累积生存率；利用Kaplan-Meier法（K-M法）绘制生存曲线；利用COX比例风险模型分析影响患者生存时间的因素。 结果所有研究对象中，完成随访1 072例（99.63%），失访4例（0.37%）；随访过程中发生AIDS相关死亡26例（2.42%）；第1、2、5年累计生存率分别为98.03%、97.92%和97.47%。研究对象生存时间中位数为264.00个月。COX比例风险模型分析显示：首次检测CD4⁺ T细胞计数< 350个/μl（HR = 4.053、95%CI：1.412~11.628）、确诊时为AIDS患者（HR = 20.651、95%CI：4.741~89.940）、未接受抗病毒治疗（HR = 30.722、95%CI：12.389~76.18）均为患者生存时间缩短的危险因素。与初中及以下文化程度的HIV/AIDS患者相比，较高文化程度为延长患者生存时间的保护因素（高中或中专：HR = 0.317、95%CI：0.122~0.826，大专及以上：HR = 0.155、95%CI：0.055~0.439）。K-M法绘制生存曲线显示，大专及以上、高中或中专文化程度HIV/AIDS患者累计生存率显著高于初中及以下文化程度HIV/AIDS患者（χ² = 26.978、P < 0.001）。首次检测CD4⁺ T细胞计数≥ 350个/μl、确诊时疾病状态为HIV感染、行抗病毒治疗的HIV/AIDS患者累计生存率高于首次检测CD4⁺ T细胞计数< 350个/μl、确诊时疾病状态为AIDS、未行抗病毒治疗的HIV/AIDS患者（χ² = 14.329、44.559、126.836，P均< 0.001）。 结论北京市东城区HIV/AIDS患者中接受抗病毒治疗、首次CD4⁺ T细胞计数≥ 350个/μl、确诊时疾病状态为HIV感染、大专及以上文化程度者生存时间较长。故提高筛查力度，尽可能早期发现HIV感染者，尽快开展治疗，可提高其确诊后生存质量和生存时间。

Survival period and influencing factors of 1 076 patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome in Dongcheng District,Beijing from 1989 to 2020

ObjectiveTo investigate the survival period and influencing factors of patients infected with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in Dongcheng District, Beijing. MethodsA retrospective cohort study was conducted to collect 1 076 HIV/AIDS patients in Dongcheng District of Beijing from January 1st, 1989 to December 31st, 2020 in China Integrated AIDS Prevention and Control Information System. Cumulative survival rate was analyzed by life table method. Kaplan-meier method (K-M method) was used to plot the survival curve. COX proportional risk model was used to analyze the influencing factors of survival period. ResultsAmong all the subjects, 1 072 cases (99.63%) were followed up, and 4 cases (0.37%) were lost. There were 26 AIDS-related deaths (2.42%) during the follow-up. The cumulative survival rates at the first, the second and the fifth year were 98.03%, 97.92% and 97.47%, respectively. The median survival period of the subjects was 264.00 months. COX proportional risk model analysis showed that initial CD4⁺ T < 350 cells/μl (HR = 4.053, 95%CI: 1.412-11.628), AIDS patients with disease status at diagnosis (HR = 20.651, 95%CI: 4.741-89.940), no antiviral therapy (HR = 30.722, 95%CI: 12.389-76.18) were risk factors to reduce their survival period. Compared with HIV/AIDS patients with junior school education or below, higher education was a protective factor for prolonging survival (senior school/professional school degree: HR = 0.317, 95%CI: 0.122-0.826; College degree or above: HR = 0.155, 95%CI: 0.055-0.439). The survival curve by K-M method showed that the cumulative survival rate of HIV/AIDS patients with college degree or above, high school or secondary school education was higher than that of HIV/AIDS patients with junior school education (χ² = 26.978, P < 0.001). The cumulative survival rate of HIV/AIDS patients whose initial CD4⁺ T ≥ 350 cells/μl and whose disease status at diagnosis was HIV-infection and those who received antiviral therapy was higher than that of initial CD4⁺ T < 350 cells/μl, patients with AIDS status at diagnosis and HIV/AIDS patients without antiviral therapy (χ² = 14.329, 44.559, 126.836; all P < 0.001). ConclusionsHIV/AIDS patients in Dongcheng District of Beijing who received antiviral therapy, whose initial CD4⁺ T ≥ 350 cells/μl, whose disease status at diagnosis was HIV infected, and who had college degree or higher education had a longer survival period. In the future, screening efforts should be improved to detect HIV infection as early as possible, and treatment should be carried out as soon as possible, so as to improve the life quality and survival period after diagnosis.