張 鵬，蔣忠勝，溫小鳳，韋靜彬，覃 川

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·論著·

高效抗反轉(zhuǎn)錄病毒治療HIV感染者和AIDS患者發(fā)生不和諧反應(yīng)的影響因素及改用洛匹那韋利托那韋的療效研究

張 鵬，蔣忠勝，溫小鳳，韋靜彬，覃 川

獲得性免疫缺陷綜合征；HIV RNA；CD4陽性T淋巴細(xì)胞；洛匹那韋利托那韋

張鵬，蔣忠勝，溫小鳳，等.高效抗反轉(zhuǎn)錄病毒治療HIV感染者和AIDS患者發(fā)生不和諧反應(yīng)的影響因素及改用洛匹那韋利托那韋的療效研究[J].中國全科醫(yī)學(xué)，2015，18(20)：2426-2429.[www.chinagp.net]

Zhang P,Jiang ZS,Wen XF,et al.Influencing factors for discordant responses to highly active antiretroviral therapy on HIV-infected and AIDS patients and efficacy of LPV/r[J].Chinese General Practice，2015，18(20)：2426-2429.

1 對象與方法

1.1 研究對象 選取2006年7月—2013年3月在柳州市人民醫(yī)院進(jìn)行免費(fèi)抗病毒治療且跟蹤隨訪的HIV感染者和AIDS患者510例為研究對象，其中男322例，女188例；年齡(42.1±12.5)歲。納入標(biāo)準(zhǔn)：(1)經(jīng)HIV初篩確診陽性；(2)治療前未使用抗HIV藥物；(3)未妊娠者；(4)未因藥物毒副作用、機(jī)會(huì)性感染及其他因素導(dǎo)致停藥。

1.4 統(tǒng)計(jì)學(xué)方法 采用SPSS 17.0軟件進(jìn)行統(tǒng)計(jì)分析，不符合正態(tài)分布的計(jì)量資料以M(QR)表示，組間比較采用非參數(shù)檢驗(yàn)；計(jì)數(shù)資料以相對數(shù)表示，組間比較采用χ2檢驗(yàn)；采用單因素和多因素Logistic回歸分析發(fā)生不和諧反應(yīng)的影響因素。以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。

2 結(jié)果

表1 HIV感染者和AIDS患者發(fā)生不和諧反應(yīng)影響因素的單因素Logistic回歸分析

Table 1 Unvariable Logistic regression analysis on influencing factors for discordant responses in HIV-infected and AIDS patients

變量β值SEWaldχ2值OR值(95%CI)P值性別-07530205134640471(0315，0704)<0001年齡0016000745921016(1001，1031)0032HIV分期 Ⅳ期---1- Ⅲ期-0858028789130424(0241，0745)0003 Ⅱ期-1482055571380227(0077，0674)0008 Ⅰ期-20710236767650126(0079，0200)<0001肺外結(jié)核-16840345237720186(0094，0365)<0001肺部真菌感染-15530377169540212(0101，0443)<0001肺孢子菌肺炎-1094036291390335(0165，0681)0003巨細(xì)胞病毒感染-1160057840290313(0101，0973)0045馬爾尼菲青霉菌病-16910456137510184(0075，0451)<0001機(jī)會(huì)性感染11890166511283283(2370，4548)<0001治療時(shí)CD+4T細(xì)胞計(jì)數(shù)-002000021069350980(0976，0984)<0001治療時(shí)CD+8T細(xì)胞計(jì)數(shù)-00010274070999(0998，0999)<0001治療時(shí)淋巴細(xì)胞計(jì)數(shù)-13850183575270250(0175，0358)<0001治療時(shí)白細(xì)胞計(jì)數(shù)-02860058240930751(0670，0842)<0001治療時(shí)血紅蛋白-00210004256970979(0971，0987)<0001治療后3個(gè)月CD+4T細(xì)胞計(jì)數(shù)-002000021139020981(0977，0984)<0001治療后3個(gè)月淋巴細(xì)胞計(jì)數(shù)-08520179225510426(0400，0606)<0001治療后6個(gè)月CD+4T細(xì)胞計(jì)數(shù)-002000021162920980(0976，0983)<0001治療后6個(gè)月淋巴細(xì)胞計(jì)數(shù)-09260183256720396(0277，0567)<0001

注：-無此數(shù)據(jù)

表2 HIV感染者和AIDS患者發(fā)生不和諧反應(yīng)影響因素的多因素logistic回歸分析

Table 2 Multivariate Logistic regression analysis on influencing factors for discordant responses in HIV-infected and AIDS patients

變量β值SEWaldχ2值OR值(95%CI)P值年齡0036003283561037(1012，1062)0004治療時(shí)CD+4T細(xì)胞計(jì)數(shù)-00120003121640988(0982，0995)<0001治療后3個(gè)月CD+4T細(xì)胞計(jì)數(shù)-00090003101920991(0985，0997)0001治療后6個(gè)月CD+4T細(xì)胞計(jì)數(shù)-0007000367730993(0988，0998)0009治療后6個(gè)月淋巴細(xì)胞計(jì)數(shù)-0837032367120433(0230，0816)0010

3 討論

實(shí)施抗HIV治療后，我國艾滋病患者整體病死率有所下降，但發(fā)生不和諧反應(yīng)的患者由于其免疫功能重建不全，其疾病惡化風(fēng)險(xiǎn)較免疫功能重建良好患者增加1倍,死亡風(fēng)險(xiǎn)也相應(yīng)增加[2-3]。因此研究此類患者發(fā)生不和諧反應(yīng)的影響因素，對降低患者病死率有重要意義。

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(本文編輯：吳立波)

Influencing Factors for Discordant Responses to Highly Active Antiretroviral Therapy on HIV-infected and AIDS Patients and Efficacy of LPV/r

ZHANGPeng,JIANGZhong-sheng,WENXiao-feng,etal.

DepartmentofInfectiousDisease,LiuzhouPeople′sHospital,Liuzhou545006,China

Acquired immunodeficiency syndrome；HIV RNA；CD4-positive T-lymphocytes；Lopinavir and ritonavir

廣西壯族自治區(qū)衛(wèi)生廳自籌經(jīng)費(fèi)科研課題(Z2012561)；柳州市應(yīng)用技術(shù)研究與開發(fā)計(jì)劃項(xiàng)目(2011J0302021)；廣西自然科學(xué)基金資助項(xiàng)目(2013GXNSFAA019213)

545006廣西柳州市人民醫(yī)院感染病科

蔣忠勝，545006廣西柳州市人民醫(yī)院感染病科；E-mail：jiangzs1111@126.com

R 512.91

A

10.3969/j.issn.1007-9572.2015.20.016

2014-12-26；

2015-03-18)