德州市艾滋病患者抗病毒治疗现状与效果研究

发布时间：2018-01-05 04:22

本文关键词：德州市艾滋病患者抗病毒治疗现状与效果研究　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景艾滋病是由艾滋病毒(HIV)感染引起的传染病,目前无有效的疫苗预防,病死率高,艾滋病的传播流行严重危害人类健康和经济社会发展。艾滋病的防治已成为全球关注的公共卫生和社会问题。高效逆转录病毒疗法(HAART)的广泛运用,使艾滋病从一种致死性疾病转变为一种慢性可控性疾病。HAART可以有效的抑制HIV在人体的复制,提高人体CD4细胞水平,恢复患者免疫功能,延缓病程进展,降低病死率。随着时间的推移,国家越来越重视艾滋病防治工作,国家免费抗病毒治疗纳入标准多次放宽,致使接受HAART的艾滋病患者急剧增长。本课题通过调查抗病毒治疗工作现况,评价治疗效果,分析影响因素,为研究防治对策,采取更有针对性、科学性、规范性的抗病毒治疗措施提供科学依据。研究目的调查德州市艾滋病患者抗病毒治疗现况,评价艾滋病抗病毒治疗效果,分析影响因素,研究防治对策,为今后的艾滋病抗病毒治疗工作提供科学依据和借鉴。研究对象与方法采用方便抽样,对德州市目前接受抗病毒治疗的艾滋病患者开展问卷调查,了解艾滋病抗病毒治疗现况。采用回顾性调查,收集德州市首次接受HAART的艾滋病患者的抗病毒治疗相关数据,包括人口学特征、基线调查数据、历次随访状况、当前转归等。对收集的治疗数据进行统计分析,了解免疫重建效果、HIV抑制、生存时间等情况,对抗病毒治疗效果进行综合评价。将现场问卷调查资料使用EPIDATA3.1软件录入,收集到的艾滋病抗病毒治疗数据以Excel软件建立调查数据库,整理后使用SPSS 19.0软件进行统计分析。计数资料比较采用x2检验。均数比较采用T检验、单因素方差分析等。Logistic回归分析筛选影响患者依从性、抗病毒治疗机构选择意愿及免疫功能重建的因素。单因素方差分析及多因素Cox比例风险回归模型用于生存率的比较。研究结果1.本次研究,抗病毒治疗现况调查共发放问卷273份,收集有效问卷264份(96.73%);抗病毒治疗效果评价纳入调查对象306例。2.艾滋病抗病毒治疗现况调查:德州市采取的是疾控机构为责任主体的抗病毒治疗工作模式;研究对象艾滋病防治基础知识知晓率为97.35%(257/264),艾滋病相关知识知晓率为65.53%(173/264),结果显示性别、婚姻状况、职业及社会组织关怀等为艾滋病相关知识知晓程度的影响因素;有228例(86.36%)患者认为治疗效果很好,95.45%(252/264)的患者自评能够配合抗病毒治疗;94.32%(249/264)的患者自评能够坚持今后的抗病毒治疗;研究对象药物有效依从性的比例为96.97%(256/264),分析显示"治疗效果自评"为影响患者漏服行为的因素;81.44%(215/264)的艾滋病患者希望今后由疾控机构负责艾滋病抗病毒治疗,18.56%(49/264)选择了医疗机构。3.艾滋病抗病毒治疗效果评价:研究对象初始治疗采用一线方案的占91.50%(280/306);有80例(26.14%)患者接受复方新诺明预防及治疗机会性感染;72例(23.53%)发生了药物毒副反应;52例(16.99%)更换了药物,换药原因包括一线药物治疗失败、毒副作用等;11例接受HAART的患者退出了治疗序列,退出原因主要包括药物毒副作用、失访、药物相互作用等;最近一次检测结果显示211例(68.95%)患者获得了良好的免疫重建效果或维持,Logistic分析显示,治疗时长、乙肝感染、基线CD4细胞计数等为免疫重建效果的影响因素;治疗12个月HIV完全抑制率为90.19%(193/214),病毒耐药率为6.16%(13/211);调查对象接受HAART后1、3、12、18个月的生存率分别为97.02%、96.01%、94.86%、93.63%,5年生存率为91.73%,50岁以上人群累计生存率为76.60%,接受抗病毒治疗3年的生存率分别为86.67%、82.98%、76.60%,低于其他人群。多因素Cox分析显示治疗时年龄及基线CD4细胞计数是患者生存时间的影响因素。结论1.德州市艾滋病抗病毒治疗效果显著。通过HAART有效恢复了患者的机体免疫机能,抑制了病毒复制,改善了艾滋病患者生活质量和生存状况,延长了患者生命,多数患者能够自觉积极配合抗病毒治疗工作,服药依从性良好,并给予抗病毒治疗工作及其效果正确、公正评价。2.德州市以疾控机构为责任主体的抗病毒治疗模式,已经不能满足当前艾滋病抗病毒治疗需求,疾控机构由于不具备医疗资质及缺乏系统、全面的艾滋病抗病毒治疗培训的从业人员,无法有效处理患者严重机会性感染、药物毒副作用等,无法对患者病情做出全面评估,存在严重的医疗风险和责任风险。同时,部分患者免疫功能重建情况不理想,基线CD4细胞计数低值人群、老年患者需要更多的关注,部分患者对现行抗病毒治疗工作存在抵触心理及惰性心理,治疗效果自我评价不高,服药依从性较差。3.现行抗病毒治疗工作模式亟待转变,将抗病毒治疗职责向医疗机构移交,提高疾病早期发现能力,遵循"知情同意"的抗病毒治疗原则,满足患者"专业"、"保密"、"方便"等抗病毒治疗需求,并注重优化资源,简化流程,加强服药依从性教育,充分发挥社会组织作用,发掘患者主观能动性,同时注意保护患者隐私,关注患者心理变化,提供更加优质的专业医疗服务。
[Abstract]:The research background is by HIV AIDS (HIV) infection caused by infectious diseases, currently no effective vaccines to prevent AIDS, high mortality, the spread of serious harm to human health and economic and social development. The prevention and control of AIDS has become a global concern for public health and social problems. Effective antiretroviral therapy (HAART) is widely used so, AIDS from a fatal disease into a chronic disease control.HAART can effectively inhibit the replication of HIV in human body, improve the level of CD4 cells, restore immune function, delay the course of disease progression and reduce mortality. As time goes on, more and more attention to the prevention and treatment of AIDS, the national free antiretroviral the treatment included many AIDS patients to relax, resulting in the rapid growth of HAART. This paper investigated the current status of antiviral therapy, therapeutic effect evaluation, divided Analysis of influencing factors for prevention strategies, more targeted, scientific, and provide scientific basis for antiviral treatment measures normative. Investigation on the status of Dezhou City AIDS antiviral treatment of AIDS antiviral treatment, evaluation results, analyze the influencing factors, research on prevention measures, provide scientific basis and reference for the future work of AIDS antiviral treatment research object and method. By convenient sampling, to carry out the survey in Dezhou city currently receiving antiretroviral treatment of AIDS patients, to understand the AIDS antiviral treatment status. By retrospective investigation, collection of Dezhou city for the first time to accept the HAART AIDS antiviral treatment related data, including demographic characteristics, baseline survey data, the current status of previous follow-up, prognosis the treatment. The collected data for statistical analysis, to understand the immune reconstitution effect, HIV inhibition, survival Time, comprehensive evaluation of antiviral treatment. The field survey data using EPIDATA3.1 software, antivirus treatment of AIDS data collected by the Excel software to establish the survey database, after finishing using the SPSS 19 software was used for statistical analysis. Count data were compared by x2 test. Were compared by T test, single factor analysis of variance.Logistic regression analysis screening effect of patient compliance, intention and selection factors of immune reconstitution of antiviral therapy. Univariate analysis and multivariate Cox proportional hazard regression model was used to compare the survival rate of 1.. The results of this study, antiviral therapy in a total of 273 questionnaires, 264 valid questionnaires were collected (96.73%); evaluation of antiviral treatment included in the survey,.2. survey of AIDS antiviral treatment of 306 cases of status: Dezhou city is taken. The main responsibility for antiviral treatment work mode control mechanism; study of AIDS prevention knowledge awareness rate was 97.35% (257/264), AIDS related knowledge awareness rate was 65.53% (173/264), the results show that the gender, marital status, occupation and social organization care and other factors affecting the degree of awareness of AIDS related knowledge; 228 cases (86.36%) patients that the treatment effect is very good, 95.45% (252/264) patients with self rating with antiviral therapy; 94.32% (249/264) patients with self rating to adhere to the antiviral treatment in the future; the object of study drug compliance ratio was 96.97% (256/264), "the analysis showed that the treatment effect of self rating" for the factors affecting the service behavior leakage patients; 81.44% (215/264) of AIDS patients hope by the disease control agency in charge of AIDS antiviral treatment, 18.56% (49/264) chose.3. antiretroviral therapy in medical institutions Evaluation: the object of study initiated treatment with first-line accounted for 91.50% (280/306); 80 cases (26.14%) patients received cotrimoxazole prophylaxis and treatment of opportunistic infections; 72 cases (23.53%) had adverse drug reactions; 52 cases (16.99%) of replacement drugs, including first-line treatment failure reasons of dressing, poison side effects; 11 cases of HAART patients withdrew from the treatment sequence, exit reasons mainly include side effects, drug lost, drug interactions; a recent test results showed that 211 cases (68.95%) patients achieved good immune effect of reconstruction or maintain, Logistic analysis shows that the duration of treatment, hepatitis B the infection factors, baseline CD4 cell count for immune reconstruction effect; for 12 months HIV completely inhibited the rate of 90.19% (193/214), virus resistant rate was 6.16% (13/211); the survey by HAART after 1,3,12,18 months survival rates were 97.02%, 96.01%, 94.86%, 93.63%, 5 year survival rate was 91.73%, 50 people over the age of the cumulative survival rate was 76.60%, the survival rate of receiving antiretroviral treatment for 3 years were 86.67%, 82.98%, 76.60%, lower than the other groups. Cox regression analysis showed that the treatment of age and baseline CD4 cell count are the factors influencing the survival time of patients. The conclusion of the 1. Dezhou City AIDS antiviral treatment effect. Through the HAART effective recovery of the immune function of patients, inhibit viral replication, improve the quality of life and survival status of AIDS patients, prolong the life of patients, most patients can consciously actively cooperate with the anti viral treatment, good compliance, and given anti viral treatment and its effect correct and fair evaluation.2. in Dezhou City CDC antiviral treatment mechanism is the main responsibility mode, has been unable to meet the current needs of AIDS antiviral treatment, disease control machine Structure because they do not have medical qualifications and the lack of systematic, comprehensive training of AIDS antiviral therapy practitioners, not effective treatment in patients with severe opportunistic infections, drug toxicity, unable to make a comprehensive assessment of the patient's condition, there is a serious health risk and liability risk. At the same time, part of the immune function of patients with reconstruction of the situation is not ideal, baseline CD4 cell count low value population, elderly patients need more attention, some patients have psychological conflict and psychological inertia of current antiviral therapy, the treatment effect of self evaluation is not high, poor compliance.3. current antiviral therapy work mode should be changed, the antiviral treatment of transfer of responsibility to medical institutions, improve the ability to find the disease early, follow the "antiviral treatment of informed consent" principle, to meet with the "professional", "confidential", "demand for convenient treatment and antiviral, and focus on the advantages of Resources should be simplified, processes should be streamlined, medication adherence education should be strengthened, the role of social organizations should be brought into full play, and patients' subjective initiative could be explored. At the same time, attention should be paid to protecting patients' privacy, paying attention to psychological changes of patients, and providing more high-quality professional medical services.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.91

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