上海市艾滋病患者抗病毒治疗疗效研究

发布时间：2018-07-01 17:48

本文选题：艾滋病 + 抗反转录病毒治疗　；参考：《复旦大学》2014年硕士论文

【摘要】：研究目的：评价上海地区接受国家免费高效抗反转录病毒治疗(HAART)的治疗效果及其相关影响因素；探讨国内治疗方案及治疗时机与延长艾滋病病人生存时间、生存质量的关系,为制定更加合理的治疗方案和决策支持提供科学依据,进一步遏制艾滋病在我国的蔓延。研究方法：采用回顾性队列研究方法,对上海地区自2005年9月30日至2008年12月31日纳入国家免费抗病毒治疗艾滋病患者的临床资料、细胞免疫、病毒学应答、药物的不良反应及生存情况进行综合评估。观察终点时间为2012年12月底。本次数据录入与分析,分别采用EpiData和SPSS 17.0统计软件。研究结果：本次研究共纳)-410例患者,其中男321例、女89例,平均年龄(42.1±12.4)岁。其中以20-49岁的中青年为主(71.7%),已婚或同居者236例(57.6%)：感染途径以性传播为主,异性传播占52.2%,同性传播占22.4%；在接受本次治疗前,3.7%的病例接受过中药治疗,19.5%的病例接受过抗病毒治疗。本研究病例纳入治疗时多数已进入艾滋病晚期,75.9%病例的CD4+T淋巴细胞计数200个/μl治疗前平均CD4+T淋巴细胞计数为(121.1±111.8)个/μl。平均随访治疗时间为(59.4±1.3)个月。随着治疗时间的延长,患者体内病毒载量得到很好的抑制。在HAART第12、24、36、48、60及72个月时病毒完全抑制率分别为23.4%,64.4%,73.4%,86.7%,87.2%及84%；患者的CD4+T细胞计数呈现不同程度的增长,治疗后各个随访时间点的CD4+T淋巴细胞计数平均水平随着治疗时间的推移呈上升趋势,治疗后第3、6、12、24、36、48、60、72月份患者CD4+T淋巴细胞平均计数分别为199、220、264、310、345、373、386、395个/μl,与基线平均水平相比均具有显著性意义(P0.001)。而且,患者中CD4+T淋巴细胞计数200个/μl的比例随着抗病毒治疗时间的推移呈下降趋势,第3、6、12、18、24、36、48、60、72月份病人中CD4+T细胞计数200个/μl的百分比与基线比较均具有显著性意义(P0.001)。截止至研究终点,失访13例,转诊8例,因艾滋相关死亡31例,1例自杀,仍有357例患者继续接受ART。死亡病例平均年龄为52.2岁,平均治疗时间为5.1个月(2天-29个月)。在接受抗病毒治疗后第1、2、3、4、5、6、7年,生存率分别为0.93、0.92、0.92、0.92、0.92、0.92、0.92。应用Cox比例风险回归模型单因素分析,发现年龄(44岁组、44-59岁组和60岁组)和基线CD4+T淋巴细胞计数(=100个/μl组和100个/μl组)与生存时间有统计学意义(P0.05)。多因素Cox比例风险回归模型分析发现：在控制了年龄、性别、婚姻状况等因素的潜在混杂作用影响后,基线CD4+T淋巴细胞计数与其生存时间之间存在统计学关联。基线CD4+T淋巴细胞计数=100个/μl组死于艾滋病相关疾病的风险较基线CD4+T淋巴细胞计数100个/μl组的艾滋病患者低(HR=0.21,95%CI：0.15-0.78)在本研究过程中,71.2%的患者出现抗病毒药物相关不良反应,以恶心呕吐、胃纳减少等消化道症状为主,大多数药物不良反应比较轻微,经对症治疗后缓解,其中125例次患者因药物不良反应更改治疗方案。研究结论：上海地区艾滋病人通过接受免费抗病毒治疗,使体内HIV病毒复制得到有效抑制,同时免疫功能也得到提高。在降低艾滋病病人的病死率,延长病人的生存时间,取得了良好的治疗效果；在长期的治疗随访过程中发现药物的不良反应是更换治疗方案的主要原因,要加强对各种抗病毒药物不良反应的监测,提供相应的治疗策略,提高病人依从性,减少换药的人次和频度,在有限的药物选择范围内达到最佳的治疗效果。
[Abstract]:Objective: To evaluate the therapeutic effect of national free high performance antiretroviral therapy (HAART) in Shanghai and its related factors, and to explore the relationship between the domestic treatment plan and the time of treatment and the survival time of AIDS patients and the quality of life, and provide a scientific basis for making more reasonable treatment schemes and decision support. To further curb the spread of AIDS in China. Methods of retrospective cohort study, a comprehensive assessment of the clinical data, cellular immunity, virological response, adverse drug reactions and survival of the national free antiviral treatment of AIDS patients from September 30, 2005 to December 31, 2008 in Shanghai was evaluated. The end of the study was the end of December 2012. EpiData and SPSS 17 statistical software were used for the data entry and analysis. The results of the study were included in this study. The results were included in this study. In this study, there were 321 males and 89 females with the average age of (42.1 + 12.4) years old. Among them, the middle and young people were 20-49 years old (71.7%), and 236 cases (57.6%) were married or cohabitation (57.6%): the infection pathway was found. Sexually transmitted transmission, heterosexual transmission accounted for 52.2%, homosexual transmission accounted for 22.4%; before receiving this treatment, 3.7% of the cases received traditional Chinese medicine and 19.5% of the cases received antiviral treatment. Most of the cases included in the treatment of this study had entered the advanced AIDS, the 75.9% cases of CD4+T lymphocytic count 200 / Mu l before the average CD4+T lymphocyte The average time of follow-up treatment was (121.1 + 111.8) / mu L. (59.4 + 1.3) months. With the prolonged treatment time, the viral load in the patient was well suppressed. The total inhibition rate of the virus was 23.4%, 64.4%, 73.4%, 86.7%, 87.2% and 84% respectively at the time of 12,24,36,48,60 and 72 months of HAART; the CD4+T cell count of the patients presented different processes. The average level of CD4+T lymphocyte counts increased with the time of treatment, and the average count of CD4+T lymphocytes in patients after treatment was 199220264310345373386395 / U L respectively after treatment (P), compared with the baseline average level (P). 0.001). Moreover, the proportion of CD4+T lymphocyte counts of 200 / u l decreased with the time of antiviral therapy, and the percentage of CD4+T cell counts of 200 / u l in month 3,6,12,18,24,36,48,60,72 was significant (P0.001). 31 cases of related death, 1 cases of suicidal, and 357 patients who continued to accept ART. death, the average age was 52.2 years, the average time of treatment was 5.1 months (2 days -29 months). In the 1,2,3,4,5,6,7 year after the treatment of antiviral treatment, the survival rate was the single factor analysis of the Cox proportional risk regression model of the 0.93,0.92,0.92,0.92,0.92,0.92,0.92. application, respectively. The present age (44 year old group, 44-59 year old group and 60 year old group) and the baseline CD4+T lymphocyte count (=100 / mu l group and 100 / L Group) and survival time were statistically significant (P0.05). Multiple factor Cox proportional risk regression model analysis found that the baseline CD4+T lymphocyte after controlling the potential confounding of factors such as age, sex, marital status and so on. There was a statistical correlation between the count and the survival time. The baseline CD4+T lymphocyte count =100 / u l group died of AIDS related diseases at a lower baseline CD4+T lymphocyte count of 100 / u l groups of AIDS patients (HR=0.21,95%CI:0.15-0.78) in this study, and in this study, the adverse reactions associated with antiviral drugs were found. The main symptoms of digestive tract were nausea and vomiting and reduction of gastric intake. Most of the drug adverse reactions were mild and were relieved after symptomatic treatment. 125 of them changed the treatment program due to adverse drug reactions. The study concluded that the AIDS patients in Shanghai area were treated with free disease resistant treatment to effectively inhibit the replication of HIV virus in the body. The immune function is also improved. In reducing the mortality rate of AIDS patients and prolonging the patient's survival time, a good therapeutic effect has been obtained. In the long-term follow-up process, the adverse reaction of the drug is found to be the main reason for the replacement of the treatment plan, and the monitoring of adverse drug reactions of various antiviral drugs should be strengthened and the corresponding treatment should be provided. The treatment strategy improves patient compliance, reduces the number and frequency of dressing change, and achieves the best therapeutic effect within the limited range of drug selection.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.91

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