| 何丹,蒲杰,刘伟信,张燕,孙玲玲,宋筱.四川省HIV感染孕产妇所生围产儿死亡现状与影响因素研究[J].中华流行病学杂志,2020,41(10):1686-1691 |
| 四川省HIV感染孕产妇所生围产儿死亡现状与影响因素研究 |
| Perinatal outcomes on mortality and influencing factors among HIV-infected mothers in Sichuan province |
| 收稿日期:2019-12-25 出版日期:2020-10-27 |
| DOI：10.3760/cma.j.cn112338-20191225-00914 |
| 中文关键词: 艾滋病病毒 孕产妇 围产儿死亡 |
| 英文关键词: HIV Pregnant women Perinatal deaths |
| 基金项目:四川省卫生健康委重点研究项目（18ZD046） |
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| 中文摘要: |
| 目的 了解HIV感染孕产妇所生围产儿死亡情况，探讨影响围产儿死亡的因素，为降低四川省HIV感染孕产妇所生围产儿死亡水平和减少艾滋病母婴传播提供参考依据。方法 在四川省2005－2016年开展预防艾滋病母婴传播的183个县（市、区）医疗保健机构，选取HIV感染孕产妇4 734例及其所生围产儿4 786例作为研究对象。收集其母亲孕产期及围产儿相关流行病学调查资料，采用单因素χ2检验和多因素logistic回归，分析围产儿死亡情况及其影响因素。结果 HIV感染孕产妇所生围产儿死亡率为25.7‰（123/4 786），呈逐年下降趋势（趋势χ2=32.220，P=0.000），凉山州围产儿死亡率高于四川省其他地区（χ2=4.130，P=0.042），凉山州死胎/死产较多、四川省其他地区7 d内死亡较多（χ2=29.626，P=0.000）。多因素logistic回归分析结果显示，母亲怀孕1~2次及3~4次的围产儿死亡率低于怀孕≥5次者（1~2次的OR=0.417，95% CI：0.184~0.943；3~4次的OR=0.447，95% CI：0.223~0.895），孕产期使用基于以洛匹那韦/利托那韦（克力芝，LPV/r）为主的蛋白酶抑制剂（PI）三联抗病毒治疗方案的HIV感染孕产妇所生围产儿更容易避免死亡（OR=0.530，95% CI：0.285~0.986），医疗机构分娩的围产儿死亡率低于家中或途中分娩者（市级及以上助产机构OR=0.222，95% CI：0.098~0.499；县级助产机构OR=0.282，95% CI：0.166~0.480；乡级助产机构OR=0.134，95% CI：0.031~0.586），早产、新生儿窒息导致围产儿死亡的危险性增加（早产OR=8.285，95% CI：5.073~13.533；新生儿窒息OR=9.624，95% CI：4.625~20.028）。结论 四川省HIV感染孕产妇所生围产儿死亡率远高于全国、四川省孕产妇所生围产儿死亡率，应减少HIV感染孕产妇的孕次、采用基于LPV/r的三联抗病毒治疗方案，提倡住院分娩，减少围产儿发生早产和新生儿窒息。 |
| 英文摘要: |
| Objective To explore the influencing factors on perinatal mortality of pregnant women with HIV infection to reduce the mother-to-child transmission in Sichuan province. Methods In this study, 4 786 perinatal infants of the HIV-infected pregnant women were included. Related data on perinatal epidemiology was reported by all the 183 medical and health care institutions where the HIV prevention of mother-to-child transmission program was initiated in 2005-2016. Univariate χ2 test and multivariate logistic regression methods were used to analyze the perinatal mortality outcomes and influencing factors. Results The overall perinatal mortality rate was 25.7‰ (123/4 786) among HIV-infected pregnant women, with annual downwarding trend (trend χ2=32.220, P=0.000). Perinatal mortality rate appeared the highest (χ2=4.130, P=0.042), with more fetal deaths and stillbirths and less early neonatal death within 7 days in Liangshan county (χ2=29.626, P=0.000). Results from the multivariate logistic regression analysis showed that fewer pregnant numbers would contribute to the, lower perinatal mortality rate (1-2 pregnancies OR=0.417, 95% CI: 0.184-0.943; 3-4 pregnancies OR=0.447, 95% CI: 0.223-0.895). Perinatal deaths were more likely to be prevented if LPV/r protease inhibitor-based triple antiviral therapy was provided (OR=0.530, 95% CI: 0.285- 0.986) or delivery was taken place in the hospital (hospital of municipal-level and above OR=0.222, 95% CI:0.098-0.499; county-level hospital OR=0.282, 95% CI: 0.166-0.480; township-level hospital OR=0.134, 95% CI: 0.031-0.586) among HIV-infected pregnant women. However, premature delivery or neonatal asphyxia would increase the risk of perinatal mortality (premature delivery OR=8.285, 95% CI: 5.073-13.533; neonatal asphyxia OR=9.624, 95% CI: 4.625-20.028). Conclusions The perinatal mortality rate of HIV-infected pregnant women appeared significantly higher than that in the province or the whole country. Strategies involving LPV/r-based triple antiviral therapy, promotion of hospital delivery, reducing the incidence rates of premature deliveries and neonatal asphyxia, should be strengthened. |
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