| 何佳谕,高洁,杨跃诚,叶润华,曹东冬,王继宝,丁盈盈,段松,何纳.德宏傣族景颇族自治州抗病毒治疗的HIV感染者血小板动态变化的纵向研究[J].中华流行病学杂志,2021,42(11):1994-2000 |
| 德宏傣族景颇族自治州抗病毒治疗的HIV感染者血小板动态变化的纵向研究 |
| A longitudinal analysis on dynamic change of platelet count in HIV-infected patients with access to antiretroviral therapy in Dehong Dai and Jingpo Autonomous Prefecture |
| 收稿日期:2021-06-07 出版日期:2021-11-20 |
| DOI：10.3760/cma.j.cn112338-20210607-00459 |
| 中文关键词: 艾滋病病毒 血小板计数 性别 肝纤维化 纵向研究 |
| 英文关键词: HIV Platelet count Gender Liver fibrosis Longitudinal study |
| 基金项目:国家自然科学基金（81773485）；国家科技重大专项（2018ZX10721102-004） |
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| 中文摘要: |
| 目的 分析云南省德宏傣族景颇族自治州（德宏州）抗病毒治疗的HIV感染者血小板动态变化情况及相关影响因素。方法 纵向观察抗病毒治疗的HIV感染者血小板动态变化情况，采用线性混合模型分析血小板动态变化的影响因素，并进行敏感性分析和分层分析。结果 基线招募761例HIV感染者，随访次数≥ 1次的HIV感染者608例，随访率为80.0%（608/761），6、12和24个月的随访HIV感染者分别为374、555和233例。基线及各次随访的平均血小板计数和血小板计数偏高（>300×109/L）的比例女性均高于男性（P<0.05）。在无明显肝纤维化的HIV感染者中，女性的基线及各次随访的平均血小板计数均高于男性（P<0.05）；有肝纤维化的HIV感染者中，基线平均血小板计数女性仍高于男性（P<0.05），但各次随访的差异无统计学意义。多因素线性混合模型分析结果显示，随访血小板计数与女性（β=5.90，95%CI：1.09~10.70，P=0.016）、基线血小板计数（β=0.82，95%CI：0.79~0.86，P<0.001）和随访时间（β=1.76，95%CI：1.52~2.01，P<0.001）呈显著正相关。对同时有12和24个月随访记录的220例HIV感染者进行敏感性分析，结果提示，随访血小板计数与女性（β=10.50，95%CI：2.24~18.74，P=0.013）、基线血小板计数（β=0.71，95%CI：0.65~0.77，P<0.001）和随访时间（β=1.60，95%CI：1.20~1.99，P<0.001）呈显著正相关；与年龄（β=-0.42，95%CI：-0.78~-0.06，P=0.021）呈负相关。结论 抗病毒治疗后，HIV感染者血小板计数逐渐增加。女性HIV感染者平均血小板计数持续高于男性，应关注HIV感染者血小板计数的性别差异，及时给予干预，以减少相关疾病的发病率和病死率。 |
| 英文摘要: |
| Objective To explore the dynamic change of platelet count and related factors in HIV-infected patients with access to antiretroviral therapy (ART) in Dehong Dai and Jingpo autonomous prefecture of Yunnan province. Methods A longitudinal analysis was used to analyze the dynamic change of platelet count in HIV-infected patients with access to ART. Linear mixed model (LMM) was used to analyze factors associated with the dynamic change of platelet count. Stratified analysis and sensitivity analysis were also conducted. Results A total of 761 HIV-infected patients were recruited and 608 cases had at least one follow-up record (80.0%,608/761). 374, 555 and 233 cases were investigated in follow-up visits at month 6, 12 and 24, respectively. The mean platelet count and the proportion of higher platelet count (>300×109/L) were significantly higher in women than in men at both baseline survey and each follow-up visit (P<0.05). Among patients with no obvious liver fibrosis, the mean platelet count was significantly higher in women than in men at baseline survey and each follow-up visit; while in the patients with liver fibrosis, the mean baseline platelet count was still significantly higher in women than in men, but the difference had no significance at follow-up visits. Results of LMM revealed that follow-up platelet count was positively correlated with gender (β=5.90, 95%CI:1.09-10.70, P=0.016), baseline platelet count (β=0.82, 95%CI:0.79-0.86, P<0.001) and time (β=1.76, 95%CI:1.52-2.01, P<0.001). Sensitivity analysis among 220 cases who had both 12- and 24-month follow-up visits further confirmed that follow-up platelets count was still positively associated with gender (β=10.50, 95%CI:2.24-18.74, P=0.013), baseline platelet count (β=0.71, 95%CI:0.65-0.77, P<0.001) and time (β=1.60, 95%CI:1.20-1.99, P<0.001) but negatively associated with age (β=-0.42, 95%CI:-0.78--0.06, P=0.021). Conclusions The platelet count of HIV-infected patients gradually increased after ART. The mean platelet count was consistently higher in women than in men. Attention should be paid to the gender specific difference in platelet count in HIV-infected patients and timely intervention should be given to reduce the morbidity and mortality of platelet-related diseases. |
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