| 夏晶晶,汪剡灵,胡雅飞,沈伟伟,林海江,石瑞紫,马中慧,李自慧,李仕祯,丁盈盈,陈潇潇,何纳.抗病毒治疗HIV感染者神经认知损伤与认知表现特征研究[J].中华流行病学杂志,2022,43(10):1651-1657 |
| 抗病毒治疗HIV感染者神经认知损伤与认知表现特征研究 |
| Neurocognitive impairment and characteristics of neurocognitive performance among people with HIV on antiretroviral treatment |
| 收稿日期:2022-05-24 出版日期:2022-10-18 |
| DOI：10.3760/cma.j.cn112338-20220524-00456 |
| 中文关键词: 艾滋病病毒 神经认知损伤 聚类分析 |
| 英文关键词: HIV Neurocognitive impairment Cluster analysis |
| 基金项目:国家自然科学基金（82173579）；台州市科技计划（21ywa68） |
| 作者 | 单位 | E-mail | | 夏晶晶 | 复旦大学公共卫生学院流行病学教研室, 上海 200032
复旦大学义乌研究院, 义乌 322000 | | | 汪剡灵 | 台州市疾病预防控制中心, 台州 318000 | | | 胡雅飞 | 台州市疾病预防控制中心, 台州 318000 | | | 沈伟伟 | 台州市疾病预防控制中心, 台州 318000 | | | 林海江 | 台州市疾病预防控制中心, 台州 318000 | | | 石瑞紫 | 复旦大学公共卫生学院流行病学教研室, 上海 200032
复旦大学义乌研究院, 义乌 322000 | | | 马中慧 | 复旦大学公共卫生学院流行病学教研室, 上海 200032
复旦大学义乌研究院, 义乌 322000 | | | 李自慧 | 复旦大学公共卫生学院流行病学教研室, 上海 200032
复旦大学义乌研究院, 义乌 322000 | | | 李仕祯 | 复旦大学公共卫生学院流行病学教研室, 上海 200032
复旦大学义乌研究院, 义乌 322000 | | | 丁盈盈 | 复旦大学公共卫生学院流行病学教研室, 上海 200032
复旦大学义乌研究院, 义乌 322000 | | | 陈潇潇 | 台州市疾病预防控制中心, 台州 318000 | tzcdccxx@126.com | | 何纳 | 复旦大学公共卫生学院流行病学教研室, 上海 200032
复旦大学义乌研究院, 义乌 322000 | nhe@fudan.edu.cn |
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| 中文摘要: |
| 目的 联合应用两种神经认知评价量表，探讨接受抗病毒治疗（ART）的HIV感染者神经认知损伤患病率、影响因素及其神经认知表现特征。方法 纳入浙江省台州市开展的HIV与衰老相关疾病前瞻性队列研究中2 250例接受ART的HIV感染者。使用中国版简易智能精神状态检查量表（MMSE）和国际HIV相关性痴呆量表（IHDS）评价其神经认知损伤情况，并对2个量表中的7个神经认知域进行聚类分析。结果 在接受ART的HIV感染者2 250例中，年龄集中在45~89岁（48.0%，1 080/2 250），男性占79.2%（1 782/2 250），小学及以下文化程度者占37.8%（852/2 250）。MMSE和IHDS判断的神经认知损伤的患病率分别为14.3%（321/2 250）和31.8%（716/2 250）。多因素logistic回归分析结果显示，HIV感染者MMSE判断的神经认知损伤危险因素包括60~89岁（aOR=2.63，95%CI：1.52~4.56）、抑郁症状（aOR=5.58，95%CI：4.20~7.40）和使用依非韦伦（EFV）治疗（aOR=2.86，95%CI：1.89~4.34）；男性（aOR=0.71，95%CI：0.51~1.00）、偏胖（aOR=0.63，95%CI：0.44~0.89）和文化程度较高（aOR=0.11，95%CI：0.05~0.25）为保护因素。IHDS判断的神经认知损伤危险因素包括60~89岁（aOR=3.10，95%CI：2.09~4.59）、抑郁症状（aOR=1.78，95%CI：1.44~2.20）和使用EFV治疗（aOR=1.79，95%CI：1.41~2.29）；男性（aOR=0.75，95%CI：0.58~0.97）、偏瘦（aOR=0.67，95%CI：0.47~0.96）、基线CD4+T淋巴细胞（CD4）计数≥350个/μl（aOR=0.69，95%CI：0.53~0.91）和文化程度较高（aOR=0.23，95%CI：0.14~0.39）是保护因素。HIV感染者的神经认知表现分为4种主要类型，在年龄、性别、文化程度、饮酒、抑郁症状、腰臀比、高血压病史、糖尿病病史、基线CD4计数和使用EFV治疗的差异有统计学意义（均P < 0.05）。结论 接受ART的HIV感染者神经认知表现分为4种类型，神经认知损伤患病率较高，需对不同类型者采取针对性的监测、预防与控制措施。 |
| 英文摘要: |
| Objective Using two measuring tools to examine the prevalence and correlates of neurocognitive impairment (NCI) as well as characteristics of neurocognitive performance among people with HIV (PWH) on antiretroviral treatment (ART).Methods A total of 2 250 treated PWH from the Comparative HIV and Aging Research in Taizhou (CHART) were recruited in Taizhou, Zhejiang province. The Chinese version of the Mini-mental State Examination (MMSE) and the International HIV Dementia Scale (IHDS) were used to evaluate their neurocognitive performance. Cluster analysis was conducted on the seven cognitive domains in the scale.Results Among 2 250 treated PWH, 48.0% (1 080/2 250) were aged 45 to 89, 79.2% (1 782/2 250) were male, and 37.8% (852/2 250) had primary school education or below. The prevalence of neurocognitive impairment judged by MMSE and IHDS among HIV-infected people was 14.3% (321/2 250) and 31.8% (716/2 250), respectively. Aged 60 to 89 (aOR=2.63, 95%CI:1.52-4.56), depressive symptoms (aOR=5.58, 95%CI:4.20-7.40) and treatment with EFV (aOR=2.86, 95%CI:1.89-4.34) were main risk factors of NCI diagnosed by MMSE. Male (aOR=0.71, 95%CI:0.51-1.00), overweight (aOR=0.63, 95%CI:0.44-0.89), and high education level (aOR=0.11, 95%CI:0.05-0.25) were protective factors of NCI diagnosed by MMSE. Aged 60 to 89 (aOR=3.10, 95%CI:2.09-4.59), depressive symptoms (aOR=1.78, 95%CI:1.44-2.20) and treatment with EFV (aOR=1.79, 95%CI:1.41-2.29) were risk factors of NCI diagnosed by IHDS. Male (aOR=0.75, 95%CI:0.58-0.97), underweight (aOR=0.67, 95%CI:0.47-0.96), baseline CD4+ T lymphocyte (CD4) counts ≥ 350 cells/μl (aOR=0.69, 95%CI:0.53-0.91) and high education level (aOR=0.23, 95%CI:0.14-0.39) were protective factors of NCI diagnosed by IHDS. The neurocognitive performance of HIV-infected people can be divided into four main types. Among four types, age, gender, education level, alcohol drinking, depressive symptoms, waist-to-hip ratio, hypertension, diabetes, baseline CD4 counts and treatment with EFV were different statistically (all P < 0.05).Conclusions There are four main types of neurocognitive performance in treated PWH. The prevalence of NCI is high among this population, underscoring the need for tailored prevention and intervention. |
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