广西壮族自治区结核分枝杆菌/HIV联合感染患者抗病毒治疗对死亡影响的分析

郑志刚; 崔哲哲; 黄敏莹; 潘冬香

Abstract

郑志刚,崔哲哲,黄敏莹,潘冬香.广西壮族自治区结核分枝杆菌/HIV联合感染患者抗病毒治疗对死亡影响的分析[J].Chinese journal of Epidemiology,2015,36(2):124-127

广西壮族自治区结核分枝杆菌/HIV联合感染患者抗病毒治疗对死亡影响的分析

Effect of antiretroviral therapy in reducing deaths among patients co-infected with Mycobacterium tuberculosis and human immunodeficiency virus in Guangxi

Received:August 13, 2014

DOI：10.3760/cma.j.issn.0254-6450.2015.02.005

KeyWord: 抗病毒治疗艾滋病结核病死亡

English Key Word: Antiretroviral therapy AIDS Tuberculosis Death influence

FundProject:

Author Name	Affiliation	E-mail
Zheng Zhigang	Guangxi Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China	tinygang@hotmail.com
Cui Zhezhe	Guangxi Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
Huang Minying	Guangxi Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
Pan Dongxiang	Guangxi Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China

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Abstract:

目的分析抗病毒治疗(ART)对结核分枝杆菌/HIV联合感染患者(TB/HIV)死亡的影响。方法收集2011年广西壮族自治区(广西)各市、县(区)结核病监测系统中既往HIV阳性和新确诊HIV阳性的结核病(TB)患者信息,经核对“中国疾病预防控制系统-艾滋病综合防治信息系统”信息,确定TB/HIV;采用回顾性对照研究方法,按是否开展ART将患者分为ART和非ART两组,用统计学方法比较两组患者特征,并计算死亡比例,采用Kaplan-Meier法分析两组生存情况,同时分析死亡优势比和开始抗结核治疗1年内ART保护率。结果 519例TB/HIV中,100例(19.3%)开展ART;开展抗结核治疗1年内84例(16.2%)死亡,其中ART组8例(9.5%),非ART组76例(占死亡患者90.5%);ART组死亡占TB/HIV总数的8.08%,非ART组死亡占TB/HIV总数的18.7%,两组差异有统计学意义(χ²=6.12,P<0.01);Kaplan-Meier生存曲线显示,ART组TB/HIV治疗开始1年内生存概率大于非ART组;两组生存曲线差异有统计学意义(P<0.05);相对于ART组,非ART组TB/HIV死亡优势比为2.31;ART组在抗结核第一年内能保护56.7%的TB/HIV免于死亡。结论在抗结核开始1年内,非ART组TB/HIV死亡比例显着高于ART组;ART患者生存时间较非ART组长;ART可以保护半数以上TB/HIV在抗结核开始1年内免于死亡;为挽救更多生命,需不断提高TB/HIV中ART覆盖面。

English Abstract:

Objective To understand the effect of antiretroviral therapy (ART) in reducing deaths among patients co-infected with Mycobacterium tuberculosis and human immunodeficiency virus (TB/HIV),and provide data-based evidence for improving ART in TB/HIV patients. Methods The information about TB patients who were HIV positive confirmed previously or recently in Guangxi were collected,and the TB/HIV patients were confirmed by using the related data from national AIDS prevention and treatment information system. Then a retrospective case control study was conducted to understand the survivals and deaths in the patients receiving ART or receiving no ART by using Kaplan-Meier method and estimate the ART protective rate within 1 year after TB treatment initiation. Results Among 519 TB/HIV patients,100 received ART(19.3%);Among 84 TB/HIV patients who died within 1 year after TB treatment,8(9.5%) received ART,while 76(90.5%) received no ART. Compared with the 18.7% mortality rate in non-ART group,TB/HIV patients mortality rate in ART group was only 8.08%,the difference was statistical significant (P<0.05). Kaplan-Meier survival curve showed that the survival rate in patients receiving ART was higher than that in patients receiving no ART within 1 year after TB treatment,the difference was statistical significant (Log-rank=4.96,P=0.02). Compared with patients receiving ART,the OR value was 2.31 times higher than that in patients receiving no ART;ART could protect 56.7% of TB/HIV patients against death during the first year of anti-TB therapy. Conclusion In the first year of anti-TB therapy,the risk of death in TB/HIV patients receiving no ART was much higher than that in TB/HIV patients receiving ART,and the survival time was longer in the patients receiving ART. The ART coverage should be expanded in TB/HIV patients.

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