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目的分析HIV/AIDS合并结核分枝杆菌感染病例的生存时间,并分析其影响因素。方法采用回顾性队列研究方法,通过“艾滋病综合防治信息系统”收集HIV确证日期为2007年1月~2014年6月且在成都市报告或接受检测、随访服务的病例,筛选历次随访中“结核病检查结果”报告为“肺外结核”或“肺结核”的患者。采用Kaplan-Meier乘积极限法计算生存率,并采用单因素和多因素Cox比例风险回归模型分析双重感染者生存时间的影响因素。结果 583例双重感染者中,分别有278例(47.7%),469例(80.4%)在HIV确证后2个月、12个月内发现合并结核感染,HIV/AIDS在发现合并结核感染后1年生存率为79.6%。以随访发现合并结核感染为观察开始日期,截至2014年11月30日,共随访1 165.05人年,发生141例死亡,死亡密度达12.10人/100人年。多因素Cox风险比例回归模型分析结果显示,HIV确证时年龄(岁)越大者(HR=1.019,95%CI:1.003~1.035)、未进行抗病毒治疗者(HR=12.278,95%CI:7.918~19.038)和首次CD4+T淋巴细胞计数越低者(HR=1.712,95%CI:1.369~2.141)的死亡风险越高。同性传播感染(HR=0.334,95%CI:0.166~0.672)和异性传播感染(HR=0.328,95%CI:0.137~0.781)死亡风险低于非性途径传播感染病例。结论 HIV/AIDS病例合并结核感染主要在HIV确证后1年内随访发现,年龄、非性传播途径感染、未进行抗病毒治疗、首次CD4+T淋巴细胞计数低是双重感染者死亡的危险因素。
Objective To analyze the survival time of HIV / AIDS complicated with Mycobacterium tuberculosis infection and analyze its influential factors. Methods A retrospective cohort study was conducted to identify cases of follow-up services reported in HIV testing or follow-up in Chengdu from January 2007 to June 2014 through HIV / AIDS Integrated Information System “Tuberculosis test results ” reported as “extra-pulmonary tuberculosis” or “pulmonary tuberculosis” patients. Survival rates were calculated using the Kaplan-Meier product-limit method and univariate and multivariate Cox proportional hazards regression models were used to analyze the influencing factors of survival time of patients with dual infection. Results Among 583 cases of double infection, 278 cases (47.7%) and 469 cases (80.4%) were found to be infected with tuberculosis within 2 months and 12 months after HIV diagnosis. HIV / AIDS was found in 1 The annual survival rate was 79.6%. At the follow-up, we found that the combined tuberculosis infection was the starting date of the observation. As of November 30, 2014, a total of 1 165.05 person-years of follow-up were observed, with 141 deaths and a death rate of 12.10 deaths per 100 person-years. Multivariate Cox risk proportional regression model analysis showed that HIV-positive patients (HR = 1.019, 95% CI: 1.003-1.035) and those without antiviral therapy (HR = 12.278, 95% CI: 7.918 ~ 19.038) and the lower the first CD4 + T lymphocyte count (HR = 1.712, 95% CI: 1.369 ~ 2.141), the higher the risk of death. The risk of death from sexually transmitted infections (HR = 0.334, 95% CI: 0.166-0.662) and heterosexual transmission infections (HR = 0.328, 95% CI: 0.137-0.781) was lower than that of non- sexually transmitted infections. Conclusions HIV / AIDS cases with tuberculosis infection are mainly followed up within 1 year after HIV confirmation. The age, non-transmission route of infection and no anti-virus treatment, and the low first CD4 + T lymphocyte count are the risk factors for death from double infection.