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目的分析高效抗反转录病毒治疗(HAART)过程中影响免疫功能重建的因素。方法 2003年9月至2013年6月,采用回顾式队列分析,从国家艾滋病抗病毒治疗数据库中筛选出按要求完成随访的病人5567例,检测病人基线及HAART治疗9-15个月后的CD+4T淋巴细胞(简称CD4细胞)数量,将CD4细胞<200个/μL或较基线增长<20%定义为免疫重建不良,采用Logistic回归分析观察其影响因素。结果 HAART有效率为54.25%,共有2547例病人发生免疫重建不良,男性[比值比(OR):1.58,95%可信区间(CI):(1.41~1.76)]、高龄[~60岁OR:2.25,95%CI:(1.38~3.67)]、>60岁OR:2.57,95%CI:(1.54~4.31)]、静脉吸毒、基线CD4细胞水平过低、合并丙型肝炎病毒(HCV)[OR:1.68,95%CI(1.26~2.24)]感染、结核菌(TB)感染、病毒抑制不良[>5000拷贝OR:4.05,95%CI:(2.82~5.82)]等,均是发生免疫重建不良的危险因素,而乙型肝炎病毒表面抗原(HBsAg)阳性未发现与免疫重建相关[OR:0.90,95%CI:(0.71~1.16)]。结论男性、高龄、静脉吸毒、基线CD4细胞水平过低、合并HCV感染、病毒抑制不良等,均是发生免疫重建不良的危险因素,临床上需引起注意。
Objective To analyze the factors affecting the reconstruction of immune function in highly active antiretroviral therapy (HAART). Methods From September 2003 to June 2013, we used retrospective cohort analysis to screen 5 667 patients who completed the required follow-up from the national HIV / AIDS treatment database. The patients’ baseline and the CD-ROM of 9-15 months after HAART were detected. + 4T lymphocytes (referred to as CD4 cells), the number of CD4 cells <200 / μL or more than 20% of the baseline was defined as poor immune reconstitution, using Logistic regression analysis to observe the influencing factors. Results The effective rate of HAART was 54.25%. A total of 2547 patients had poor immune reconstitution. The odds ratio (OR) was 1.58, 95% confidence interval (CI): (1.41-1.76) 2.25, 95% CI: 1.38 to 3.67),> 60 years OR: 2.57, 95% CI: (1.54 to 4.31)]. Intravenous drug use and baseline CD4 cell levels were too low for HCV [ OR: 1.68, 95% CI (1.26-2.224)], tuberculosis (TB) infection, poor virus suppression [> 5000 copies OR: 4.05,95% CI: (2.82-5.82)], However, no positive correlation was found between HBsAg positive and immune reconstruction [OR: 0.90, 95% CI: (0.71-1.16)]. Conclusion Male, elderly, intravenous drug use, baseline CD4 cell level is too low, with HCV infection, poor virus inhibition, are risk factors for poor immune reconstruction, clinically necessary attention.