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中华实验和临床感染病杂志(电子版) ›› 2019, Vol. 13 ›› Issue (05) : 377 -381. doi: 10.3877/cma.j.issn.1674-1358.2019.05.006

所属专题： 文献；

论著

经联合抗反转录病毒治疗的因献血感染人类免疫缺陷病毒者肝病相关死亡分析
杨蓉蓉1, 桂希恩1,†(), 熊勇1, 高世成1   
  1. 1. 430071　武汉市，武汉大学中南医院感染科
  • 收稿日期:2019-02-15 出版日期:2019-10-15
  • 通信作者: 桂希恩
  • 基金资助:
    湖北省卫生计生青年人才项目(No. WJ2015Q019)

Analysis of liver-related mortality among human immunodeficiency virus infected patients after blood donation who received combined antiretroviral therapy

Rongrong Yang1, Xien Gui1,†(), Yong Xiong1, Shicheng Gao1   

  1. 1. Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
  • Received:2019-02-15 Published:2019-10-15
  • Corresponding author: Xien Gui
  • About author:
    Corresponding author: Gui Xien, Email:
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杨蓉蓉, 桂希恩, 熊勇, 高世成. 经联合抗反转录病毒治疗的因献血感染人类免疫缺陷病毒者肝病相关死亡分析[J/OL]. 中华实验和临床感染病杂志(电子版), 2019, 13(05): 377-381.

Rongrong Yang, Xien Gui, Yong Xiong, Shicheng Gao. Analysis of liver-related mortality among human immunodeficiency virus infected patients after blood donation who received combined antiretroviral therapy[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2019, 13(05): 377-381.

目的

探讨联合抗反转录病毒治疗（cART）对既往因献血感染人类免疫缺陷病毒（HIV）者肝病相关病死率的影响。

方法

收集2003年1月至2015年12月武汉大学中南医院诊治的940例既往因献血感染HIV者的性别、年龄、诊断时间、治疗情况、死亡日期和主要死因等资料，回顾性分析638例行cART死亡患者（cART治疗组）和302例未行cART死亡患者（未治疗组）的肝病相关死亡影响因素。

结果

cART治疗组患者总体病死率为33.9%（216/638），显著低于未治疗组（93.4%、282/302），差异有统计学意义（χ2 = 291.511、P < 0.001）；但cART治疗组肝病相关病死率为7.8%（50/638），显著高于未治疗组（4.0%、12/302），差异有统计学意义（χ2 = 4.966、P = 0.026）。其中，cART治疗组患者丙型肝炎病毒感染相关病死率和死亡比例分别为7.1%（45/638）和20.8%（45/216），均显著高于未治疗组[2.6%（8/302）和2.8%（8/282）]，差异有统计学意义（χ2 = 7.473、P = 0.006，χ2 = 41.655、P < 0.001）。

结论

在既往因献血感染HIV人群中，cART可降低其总体病死率，但HCV感染相关病死率增加。

关键词: 人类免疫缺陷病毒, 联合抗反转录病毒治疗, 病死率, 肝病
Objective

To investigate the effect of combined antiretroviral therapy (cART) on liver-related mortality among human immunodeficiency virus (HIV)-infected patients after blood donation.

Methods

From January 2003 to December 2015, gender, age, diagnosis point, treatment status, date of death, main causes of death and other information of 940 patients with acquired immunodeficiency syndrome (AIDS) were collected. The factors influencing the related death of liver disease of 638 patients with cART (cART treated group) and 302 untreated patients (untreated group) were analyzed, retrospectively.

Results

The overall mortality of patients in cART treated group was 33.9% (216/638), which was significantly lower than that in untreated group (93.4%, 282/302), with significant difference (χ2 = 291.511, P < 0.001). However, the mortality of liver disease of patients in cART group was 7.8% (50/638), significantly higher than that in untreated group (4.0%, 12/302), with significant difference (χ2 = 4.966, P = 0.026). The mortality and fatality rates of hepatitis C virus infection of patients in cART group were 7.1% (45/638) and 20.8% (45/216), which were significantly higher than those in untreated group [2.6% (8/302) and 2.8% (8/282)], with significant differences (χ2 = 7.473, P = 0.006; χ2 = 41.655, P < 0.001).

Conclusions

In previous HIV-infected people, cART could reduce the overall case-fatality rate, but the mortality associated with HCV infection increased.

Key words: Human immunodeficiency virus, Combination antiretroviral therapy, Mortality, Liver diseases
表1 cART治疗和未治疗组患者的一般资料
组别 例数 男性[例（%）] 年龄（±s，岁） HBsAg阳性[例（%）] 抗-HCV阳性[例（%）] HCV RNA检测例数 HCV RNA阳性[例（%）]
cART治疗组 638 462（72.4） 53.8 ± 3.78 62（9.7） 555（87.0） 500 372（74.4）
未治疗组 302 218（72.2） 54.6 ± 8.20 29（9.6） 266（88.1） 240 180（75.0）
统计量 ? χ2 = 0.005 t = 0.193 χ2 = 0.003 χ2 = 0.220 — χ2 = 0.031
P值 ? 0.942 0.847 0.956 0.639 — 0.861
表2 cART治疗组和未治疗组患者总体病死率和肝病相关病死率[例（%）]
组别 例数 总病死率a 肝病相关病死率b
HBV感染相关c HCV感染相关d
cART治疗组 638 216（33.9） 5（0.8） 45（7.1）
未治疗组 302 282（93.4） 4（1.3） 8（2.6）
χ2值 ? 291.511 0.632 7.473
P值 ? < 0.001 0.427 0.006
表3 cART治疗组和未治疗组各类型肝病相关死亡比例[例（%）]
组别 总例病死数 肝病相关死亡 按终末期肝病临床类型分类 按肝炎病毒分类
肝硬化a 原发性肝癌b 肝功能衰竭 HBV相关 HCV相关
cART治疗组 216 50（23.1） 34（15.7） 14（6.5） 2（0.9） 5（2.3） 45（20.8）
未治疗组 282 12（4.3） 6（2.1） 4（1.4） 2（0.7） 4（1.4） 8（2.8）
χ2值 ? 40.054 30.685 9.000 0.072 0.554 41.655
P值 ? < 0.001 < 0.001 0.003 0.788 0.457 < 0.001
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