中国全科医学 ›› 2022, Vol. 25 ›› Issue (30): 3796-3802.DOI: 10.12114/j.issn.1007-9572.2022.0336

• 论著·重点人群健康问题研究·HIV/AIDS • 上一篇    下一篇

HIV/AIDS患者结核潜伏感染的影响因素研究

蒋泽顺1,2, 杨正贵3, 李江平1,2, 韩雪4, 任立芳5, 齐晟宏1,2, 柳欣沂1,2, 刘兰1,2,*()   

  1. 1.750004 宁夏回族自治区银川市,宁夏医科大学公共卫生与管理学院流行病与卫生统计学系
    2.750004 宁夏回族自治区银川市,宁夏环境因素与慢性病控制重点实验室
    3.750021 宁夏回族自治区银川市,宁夏回族自治区第四人民医院办公室
    4.750021 宁夏回族自治区银川市,宁夏回族自治区第四人民医院感染与免疫科
    5.750100 宁夏回族自治区银川市,永宁县人民医院感染性疾病科
  • 收稿日期:2022-04-10 修回日期:2022-06-15 出版日期:2022-10-20 发布日期:2022-07-08
  • 通讯作者: 刘兰
  • 蒋泽顺和杨正贵为共同第一作者 蒋泽顺,杨正贵,李江平,等. HIV/AIDS患者结核潜伏感染的影响因素研究[J].中国全科医学,2022,25(30):3796-3802.[www.chinagp.net]
    作者贡献:蒋泽顺负责数据分析和论文撰写;杨正贵负责文章构思与设计及论文撰写;李江平负责统计方法的整体把关和方案设计;韩雪、任立芳为本次试验的开展提供专业技术支持;齐晟宏、柳欣沂负责数据的收集和整理;刘兰指导论文的撰写,负责质量控制及审校,对文章整体负责、监督管理。
  • 基金资助:
    宁夏回族自治区重点研发计划项目(2020BEG03018); 中国公共卫生联盟(第一批)课题(GWLM202021)

Influencing Factors of Latent Tuberculosis Infection in Patients Living with HIV/AIDS

Zeshun JIANG1,2, Zhenggui YANG3, Jiangping LI1,2, Xue HAN4, Lifang REN5, Shenghong QI1,2, Xinyi LIU1,2, Lan LIU1,2,*()   

  1. 1. Department of Epidemiology and Biostatistics, School of Public Health and Management, Ningxia Medical University, Yinchuan 750004, China
    2. Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
    3. Department of Region Office, the Fourth People's Hospital of Ningxia Hui Autonomous Region, Yinchuan 750021, China
    4. Department of Infection and Immunology, the Fourth People's Hospital of Ningxia Hui Autonomous Region, Yinchuan 750021, China
    5. Department of Infectious Diseases, Yongning County People's Hospital, Yinchuan 750100, China
  • Received:2022-04-10 Revised:2022-06-15 Published:2022-10-20 Online:2022-07-08
  • Contact: Lan LIU
  • About author:
    JIANG Z S, YANG Z G, LI J P, et al. Influencing factors of latent tuberculosis infection in patients living with HIV/AIDS[J]. Chinese General Practice, 2022, 25 (30) : 3796-3802. JIANG Zeshun and YANG Zhenggui are co-first authors

摘要: 背景 结核病是导致人免疫缺陷病毒/获得性免疫缺陷综合征(HIV/AIDS)患者死亡的首要原因,而HIV感染也是导致结核潜伏感染(LTBI)发展为结核病的主要危险因素。因此,对HIV/AIDS患者进行LTBI筛查和治疗是预防该类人群结核病的发生从而减少其死亡的重要举措。 目的 对宁夏回族自治区银川市市区内HIV/AIDS患者进行LTBI筛查,并分析其影响因素,识别高危人群,为HIV/AIDS患者结核病的预防性治疗提供科学依据。 方法 选取2021年3—8月于宁夏回族自治区银川市市区内定点管理单位治疗的546例HIV/AIDS患者为研究对象。通过现场问卷调查及查阅患者管理档案的方式收集HIV/AIDS患者的一般资料,其中一般人口学特征包括性别、年龄、民族、学历、婚姻状况、家庭人均年收入、职业类型、体质指数(BMI)、吸烟情况、饮酒情况等;临床资料包括慢性病患病情况、与结核病患者密切接触情况、HIV/AIDS确诊时长、抗病毒治疗时长、合并其他感染情况、近期CD4+ T淋巴细胞计数(CD4)等。通过结核菌素皮肤试验(TST)对研究对象进行LTBI筛查,根据TST结果将546例HIV/AIDS患者分为非LTBI组(TST阴性413例)和LTBI组(TST阳性133例)。比较两组患者的一般资料,采用多因素Logistic回归分析探讨HIV/AIDS患者发生LTBI的影响因素,并利用R软件建立限制性立方样条模型拟合CD4与LTBI风险之间的量效关系。 结果 银川市市区内HIV/AIDS患者的TST阳性率为24.4%。已婚〔OR=0.544,95%CI(0.321,0.922),P<0.05〕是HIV/AIDS患者发生LTBI的保护因素;吸烟〔OR=1.919,95%CI(1.213,3.037),P<0.05〕、与结核病患者有过密切接触〔OR=11.100,95%CI(2.889,42.648),P<0.05〕是HIV/AIDS患者发生LTBI的危险因素。限制性立方样条模型拟合结果显示,HIV/AIDS患者的CD4与LTBI风险呈近似"n"形的非线性关系(非线性检验χ2=29.080,P<0.001)。 结论 应重点关注HIV/AIDS患者中未婚、吸烟、与结核病患者有过密切接触人群LTBI的发生情况,并及时进行预防性治疗;对于CD4较低的患者,建议采用多种方法进行LTBI筛查。

关键词: 人免疫缺陷病毒, 获得性免疫缺陷综合征, 结核分枝杆菌, 结核潜伏感染, 影响因素, 限制性立方样条

Abstract:

Background

Tuberculosis is the leading cause of death in patients living with HIV/AIDS, and HIV infection is also a major risk factor for latent tuberculosis infection (LTBI) developing to tuberculosis. So screening and treatment of LTBI is an important measure to prevent the incidence of tuberculosis to reduce the mortality rate in this population.

Objective

To examine the prevalence of LTBI and associated factors, and to identify the high-risk individuals among HIV/AIDS patients in Yinchuan urban areas, Ningxia Hui Autonomous Region, providing a scientific basis for the preventive treatment of tuberculosis in this population.

Methods

A total of 546 HIV/AIDS patients who were treated in designated institutions for HIV/AIDS management in the urban area of Yinchuan, Ningxia Hui Autonomous Region from March to August 2021 were selected. By use of an on-site survey in combination with reviewing management files, general information (including demographic characteristics such as sex, age, ethnic group, education level, marital status, annual household income per capita, occupation, BMI, smoking and drinking) and clinical information (chronic disease prevalence, closely contacting with tuberculosis patients, time since the HIV/AIDS diagnosis, duration of antiviral treatment, other co-infections, recent CD4+ T cell count) were collected. LTBI was screened by the tuberculin skin test (TST) . The general information was compared between those with LTBI (n=133) and those without (n=413) . Multivariate Logistic regression analysis was used to explore the influencing factors of LTBI in HIV/AIDS patients. R software was used to establish a restricted cubic spline model to fit the dose-effect relationship between CD4+ T cell count and the risk of LTBI.

Results

The prevalence of LTBI detected by TST was 24.4%. Married 〔OR=0.544, 95%CI (0.321, 0.922) , P<0.05〕was associated with decreased risk of LTBI in HIV/AIDS, while smoking〔OR=1.919, 95%CI (1.213, 3.037) , P<0.05〕, and closely contacting with tuberculosis patients 〔OR=11.100, 95%CI (2.889, 42.648) , P<0.05〕were associated with increased risk of LTBI in HIV/AIDS. The fitting results of the restricted cubic spline model showed that the CD4+ T cell count and LTBI risk had an approximate "n" -shaped nonlinear relationship (non-linear test χ2=29.080, P<0.001) .

Conclusion

To reduce the incidence of LTBI in people living with HIV/AIDS, more attention and timely preventive treatment should be given to those unmarried, smokers, and close contacts of tuberculosis patients. In addition, multiple methods are recommended for screening for LTBI in those with low CD4+ T cell count.

Key words: Human immunodeficiency viruses, Acquired immunodeficiency syndrome, Mycobacterium tuberculosis, Latent tuberculosis infection, Influencing factors, Restrictive cubic spline