HIV感染/AIDS者结核感染的影响因素分析

doi:10.3969/j.issn.1000-6621.2020.04.011

摘要/Abstract

摘要：

目的分析HIV感染/AIDS者结核感染情况及其影响因素。方法于2017年1—7月采用随机整群抽样的方法,抽取江苏省常州地区3家社区医院,以其10年累计登记的HIV感染/AIDS者作为研究对象,最终纳入475例,平均年龄(44.44±13.85)岁,其中,男378例(79.58%),女97例(20.42%);HIV感染者273例(57.47%),AIDS患者202例(42.53%)。收集研究对象的社会人口学信息及临床相关信息;采集研究对象外周静脉血,检测HIV病毒载量,并选取CD4 ⁺T细胞计数>200个/μl者采用QuantiFERON ^®-TB Gold (QFT)检测结核感染情况;分析研究对象结核感染情况,并采用多因素非条件logistic回归分析结核感染的影响因素。结果研究对象中CD4 ⁺T细胞计数>200个/μl者有429例,结核感染率为10.02%(43/429)。单因素分析显示,CD4 ⁺T细胞计数>200个/μl者中有结核病接触史者结核感染率(30.30%,10/33)高于无接触史者(8.33%,33/396);CD4 ⁺T细胞计数>500个/μl者结核感染率(13.15%,33/251)高于CD4 ⁺T细胞计数为200~500个/μl者(5.62%,10/178),差异均有统计学意义(χ ²分别为16.30、6.55,P值均<0.05)。进一步的非条件logistic回归分析显示,CD4 ⁺T细胞计数>200个/μl的HIV感染/AIDS者中,有结核病患者接触史者结核感染风险是无接触史者的4.61倍[调整OR值(95%CI值)为4.61(2.00~10.63)];CD4 ⁺T细胞计数>500个/μl的HIV感染/AIDS者结核感染风险是CD4 ⁺T细胞计数200~500个/μl者的2.47倍[调整OR值(95%CI值)为2.47(1.17~5.21)]。结论免疫水平低下的HIV感染/AIDS者结核感染检出率低;结核病患者接触史、免疫水平是HIV感染/AIDS者结核感染的重要影响因素。

关键词: 分枝杆菌,结核, 感染, HIV感染, 获得性免疫缺陷综合征, 共病现象, 因素分析,统计学

Abstract:

Objective To analyze the MTB infection and its influencing factors in HIV/AIDS patients. Methods From January to July 2017, 3 community hospitals were selected by a random cluster sampling method in Changzhou, in which HIV/AIDS patients by the 10-year cumulative registration were used as the research subjects. As a result, a total of 475 subjects were included, with an average age (44.44±13.85) years, including 378 males (79.58%) and 97 females (20.42%); 273 HIV-infected patients (57.47%) and 202 AIDS patients (42.53%). The sociodemographic information and clinically relevant information of the subjects were collected. Peripheral venous blood from subjects was tested for HIV viral load, then the subjects with CD4 ⁺ T cell counts>200 cells/μl were selected for MTB infection detection using QuantiFERON ^®-TB Gold (QFT). The MTB infection status of the subjects was analyzed and influencing factors of MTB infection were analyzed by multivariate non-conditional logistic regression. Results There were 429 subjects with CD4 ⁺ T cell counts>200 cells/μl, and the MTB infection rate was 10.02% (43/429). Univariate analysis showed that the MTB infection rate of subjects with CD4 ⁺ T cell counts>200 cells/μl who had a history of tuberculosis exposure was higher than that of subjects without history of tuberculosis exposure (30.30%(10/33) vs. 8.33% (33/396); χ ²=16.30, P<0.05); and the MTB infection rate of subjects with CD4 ⁺ T cell counts >500 cells/μl was higher than that of subjects with CD4 ⁺ T cell counts from 200 to 500 cells/μl (13.15% (33/251) vs. 5.62% (10/178); χ ²=6.55, P<0.05). Further unconditional logistic regression analysis showed that among HIV/AIDS patients with CD4 ⁺ T cell counts>200 cells/μl, the risk of MTB infection in the subjects with history of tuberculosis exposure was 4.61 times of subjects without history of tuberculosis exposure (adjusted OR=4.61, 95%CI=2.00-10.63); and the MTB infection risk of HIV/AIDS patients with CD4 ⁺ T cell counts>500 cells/μl was 2.47 times of the HIV/AIDS patients with CD4 ⁺ T cell counts from 200 to 500 cells/μl (adjusted OR=2.47, 95%CI=1.17-5.21). Conclusion The detection rate of MTB infection is low in HIV/AIDS patients with low immune level. The history of tuberculosis exposure and immune level are important influencing factors of MTB infection in HIV/AIDS patients.

Key words: Mycobacterium tuberculosis, Infection, HIV infections, Acquired immunodeficiency syndrome, Comorbidity, Factor analysis,statistical

张兴,王凤鸣,吕旭峰,华天齐,张学军,蒋靖怡,丁陈丽,朱伟,夏国栋,吉俊敏,赵飞. HIV感染/AIDS者结核感染的影响因素分析[J]. 中国防痨杂志, 2020, 42(4): 360-365. doi: 10.3969/j.issn.1000-6621.2020.04.011

ZHANG Xing,WANG Feng-ming,LYU Xu-feng,HUA Tian-qi,ZHANG Xue-jun,JIANG Jing-yi,DING Chen-li,ZHU Wei,XIA Guo-dong,JI Jun-min,ZHAO Fei. Analysis of influencing factors of Mycobacterium tuberculosis infection in HIV/AIDS patients[J]. Chinese Journal of Antituberculosis, 2020, 42(4): 360-365. doi: 10.3969/j.issn.1000-6621.2020.04.011

图/表 4

图1

表1

CD4+T细胞计数>200个/μl的HIV感染/AIDS者结核感染情况单因素分析

影响因素	受检者 (例)		结核感染检测		χ²值	P值
影响因素	受检者 (例)		阳性[例 (构成比,%)]	阴性[例 (构成比,%)]	χ²值	P值
年龄组(岁)					3.59^a	0.166
<40	188		13(6.91)	175(93.09)
40~	161		20(12.42)	141(87.58)
≥60	80		10(12.50)	70(87.50)
性别					3.68	0.055
男	338		29(8.58)	309(91.42)
女	91		14(15.38)	77(84.62)
BMI					3.59	0.166
<18.5	39		7(17.95)	32(82.05)
18.5~	272		23(8.46)	249(91.54)
≥24	118		13(11.02)	105(88.98)
地区					0.09	0.958
武进	252		25(9.92)	227(90.08)
金坛	83		9(10.84)	74(89.16)
溧阳	94		9(9.57)	85(90.43)
婚姻状况					1.44	0.488
未婚	302		27(8.94)	275(91.06)
已婚及同居	52		6(11.54)	46(88.46)
离婚及分居	75		10(13.33)	65(86.67)
文化程度					1.52	0.469
初中及以下	221		21(9.50)	200(90.50)
高中、中专、中技	118		15(12.71)	103(87.29)
大专、大学及以上	90		7(7.78)	83(92.22)
家庭人均年收入(万元)					3.86^a	0.049
<1.67	119		17(14.29)	102(85.71)
1.67~	202		19(9.41)	183(90.59)
≥5.00	108		7(6.48)	101(93.52)
吸烟					0.05	0.830
否	283		29(10.25)	254(89.75)
是	146		14(9.59)	132(90.41)
影响因素		受检者 (例)	结核感染检测		χ²值	P值
影响因素		受检者 (例)	阳性[例 (构成比,%)]	阴性[例 (构成比,%)]	χ²值	P值
饮酒					0.04	0.834
否		344	35(10.17)	309(89.83)
是		85	8(9.41)	77(90.59)
身体锻炼					0.25	0.616
否		244	26(10.66)	218(89.34)
是		185	17(9.19)	168(90.81)
糖尿病					0.11	0.737
无		413	41(9.93)	372(90.07)
有		16	2(12.50)	14(87.50)
其他免疫疾病					1.09	0.296
无		411	43(10.46)	368(89.54)
有		18	0(0.00)	18(100.00)
结核病患者接触史					16.30	<0.01
无		396	33(8.33)	363(91.67)
有		33	10(30.30)	23(69.70)
患者类型					0.01	0.905
HIV感染者		263	26(9.89)	237(90.11)
AIDS患者		166	17(10.24)	149(89.76)
病毒载量(拷贝/ml)					3.28^a	0.070
<20		132	18(13.64)	114(86.36)
20~500		230	21(9.13)	209(90.87)
>500		67	4(5.97)	63(94.03)
CD4⁺T细胞计数(个/μl)					6.55^a	0.011
200~500		178	10(5.62)	168(94.38)
>500		251	33(13.15)	218(86.85)
CD8⁺T细胞计数(个/μl)					1.29	0.256
≤500		34	1(2.94)	33(97.06)
>500		395	42(10.63)	353(89.37)

表1

表2

表3

CD4+T细胞计数>200个/μl的HIV感染/AIDS者结核感染的多因素logistic回归分析

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	调整OR值(95%CI值)
结核病患者接触史	1.53	0.34	78.98	<0.01	4.61(2.00~10.63)
CD4⁺T细胞计数>500 个/μl	0.91	0.38	5.66	0.017	2.47(1.17~5.21)

表3

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变量名称	变量赋值
年龄	<40岁^a=0;40~岁=1;≥60岁=2
性别	女=0;男=1
家庭人均年收入	<1.67元^a=0;1.67~元=1;≥5.00元=2
结核病接触史	无=0;有=1
CD4⁺T细胞计数	200~个/μl=0;>500个/μl=1