2001～2017年某大型综合医院新发HIV/AIDS患者的临床流行病学分析
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摘要
目的分析2001～2017年新发现人类免疫缺陷病毒(HIV)/获得性免疫缺陷综合征(AIDS)患者在某大型综合医院的临床流行病学特征和趋势,为综合医院的HIV/AIDS防治工作提供科学依据。方法回顾性纳入四川大学华西医院2001～2017年新发HIV/AIDS病例的临床流行病学资料,分析确证阳性率及新发HIV/AIDS患者的分层分布,并分析及其传播途径的分布特征。结果 2001～2017年于四川大学华西医院接受HIV筛查的患者共1 520 228例,其中门急诊患者285 983例,住院患者1 234 245例。共确证新发HIV/AIDS患者4 037例,总确证阳性率为0.27%,门急诊患者和住院患者2001～2013年确证阳性率增加,2014～2017年略有下降。男性、女性新发HIV/AIDS患者分布整体比例为3.49∶1,历年比例在1.65∶1和5.08∶1之间波动;以汉族(88.23%)、低学历(58.66%)、已婚者(54.75%)、农民/牧民(26.33%)为主要人群;青少年(15～29岁)、中老年群体(≥50岁),高学历群体(高中以上),未婚群体分布均呈增长趋势。传播途径分析显示,17年间,异性传播比例稳定在60%左右,同性传播途径增长明显(χ~2_(趋势)=14.436,P<0.005),从2008年开始增长后稳定在15%左右。注射毒品(χ~2_(趋势)=71.633,P<0.005)和血液传播(χ~2_(趋势)=16.672,P<0.005)途径均明显下降。899例女性新发HIV/AIDS患者中77.20%为异性传播,无同性传播;3138例男性中61.41%为异性传播,18.10%为同性传播。同性传播随年龄的增大而下降,异性传播随着年龄的增大而上升。母婴传播则集中在0～15岁(100%)。结论 17年来,四川大学华西医院新发HIV/AIDS经历长期增长后渐入平缓期,青少年、中老年,高中以上学历,未婚群体增长明显。注射毒品和血液传播HIV/AIDS的途径得到控制,异性传播仍为主要传播途径。
Objective To determine the clinical epidemiological characteristics of newly reported human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS) in a certain general hospital from 2001 to 2017. Methods Clinical data of newly diagnosed HIV/AIDS from 2001 to 2017 in the West China Hospital of Sichuan University were reviewed and analyzed. Results A total of 1 520 228 patients were screened for HIV, including 285 983 outpatient and emergency patients and 1 234 245 inpatients. About 4 037(0.27%) patients were confirmed with HIV/AIDS. The confirmation rate increased from 2001 to 2013, followed by a slight decline from 2014 to 2017. The male to female sex ratio of confirmed HIV/AIDS was 3.49∶1, ranging from 1.65∶1 to 5.08∶1. The majority of patients were identified as Han(88.23%), had low education(58.66%), and married(54.75%).Peasants/herdsman comprised 26.33% of the patients. The proportion of young(15-29 years old), and middle-aged(≥50 years old) patients and those who were unmarried and had high education(senior high school and above) increased over time. Heterosexual transmission remained stable at about 60% while homosexual transmission increased by about 15%(χ~2=14.436,P<0.005) since 2008. Transmissions through drug abuse(χ~2=71.633,P<0.005) and blood(χ~2=16.672,P<0.005) decreased. Of the 899 female newly reported HIV/ADIS patients, 77.20% were infected through heterosexual relationship. In comparison, of the 3 138 male patients, 61.41% were infected through heterosexual and 18.10% through homosexual relationships. Homosexual transmissions decreased with age, but heterosexual transmissions increased with age. Mother-to-child transmissions were concentrated in those between 0 and 15 years old(100%). Conclusion Newly diagnosed HIV/AIDS cases increased over the years in the West China Hospital of Sichuan University, in particular in those of young and middle-aged, highly educated and unmarried. Heterosexual transmissions remain the main route.
Objective To determine the clinical epidemiological characteristics of newly reported human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS) in a certain general hospital from 2001 to 2017. Methods Clinical data of newly diagnosed HIV/AIDS from 2001 to 2017 in the West China Hospital of Sichuan University were reviewed and analyzed. Results A total of 1 520 228 patients were screened for HIV, including 285 983 outpatient and emergency patients and 1 234 245 inpatients. About 4 037(0.27%) patients were confirmed with HIV/AIDS. The confirmation rate increased from 2001 to 2013, followed by a slight decline from 2014 to 2017. The male to female sex ratio of confirmed HIV/AIDS was 3.49∶1, ranging from 1.65∶1 to 5.08∶1. The majority of patients were identified as Han(88.23%), had low education(58.66%), and married(54.75%).Peasants/herdsman comprised 26.33% of the patients. The proportion of young(15-29 years old), and middle-aged(≥50 years old) patients and those who were unmarried and had high education(senior high school and above) increased over time. Heterosexual transmission remained stable at about 60% while homosexual transmission increased by about 15%(χ~2=14.436,P<0.005) since 2008. Transmissions through drug abuse(χ~2=71.633,P<0.005) and blood(χ~2=16.672,P<0.005) decreased. Of the 899 female newly reported HIV/ADIS patients, 77.20% were infected through heterosexual relationship. In comparison, of the 3 138 male patients, 61.41% were infected through heterosexual and 18.10% through homosexual relationships. Homosexual transmissions decreased with age, but heterosexual transmissions increased with age. Mother-to-child transmissions were concentrated in those between 0 and 15 years old(100%). Conclusion Newly diagnosed HIV/AIDS cases increased over the years in the West China Hospital of Sichuan University, in particular in those of young and middle-aged, highly educated and unmarried. Heterosexual transmissions remain the main route.
引文
[1] 中国疾病预防控制中心.2017年12月全国艾滋病性病疫情.中国艾滋病性病,2018,24(2):111.
[2] 汪宁.中国艾滋病流行的一些新动向.中华流行病学杂志,2010,31(11):1205-1209.
[3] 金霞,熊燃,毛宇嵘.2008～2013年我国医疗机构检测发现艾滋病病例情况分析.中华流行病学杂志,2015,36(4):323-326.
[4] 中国疾病预防控制中心.全国艾滋病检测技术规范(2015年修订版).中国病毒病杂志,2016,6(6):401-427.
[5] SHANG H,XU J,HAN X,et al.HIV prevention:bring safe sex to China.Nature,2012,485(7400):576-577.
[6] 郁红月,张维,卢戎戎,等.重庆市1995～2015年HIV感染和艾滋病的流行特点和长期趋势分析.第三军医大学学报,2017,39(20):2051-2058.
[7] 朱思远,李冬冬,王婷婷,等.中国西南地区2008～2013年HIV抗体检测结果与分析.中华实验和临床病毒学杂志,2015,29(4):335-337.
[8] 魏彬,苟瑜,杨婷婷,等.四川某三甲医院15～29岁青年HIV感染者的流行病学特征分析.现代预防医学,2017,44(2):209-212.
[9] 朱义芳,王婷婷,李冬冬,等.综合医院老年人类免疫缺陷病毒感染者的流行病学特征分析.实用医院临床杂志,2016,13(1):32-34.
[10] NANSI M,PINTI M,DE-BIASI S,et al.Aging with HIV infection:a journey to the center of inflammAIDS,immunosenescence and neuroHIV.Immunol Lett,2014,162(1):329-333.
[11] 吴延杰,申红卫,张海龙,等.2010～2014年北京大学深圳医院筛查的HIV感染者的流行病学特征分析.国际病毒学杂志,2016,23(2):95-98.
[12] 刘伦皓,刘莉,余刚,等.凉山州2005～2016年新发现HIV感染者的流行特征及趋势分析.中国艾滋病性病,2018,24(4):345-347.
[13] 黄惋莉,赖文红,曾亚莉,等.四川省美沙酮维持治疗门诊首次入组患者HIV感染状况分析.预防医学情报杂志,2017,33(12):1287-1291.
[14] 胡莹,刘莉,罗映娟,等.2011～2015年四川省男男性行为者艾滋病疫情分析.预防医学情报杂志,2017,33(7):642-647.
[15] 陈其霞,王婷婷,安静娜,等.2012年综合性医院HIV感染患者人群的特征分析.现代预防医学,2014,41(23):4240-4242.
[2] 汪宁.中国艾滋病流行的一些新动向.中华流行病学杂志,2010,31(11):1205-1209.
[3] 金霞,熊燃,毛宇嵘.2008～2013年我国医疗机构检测发现艾滋病病例情况分析.中华流行病学杂志,2015,36(4):323-326.
[4] 中国疾病预防控制中心.全国艾滋病检测技术规范(2015年修订版).中国病毒病杂志,2016,6(6):401-427.
[5] SHANG H,XU J,HAN X,et al.HIV prevention:bring safe sex to China.Nature,2012,485(7400):576-577.
[6] 郁红月,张维,卢戎戎,等.重庆市1995～2015年HIV感染和艾滋病的流行特点和长期趋势分析.第三军医大学学报,2017,39(20):2051-2058.
[7] 朱思远,李冬冬,王婷婷,等.中国西南地区2008～2013年HIV抗体检测结果与分析.中华实验和临床病毒学杂志,2015,29(4):335-337.
[8] 魏彬,苟瑜,杨婷婷,等.四川某三甲医院15～29岁青年HIV感染者的流行病学特征分析.现代预防医学,2017,44(2):209-212.
[9] 朱义芳,王婷婷,李冬冬,等.综合医院老年人类免疫缺陷病毒感染者的流行病学特征分析.实用医院临床杂志,2016,13(1):32-34.
[10] NANSI M,PINTI M,DE-BIASI S,et al.Aging with HIV infection:a journey to the center of inflammAIDS,immunosenescence and neuroHIV.Immunol Lett,2014,162(1):329-333.
[11] 吴延杰,申红卫,张海龙,等.2010～2014年北京大学深圳医院筛查的HIV感染者的流行病学特征分析.国际病毒学杂志,2016,23(2):95-98.
[12] 刘伦皓,刘莉,余刚,等.凉山州2005～2016年新发现HIV感染者的流行特征及趋势分析.中国艾滋病性病,2018,24(4):345-347.
[13] 黄惋莉,赖文红,曾亚莉,等.四川省美沙酮维持治疗门诊首次入组患者HIV感染状况分析.预防医学情报杂志,2017,33(12):1287-1291.
[14] 胡莹,刘莉,罗映娟,等.2011～2015年四川省男男性行为者艾滋病疫情分析.预防医学情报杂志,2017,33(7):642-647.
[15] 陈其霞,王婷婷,安静娜,等.2012年综合性医院HIV感染患者人群的特征分析.现代预防医学,2014,41(23):4240-4242.