中国血吸虫病防治杂志 ›› 2024, Vol. 36 ›› Issue (6): 598-605.

• 论著 • 上一篇    下一篇

2021年江苏省新报告HIV/AIDS患者贫血发生率及其危险因素分析

张之1, 2，孙琦2，邱涛2，丁萍2，王博深2，朱宝立1, 2*   

  1. 1 南京医科大学公共卫生学院（江苏 南京 210000）； 2 江苏省疾病预防控制中心（江苏 南京210009）
  • 出版日期:2024-12-25 发布日期:2024-12-31
  • 通讯作者: 朱宝立zhubl@jscdc.cn
  • 作者简介:张之，女，本科，副主任技师。研究方向：艾滋病防治
  • 基金资助:
    江苏省医学重点学科（ZDXK202249）；“十四五”流行病学重点学科（ZDXK202250）；江苏省自然科学基金面上项目（BK20221413）

Incidence and risk factors of anemia among newly reported HIV/AIDS patients in Jiangsu Province in 2021

ZHANG Zhi1, 2, SUN Qi2, QIU Tao2, DING Ping2, WANG Boshen2, ZHU Baoli1, 2*   

  1. 1 School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210000, China; 2 Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu 210009, China
  • Online:2024-12-25 Published:2024-12-31

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摘要： 目的　了解2021年江苏省新报告HIV/AIDS患者贫血发生率并评估其免疫状态，探索HIV感染者发生贫血的危险因素。方法　在全国艾滋病综合防治信息系统中，选择2021年1月1日至12月31日江苏省新报告的HIV/AIDS患者作为研究对象。采集研究对象新鲜全血，检测血红蛋白值、CD4和CD8细胞计数、HIV病毒载量等指标。根据血红蛋白水平判断是否贫血，比较贫血者及非贫血者各项免疫指标及病毒载量水平，并对HIV感染者发生贫血的危险因素进行单因素分析和多因素logistic回归分析。此外，在全国艾滋病综合防治信息系统中获取研究对象采用抗逆转录病毒治疗（antiretroviral therapy，ART）1年后的CD4细胞检测数据，对贫血及非贫血者检测数据进行比较。结果　2021年江苏省新报告HIV/AIDS患者635例，其中男性544例（85.67%）、女性91例（14.33%），年龄15 ~ 83岁；新报告HIV/AIDS患者贫血发生率为5.51%（35/635）。不同特征HIV感染人群中，男性、45岁及以下者、工人血红蛋白水平相对较高，中位数（四分位数间距）［M（QR）］分别为156（22）、154（23）、162（19） g/L。HIV感染合并贫血者及非贫血者基线病毒载量M（QR）分别为40 500.00（119 735.00）拷贝/mL和29 754.00（69 183.00）拷贝/mL，差异无统计学意义（Z = -0.91，P = 0.31）；但合并贫血者基线CD4［166（143）个/μL］、CD8细胞计数［755（653）个/μL］均低于非贫血者［308（253）、892（638）个/μL］（Z = -4.36、-2.37，P均< 0.05）。经ART治疗1年后，HIV感染合并贫血者CD4细胞计数［296（229）个/μL］仍低于非贫血者［457（313）个/μL］（Z = -3.71，P < 0.05），且合并贫血者中伴随中（40.00%）、重度（17.14%）免疫抑制状态者占比较非贫血者（21.00%、9.33%）高（[χ2]  = 10.37、8.79，P 均< 0.01）。单因素分析显示，女性HIV感染者贫血检出率高于男性［比值比（odds ratio，OR）= 4.528，95% 可信区间（confidence interval，CI）：（3.811，5.245），P < 0.001］，45 ~ < 60岁［OR = 3.415，95% CI：（1.191，9.788），P = 0.022］和60 ~ 岁感染者［OR = 5.820，95% CI：（2.013，16.826），P < 0.001］贫血检出率高于15 ~ 岁感染者，异性传播途径感染者检出率高于同性传播途径者［OR = 3.015，95% CI：（1.423，6.387），P = 0.004］，大专及以上文化程度者贫血检出率低于小学文化程度者［OR = 0.103，95% CI：（0.028，0.386），P < 0.001］，基线CD4细胞计数< 200个/μL者贫血检出率高于≥ 200 个/μL者［OR = 4.340，95% CI：（2.165，8.702），P < 0.001］，CD4/CD8细胞比值为0.208 ~ < 0.326 ［OR = 0.232，95% CI：（0.076，0.711），P = 0.011］和0.516 ~ 者［OR = 0.292，95% CI：（0.104，0.818），P = 0.019］低于比值< 0.208者。多因素logistic回归分析显示，女性［OR = 4.945，95% CI：（3.944，5.946），P = 0.002］、CD4细胞计数< 200个/μL［OR = 3.597，95% CI：（1.448，8.937），P = 0.006］是新报告HIV/AIDS患者发生贫血的危险因素。 结论　2021年江苏省新报告HIV/AIDS患者贫血发生率较低；与非贫血者相比，HIV感染合并贫血者基线及治疗后免疫状态均较差。女性及CD4细胞计数< 200个/μL的HIV感染者为贫血发生的高危人群，应加强对该人群的监测、随访以及精准干预。

关键词: HIV, 贫血, 免疫状态, 血红蛋白, CD4细胞, 危险因素, 江苏省

Abstract: Objective　To investigate the incidence of anemia and evaluate the immune status among newly reported HIV/AIDS patients in Jiangsu Province in 2021, and to identify the risk factors of anemia among patients living with HIV infections. Methods　Newly reported HIV/AIDS patients in Jiangsu Province from January 1 to December 31, 2021 that were registered in China's National AIDS Comprehensive Control Information Management System were enrolled. Subjects' fresh whole blood samples were collected, and hemoglobin levels, CD4 and CD8 cell counts and HIV viral loads were measured. Anemia was defined according to hemoglobin levels, and the immunological parameters and HIV viral loads were compared between HIV⁃infected patients with and without anemia. The risk factors of anemia were identified among individuals living with HIV infections using univariate analysis and multivariate logistic regression analysis. In addition, subjects' CD4 cell counts one year following antiretroviral therapy (ART) were retrieved from China's National AIDS Comprehensive Control Information Management System, and compared between subjects with and without anemia.  Results　A total of 635 newly diagnosed HIV/AIDS patients were reported in Jiangsu Province in 2021, including 544 males (85.67%) and 91 females (14.33%), and with ages of 15 to 83 years, and the overall incidence of anemia was 5.51% (35/635) among the study subjects. Men, individuals at ages of 45 years and lower and workers had relatively higher hemoglobin levels, with median hemoglobin levels of 156 (interquartile range, 22), 154 (interquartile range, 23) g/L and 162 (interquartile range, 19) g/L, respectively. The median baseline HIV viral load was 40 500.00 (interquartile range, 119 735.00) copies/mL among HIV⁃infected individuals with anemia and 29 754.00 (69 183.00) copies/mL among those without anemia (Z = -0.91, P = 0.31), and the median baseline CD4 and CD8 cell counts were significantly lower among HIV⁃infected individuals with anemia [166 (interquartile range, 143) cells/μL and 755 (653) cells/μL] than those without anemia [308 (253) cells/μL and 892 (638) cells/μL] (Z = -4.36 and -2.37, both P values < 0.05). The median CD4 cell counts remained lower among HIV⁃infected individuals with anemia than those without anemia [296 (interquartile range, 229) cells/μL vs. 457 (interquartile range, 313) cells/μL; Z = -3.71, P < 0.05] one year following ART, and the proportions of moderate and severe immunosuppression were significantly higher among HIV⁃infected individuals with anemia (40.00% and 17.14%) than those without anemia (21.00% and 9.33%) ([χ2]  = 10.37 and 8.79, both P values < 0.01). Univariate analysis showed a higher detection rate of anemia among female HIV⁃infected individuals than among males [odds ratio (OR) = 4.528, 95% confidence interval (CI): (3.811, 5.245), P < 0.001], a higher rate among HIV⁃infected individuals at ages of 45 to < 60 years [OR = 3.415, 95% CI: (1.191, 9.788), P = 0.022] and 60 years and older [OR = 5.820, 95% CI: (2.013, 16.826), P < 0.001] than among those at ages of 15 to < 30 years, a higher rate among HIV⁃infected individuals through heterosexual transmission than among those through homogeneous transmission [OR = 3.015, 95% CI: (1.423, 6.387), P = 0.004], a lower rate among HIV⁃infected individuals with an educational level of college and above than among those with an educational level of primary school [OR = 0.103, 95% CI: (0.028, 0.386), P < 0.001], a higher rate among HIV⁃infected individuals with baseline CD4 cell counts of < 200 cells/μL than among those with baseline CD4 cell counts of 200 cells/μL and higher [OR = 4.340, 95% CI: (2.165, 8.702), P < 0.001], and lower detection rates among HIV⁃infected individuals with CD4/CD8 cell ratios of 0.208 to < 0.326 [OR = 0.232, 95% CI: (0.076, 0.711), P = 0.011] and 0.516 and higher [OR = 0.292, 95% CI: (0.104, 0.818), P = 0.019] than among those with CD4/CD8 cell ratios of < 0.208. Multivariate logistic regression analysis identified woman [OR = 4.945, 95% CI: (3.944, 5.946), P = 0.002], and CD4 cell counts of < 200 cells/μL [OR = 3.597, 95% CI: (1.448, 8.937), P = 0.006] as risk factors of anemia among newly reported HIV/AIDS patients.  Conclusions　The incidence of anemia was low among newly reported HIV/AIDS patients in Jiangsu Province in 2021, and the immune status was poorer among HIV⁃infected individuals with anemia than those without anemia at baseline and one year following ART. Female and CD4 cell counts of < 200 cells/μL are risk factors of anemia among individuals living with HIV infections, and intensified surveillance, follow⁃up and precision interventions are recommended targeting female HIV⁃infected individuals and HIV⁃infected individuals with low CD4 cell counts.

Key words: HIV, Anemia, Immune status, Hemoglobin, CD4 cell, Risk factor, Jiangsu Province

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