目的：了解符合治疗标准而未抗病毒治疗艾滋病患者的生存时间及其影响因素。方法采取回顾性队列研究，选择2005—2013年百色市符合抗病毒治疗标准而未治疗的393例艾滋病患者为研究对象，采用SPSS 21.0统计软件分析，以寿命表法估计生存率， Kaplan-Meier绘制生存曲线， Cox比例风险回归进行生存影响因素分析。结果符合治疗标准而未抗病毒治疗艾滋病患者男女比例为2.60∶1，平均年龄(45.8±16.6）岁，以已婚／同居、壮族、初中及以下文化程度、 WHO临床分期Ⅰ期和异性性途径感染者为主， CD4+T淋巴细胞计数平均值为(185±112）个／mm3，艾滋病相关病死率为21.04／100人年，中位生存时间为78个月〔95％CI (38.15，117.85）〕，12、24、36、48、60个月累积生存率分别为73.00％、65.04％、60.73％、55.50％、49.16％。对患者进行分层分析，结果显示年龄＜55岁和≥55岁患者艾滋病相关病死率分别为17.60／100人年和32.29／100人年，中位生存时间分别为78个月〔95％CI (33.91，122.09）〕和32个月〔95％CI (16.95，47.05）〕，两者生存率比较，差异有统计学意义(χ2＝4.830， P＝0.028）； CD4+T淋巴细胞计数≤100个／mm3( A组）、101～200个／mm3( B组）和201～350个／mm3( C组）患者艾滋病相关病死率分别为92.62／100人年、30.64／100人年和5.98／100人年，中位生存时间分别为4个月〔95％CI (1.31，6.69）〕、24个月〔95％CI (4.53，43.49）〕和83个月，3组生存率比较，差异有统计学意义(χ2＝141.903， P＜0.001）。多因素Cox比例风险回归分析结果显示，患者年龄、 CD4+T淋巴细胞计数水平和WHO临床分期与生存时间存在统计学关联( P＜0.05）。结论符合治疗标准而未抗病毒治疗的艾滋病患者预后较差，发病率和病死率高，特别是年龄越高、 CD4+T淋巴细胞计数水平越低或患越严重机会性感染性疾病和肿瘤患者，其生存时间越短。因此，及早发现艾滋病患者，加强随访监测，及时处置机会性感染性疾病，尽早开始抗病毒治疗对延长艾滋病患者的生存时间有重要意义。%Objective To investigate the survival time of HIV/AIDS patients according with treatment standard but not receiving antiretroviral treatment and influencing factors.Methods In this retrospective cohort study, we enrolled 393 HIV/AIDS patients according with treatment standard but not receiving antiretroviral treatment in Baise City from 2005 to 2013.SPSS 21.0 statistical software was used; survival rate was estimated by life table; survival curve was made using Kaplan -Meier method; analysis of influencing factors for survival was conducted using Cox proportional hazard regression.Results The male-female ratio was 2.60∶1, and the average age was (45.8 ±16.6).Patients were mainly married or cohabited with others;they were mainly of Zhuang ethnic minority group; patients with educational level of junior high school took up the highest proportion; most patients were at WHO clinical stageⅠ; and they were mainly infected by sexual activity with opposite sex.The average of CD4+T lymphocyte count was (185 ±112) /mm3; the case fatality rate due to AIDS was 21.04/100 people-years;the median survival time was 78 months 〔95%CI (38.15, 117.85)〕, and the accumulate survival rates of 12, 24, 36, 48 and 60 month were 73.00%, 65.04%, 60.73%, 55.50% and 49.16%. The stratification analysis showed the following results: the fatality rates of patients <55 years old and patients ≥55 years old were 17.60/100 people-years and 32.29/100 people-years; median survival time was 78 months 〔95%CI (33.91, 122.09)〕 and 32 months 〔95%CI (16.95, 47.05)〕respectively, with significant difference (χ2 =4.830, P=0.028); the fatality rates of patients with CD4+T lymphocyte count≤100/mm3 ( group A) , 101-200/mm3 ( group B) and 201-350/mm3 ( group C) were 92.62/100 people-years, 30.64/100 people-years and 5.98/100 people-years, and the median survival time was 4 months 〔95%CI (1.31, 6.69)〕, 24 months 〔95%CI (4.53, 43.49 )〕 and 83 months respectively, with significant differences in survival rate among the three groups (χ2 =141.903, P <0.001 ) . Multivariate Cox proportional hazard regression analysis showed that age, CD4+T lymphocyte count and WHO clinical stages had statistically significant correlation with survival time (P<0.05).Conclusion HIV/AIDS patients according with treatment standard but not receiving antiretroviral treatment have poor prognosis and have high case fatality rate and mortality rate, and patients with higher age and lower CD4+T lymphocyte count and patients with severer opportunistic infectious diseases and tumors have shorter survival time.Therefore, the early detection of AIDS patients, the improvement of follow -up monitoring, timely treatment of opportunistic infectious diseases and early start of antiretroviral treatment are of significant significance in prolonging the survival time of HIV/AIDS patients.
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