【摘要】 目的 了解兰州市HIV感染者/艾滋病患者在启动抗病毒治疗（antiretroviral therapy, ART）后免疫学指标CD4~+T淋巴细胞计数水平变化，并分析影响CD4~+T淋巴细胞计数的因素。方法 选取兰州市肺科医院（甘肃省传染病医院、甘肃省公共卫生救治中心） 2017年7月1日—2023年12月31日新启动ART的HIV感染者/艾滋病患者，采用Wilcoxon符号秩检验对患者治疗前后CD4~+T淋巴细胞计数进行差异性分析，采用logistic回归分析影响CD4~+T淋巴细胞计数水平变化的影响因素。结果 共纳入1 558例HIV感染者/艾滋病患者，基线CD4~+T淋巴细胞计数与最近1次CD4~+T淋巴细胞计数差异有统计学意义（Z=-26.905,P<0.05）；启动治疗时年龄>45～60岁（OR=0.48,95%CI:0.32～0.73）、>60岁（OR=0.44,95%CI:0.20～0.98），确诊到治疗的时间>30 d(OR=0.52,95%CI:0.34～0.80)，患者来源为外地转入（OR=0.53, 95%CI:0.31～0.91），基线CD4~+T淋巴细胞计数为>200～350个/μl(OR=0.43,95%CI:0.23～0.82)和>350个/μl(OR=0.08,95%CI:0.05～0.15)与CD4~+T淋巴细胞计数提升呈负相关；初始治疗方案为一线治疗方案（OR=1.55,95%CI:1.08～2.24）与CD4~+T淋巴细胞计数提升呈正相关。结论 开始治疗时年龄、确诊到开始治疗时间、初始治疗方案及基线CD4~+T淋巴细胞计数均能影响HIV感染者/艾滋病患者CD4~+T淋巴细胞水平变化，兰州市应对HIV检测引起重视，提高其抗病毒治疗依从性，以进一步提升患者治疗效果。更多还原

【Abstract】 Objective To investigate the changes in CD4~+T lymphocyte count levels in HIV-infected individuals/AIDS patients following the initiation of antiretroviral therapy(ART) in Lanzhou City and analyze the factors influencing these changes. Methods New patients treated at Lanzhou Pulmonary Hospital(Gansu Provincial Infectious Disease Hospital, Gansu Provincial Public Health Treatment Center) from July 1, 2017, to December 31, 2023, were selected. The Wilcoxon signed-rank test was used to analyze the differences in CD4~+T lymphocyte counts before and after treatment, while logistic regression was used to analyze the influencing factors of CD4~+T lymphocyte count changes. Results A total of 1 558 cases were investigated. The difference between baseline CD4~+T lymphocyte counts and the most recent CD4~+T lymphocyte counts was statistically significant(Z=-26. 905, P<0. 05). Specifically, age >45-60 years(OR=0. 48, 95%CI: 0. 32-0. 73), and >60 years(OR=0. 44, 95%CI: 0. 20-0. 98), a time from diagnosis to treatment >30 days(OR=0. 52, 95%CI: 0. 34-0. 80), transfer from outside sources(OR=0. 53, 95%CI: 0. 31-0. 91), and baseline CD4~+T lymphocyte counts >200-350 cells/μl(OR=0. 43, 95%CI: 0. 23-0. 82), and >350 cells/μl(OR=0. 08, 95%CI: 0. 05-0. 15) were negatively correlated with CD4~+T lymphocyte count increases. Conversely, an initial treatment regimen classified as first-line therapy(OR=1. 55, 95%CI: 1. 08-2. 24) was positively correlated with CD4~+T lymphocyte count increases. Conclusions Age at treatment initiation, time from diagnosis to treatment, initial treatment regimen, and baseline CD4~+T lymphocyte counts significantly affect the changes in CD4~+ T lymphocyte levels in HIV-infected individuals/AIDS patients. Lanzhou City should pay attention to HIV testing and enhance adherence to antiretroviral therapy to improve treatment outcomes.更多还原