摘要
目的了解接受依非韦伦进行初始抗病毒治疗的人类免疫缺陷病毒(HIV)感染者或艾滋病(AIDS)患者睡眠障碍(sleep disorder)、焦虑(anxiety)和抑郁(depression)(简称SAD症状)的发生情况,并探讨其影响因素。方法符合入组条件的HIV感染/AIDS患者543例,随访观察1年。收集患者的一般资料及临床信息,并在治疗基线和治疗12个月分别通过医院焦虑抑郁情绪测量表(HADS)、匹兹堡睡眠质量指数量表(PSQI)进行SAD症状评估,比较患者治疗前后SAD症状的变化情况,分析患者在治疗后发生重度SAD症状的影响因素。结果完成12个月治疗随访的患者444例。基线PSQI、医院焦虑抑郁情绪测量表抑郁评分(HAD-D)和医院焦虑抑郁情绪测量表焦虑评分(HAD-A)异常的患者比例分别为68.9%、22.1%和29.3%,治疗12个月后PSQI评分从8.43±2.45降至5.74±2.67,HAD-D评分从10.73±2.84降至4.93±3.44,HAD-A评分从10.98±3.01降至4.69±3.24,差异均有显著统计学意义(P<0.001)。重度睡眠障碍、抑郁、焦虑情况的患者百分比分别从11.9%降至3.8%、3.8%降至0、2.5%降至0,差异均有显著统计学意义(P<0.001)。多因素logistic回归分析结果显示,职业是学生或无业、WHO分期Ⅲ/Ⅳ、基线HAD-A评分>7、基线HAD-D评分>7是重度焦虑的预测因子(P<0.05);无业、离异或分居、基线HAD-A评分>7、基线HAD-D评分>7是治疗12个月后发生重度抑郁的预测因子(P<0.05);基线HAD-D评分>7、基线PSQI>5是治疗12个月后发生重度睡眠障碍的预测因子(P<0.05)。结论HIV感染/AIDS患者在接受依非韦伦抗病毒治疗过程中发生的SAD症状与多种因素相关。严重神经系统不良反应主要发生在缺乏经济来源、缺少家庭关怀以及在药物治疗之前就存在着SAD症状等情况的患者,这部分患者应尽量避免应用依非韦伦或在治疗过程中加强神经精神状况的监测。
Objective To investigate the incidence and risk factors of anxiety,depression,and sleep disorders in the HIV/AIDS patients receiving efavirenz(EFV)antiretroviral therapy.Methods A total of 543 patients were enrolled,and assessed for sleep disorder,anxiety and depression(SAD)symptoms at baseline and after 12-month treatment by using hospital anxiety and depression assessment scale(HAD)and Pittsburgh sleep quality index(PSQI),respectively.Results A total of 444 patients were followed for 12 months.Overall,the baseline PSQI score,HAD-D,and HAD-A scores were abnormal in 68.9%,22.1%,and 29.3%of the patients,respectively.After treatment for 12 months,the PSQI score decreased from 8.43±2.45 to 5.74±2.67,HAD-D score decreased from 10.73±2.84 to 4.93±3.44,and HAD-A score decreased from 10.98±3.01 to 4.69±3.24(all P<0.001).The patients with severe sleep disorder,anxiety,or depression decreased from 11.9%to 3.8%,3.8%to 0,and 2.5%to 0,respectively(all P<0.001).Multivariate logistic analysis showed that students or unemployed,WHO stageⅢ/Ⅳ,baseline HAD-A>7,and baseline HAD-D>7 were predictors of severe anxiety after 12-month treatment(P<0.05).Unemployed,divorced/separated,baseline HAD-A>7,and baseline HAD-D>7 were predictors of severe depression after 12-month treatment(P<0.05).Baseline HAD-D>7 and baseline PSQI>5 were predictors of severe sleep disorders after 12-month treatment(P<0.05).Conclusions SAD symptoms in HIV/AIDS patients receiving EFV antiretroviral therapy may be associated with a variety of factors.The patients who lack economic sources or family care,especially those with SAD symptoms before drug therapy,may have a higher possibility of serious nervous system side effects than others during EFV treatment.Therefore,the nervous disorders should be monitored closely or EFV avoided.
作者
白少丽
白若靖
周莹荃
孟庆鑫
王建云
代丽丽
画伟
BAI Shaoli;BAI Ruojing;ZHOU Yingquan;MENG Qingxin;WANG Jianyun;DAI Lili;HUA wei(Department of Infectious Diseases,Lanzhou Pulmonary Hospital,Lanzhou 730046,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2021年第4期399-405,共7页
Chinese Journal of Infection and Chemotherapy
基金
“十三五”国家科技重大专项课题(2018ZX10721102-003-003,2018ZX10302-102)。
