中国全科医学 ›› 2024, Vol. 27 ›› Issue (32): 4009-4014.DOI: 10.12114/j.issn.1007-9572.2023.0795

• 论著 • 上一篇    下一篇

新发HIV/AIDS患者抑郁心理干预效果及其与CD4+ T细胞计数的关系研究

刘云1,*(), 卢和丽2, 邹卿3, 袁也丰3   

  1. 1.510430 广东省广州市民政局精神病院精神心理科
    2.330006 江西省南昌市,南昌大学第二附属医院心身医学科
    3.330006 江西省南昌市,南昌大学第一附属医院心身医学科
  • 收稿日期:2024-01-10 修回日期:2024-04-29 出版日期:2024-11-15 发布日期:2024-08-08
  • 通讯作者: 刘云

  • 作者贡献:

    刘云负责研究设计,论文撰写,对文章整体负责,监督管理;卢和丽、邹卿负责研究实施、数据收集及整理;袁也丰负责研究执行的管理和协调。

  • 基金资助:
    江西省重点研发计划项目(20212BBG73042); 社会组织参与艾滋病防治基金项目(2021-2022360100PYDPLWH025821C)

Study on Effectiveness of Psychological Intervention for Depression in Newly Diagnosed HIV/AIDS-infected Patients and the Relationship with CD4+ T Cell Counts

LIU Yun1,*(), LU Heli2, ZOU Qing3, YUAN Yefeng3   

  1. 1. Department of Psychiatry, Psychiatric Hospital of Guangzhou Civil Affairs Bureau, Guangzhou 510430, China
    2. Department of Psychosomatic Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
    3. Department of Psychosomatic Medicine, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
  • Received:2024-01-10 Revised:2024-04-29 Published:2024-11-15 Online:2024-08-08
  • Contact: LIU Yun

摘要: 背景 HIV/AIDS与抑郁症相关,抑郁症加大HIV相关认知紊乱(HAND)风险,并降低患者抗逆转录病毒治疗(ART)依从性,加剧HIV传播风险。国内研究较少报道新发HIV/AIDS患者(PLWHA)抑郁心理干预效果及与CD4+ T细胞计数相关性。 目的 探究新发PLWHA抑郁心理干预效果及与CD4+ T细胞计数相关性,为AIDS临床诊疗提供参考。 方法 2020年4月—2022年6月采用方便取样方法在江西省ART定点医院抽取新发PLWHA抑郁患者,患者确诊后立即启动ART及心理干预,干预总周期为12周。在干预前后采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)进行评估,并检测CD4+ T细胞计数进行分析。 结果 共纳入新发PLWHA抑郁患者200例,有效随访178例,有效率为89.0%。178例PLWHA抑郁患者轻中度88例(49.4%)、重度90例(50.6%),伴焦虑者173例(97.2%)。患者CD4+ T细胞计数均值在干预前为(346.39±156.87)个/μL,干预后为(421.93±149.61)个/μL。干预后,新发PLWHA抑郁患者CD4+ T细胞计数高于干预前(t配对=10.971,P<0.05),HAMD、HAMA总分及各因子评分均低于干预前(P<0.05)。干预前,HAMD总分与CD4+ T细胞计数分级(以500个/μL为分界值)呈负相关(rs=-0.157,P=0.036)、与HAMA总分呈正相关(rs=0.764,P<0.001)。干预后,HAMD总分与干预后CD4+ T细胞计数呈负相关(rs=-0.150,P=0.046)、与HAMA总分呈强正相关(rs=0.939,P<0.001)。干预前,新发PLWHA抑郁患者CD4+ T细胞计数<500个/μL者HAMD、HAMA总分高于CD4+ T细胞计数≥500个/μL者(P<0.05)。 结论 新发PLWHA抑郁严重程度与CD4+ T细胞计数相关,经专业心理干预能显著改善。

关键词: 获得性免疫缺陷综合征, HIV感染, CD4+ T细胞计数, 抑郁, 焦虑

Abstract:

Background

HIV/AIDS is associated with depression, which increases the risk of HIV-associated neurocognitive disorders (HAND) and reduces patient compliance with antiretroviral therapy (ART), exacerbating the risk of HIV transmission. Few domestic studies have reported on the effectiveness of psychological intervention for depressed patients of people living with HIV/AIDS (PLWHA) newly diagnosed and its correlation with CD4+ T cell counts.

Objective

To explore the effectiveness of psychological intervention for newly diagnosed PLWHA with depression and its correlation with CD4+ T cell counts, providing a reference for AIDS clinical diagnosis and treatment.

Methods

From April 2020 to June 2022, a convenient sampling method was used to select newly diagnosed PLWHA with depression from some ART-designated hospitals in Jiangxi Province. While they were diagnosed, ART and psychological intervention were immediately initiated, and the total period of intervention was 12 weeks. Before and after the intervention, the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA) were used for evaluation, and CD4+ T cell counts were calculated for analysis.

Results

A total of 200 newly diagnosed PLWHA with depression were included, 178 cases of which were effectively followed up with an effective rate of 89.0%. Among 178 cases, 88 were mild to moderate depression (49.4%), 90 were major depressive disorder (50.6%), and 173 cases were accompanied by anxiety (97.2%). The mean CD4+ T cell count before intervention was (346.39±156.87) cells/μL, and it was (421.93±149.61) cells/μL after intervention. After intervention, the CD4+ T cell counts of newly diagnosed PLWHA with depression were higher than before intervention (t=10.971, P<0.05), and the total and factor scores of HAMD, HAMA were all lower than before intervention (P<0.05). Before the intervention, the total scores of HAMD were correlated with the grades of CD4+ T cell counts negatively (500 cells/μL as the cutoff value) (rs=-0.157, P=0.036) and the scores of HAMA positively (rs=0.764, P<0.001). After the intervention, the total scores of HAMD were correlated with post-intervention CD4+ T cell counts negatively (rs=-0.150, P=0.046) and the total scores of HAMA strongly positively (rs=0.939, P<0.001). In newly diagnosed PLWHA with depression, the total scores of HAMD and HAMA of patients with CD4+ T cell counts <500 cells/μL were higher than those with CD4+ T cell counts≥500 cells/μL (P<0.05) before intervention.

Conclusion

The severity of depression in newly diagnosed PLWHA is associated with CD4+ T cell counts, which could be significantly improved by professional psychological intervention.

Key words: Acquired immunodeficiency syndrome, HIV infections, CD4+ T cell counts, Depression, Anxiety

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