期刊文献+

长期应用核苷类逆转录酶抑制剂对HIV/AIDS患者脂肪代谢的影响 被引量:9

The influence of long-term nucleotide reverse transcriptase inhibitors on lipids metabolism in HIV/ AIDS patients
原文传递
导出
摘要 目的探讨长期应用含核苷类逆转录酶抑制剂(NRTIs)的高效抗逆转录病毒治疗(HAART)对HIV/AIDs患者脂肪代谢的影响及相关因素。方法招募118例HIV/AIDs患者,其中未治疗组40例,治疗1—2年组37例,治疗〉5年组41例,以20名健康志愿者作为对照组。临床评估是否存在脂肪代谢障碍(LD)。经双能X线骨密度吸收仪(DxA)测量全身、躯干、上肢及下肢脂肪量(FM)。结果治疗〉5年组与治疗1—2年组患者临床评估LD发生率分别为51.2%和40.5%,组间比较差异无统计学意义。应用司他夫定(d4T)出现LD发生率(63.6%)为应用齐多夫定(AZT)者(26.5%)的2.4倍,差异有统计学意义(P=0.001)。DXA检测显示:治疗〉5年组患者全身及四肢FM[(9778±3758)g和上肢(960±449)g,下肢(2096±1141)g]均显著低于健康对照组[(13317±5825)g和上肢(2333±1422)g,下肢(3890±1567)g]、未治疗组[(14280±6416)g和上肢(1655±1251)g,下肢(4032±1822)g]及治疗1—2年组[(13750±5910)g和上肢(1220±634)g,下肢(3276±1890)g](P〈0.05),其躯干FM显著低于未治疗组及治疗1—2年组(P〈0.05)。治疗〉5年组中无LD患者,其全身及躯干FM亦显著低于治疗1~2年组无LD患者(P〈0.05)。全身、躯干和四肢FM与体重(r=0.140—0.568,P=0.04或〈0.01)及BMI(r=0.292—0.742,P值均〈0.01)呈正相关,四肢FM与血TG呈负相关(r=-0.240,P=0.011)。结论应用NRTIs的HIV/AIDs患者易出现LD,主要在治疗1—2年出现,应用d4T后LD发生率显著高于应用AZT。治疗1—2年组与治疗〉5年组患者LD发生率差异无统计学意义,但FM随HAART时间延长逐渐减低。DXA有助于客观定量评估FM变化,能早期发现LD并指导临床治疗。 Objective To evaluate the influence of long-term nucleotide reverse transcriptase inhibitors (NRTIs) on lipids metabolism in HIV/AIDS patients and correlating clinical factors. Methods A total of 118 HIV/AIDS patients were divided into 3 groups:untreated group (40 patients) , highly active antiretroviral therapy(HAART) for 1-2 years group (37 patients) and HAART over 5 years group (41 patients) ,with 20 healthy individuals as the control group. Clinical lipodystrophy (LD) was defined as concordance between patient's report of change and physical examination. Fat mass (FM) was measured by dual-energy X-ray absorptiometry (DXA). Results There was no significant difference in the incidence of LD between HAART for 1-2 years group and HAART over 5 years group (51.2% vs 40. 5% ,P =0. 345). The prevalence of LD was 2.4 folds with strvudine (d4T) treatment compared with zidovudine (AZT)- containing regimens (61.6% vs 23.5% , P =0. 001 ). Based on DXA measurements, FM of total body and limbs were significantly lower in the HAART over 5 years group than that in the control group, the untreated group and the HAART for 1-2 years group ( P 〈 0. 05 ). Trunk FM was significantly lower in the HAART over 5 years group than the untreated group and the HAART for 1-2 years group ( P 〈 0. 05). FM of total body and trunk were significantly lower in patients without LD in the HAART over 5 years group than patients without LD in the HAART for 1-2 years group (P 〈 0. 05 ). FM was correlated positively with body weight and BMI. Limbs FM was correlated negatively with peripheral blood triglyceride concentration. Conclusions HIV/AIDS patients with NRTIs therapy have high prevalence of LD, which mainly occurs 1-2 years after therapy, and increases with d4T treatment compared with AZT-containing regimens. There was no significant difference in the incidence of LD between the HAART for 1-2 years group and the HAART over 5 years group. FM was significantly decreased after long-term HAART in the patients with or without LD. DXA can evaluate LD objectively and guide further clinical treatment.
出处 《中华内科杂志》 CAS CSCD 北大核心 2012年第11期859-862,共4页 Chinese Journal of Internal Medicine
基金 国家“十一五”艾滋病和病毒性肝炎等重大传染病防治科技重大专项资助项目(2008ZX10001-006) 卫生部部属(管)医院临床学科重点项目(2010-2012)
关键词 司他夫定 齐多夫定 双能X线骨密度吸收仪 脂肪代谢障碍 Stavudine Zidovudine Dual-energy X-ray absorptiometry Lipodystrophy
  • 相关文献

参考文献14

  • 1Carr A, Emery S, Law M, et al. An objective case definition of lipodystrophy in HIV-infected adults: a case-control study. Lancet, 2003, 361:726-735.
  • 2Duran S, Saves M, Spire B, et al. Failure to maintain long-term adherence to highly active antiretroviral therapy: the role of lipodystrophy. AIDS, 2001,15:2441-2444.
  • 3Saves M, Raffi F, Capeau J, et al. Factors related to lipodystrophy and metabolic alterations in patients with human immunodeficiency virus infection receiving highly active antiretroviral therapy. Clin Infect Dis,2002,34 : 1396-1405.
  • 4李太生.如何提高我国抗艾滋病病毒治疗成功率[J].中华医学杂志,2011,91(21):1441-1442. 被引量:17
  • 5张璐,黎明,陶梅梅,邱志峰,谢静,韩扬,余卫,李太生.中国成人HIV相关脂肪营养不良综合征55例研究[J].中华内科杂志,2009,48(2):118-121. 被引量:13
  • 6Yao J, Yu W, Li T, et al. The pilot study of DXA assessment in chinese HIV-infected men with clinical lipodystrophy. J Clin Densitom, 2011,14:58-62.
  • 7Martinez E, Mocroft A, Garcia-Viejo MA, et al. Risk of lipodystrophy in HIV-1-infected patients treated with protease inhibitors: a prospective cohort study. Lancet, 2001,357: 592- 598.
  • 8i Miller J, Carr A, Emery S, et al. HIV lipodystrophy : prevalence, severity and correlates of risk in Australia. HIV Med, 2003,4: 293-301.
  • 9Mallon PW, Miller J, Cooper DA, et al. Prospective evaluation of the effects of antiretroviral therapy on body composition in HIV-1- infected men starting therapy. AIDS,2003,17:971-979.
  • 10van Griensven J, De Naeyer L, Mushi T, et al. High prevalence of lipoatrophy among patients on stavudine-containing first-line antiretroviral therapy regimens in Rwanda. Trans R Soc Trop Med Hyg, 2007,101:793-798.

二级参考文献20

  • 1韩扬,邱志峰,李太生,谢静,左玲燕,匡季秋,王爱霞.CD_8^+ T细胞激活分子CD_(38)、HLA-DR与HIV-1载量的相关性研究[J].中华内科杂志,2006,45(6):459-462. 被引量:23
  • 2韩扬,邱志峰,李太生,谢静,左玲燕,李雁凌,王爱霞.艾滋病患者淋巴细胞数和CD_4^+ T细胞计数的相关性研究[J].中华检验医学杂志,2006,29(7):596-600. 被引量:26
  • 3Bernasconi E, Boubaker K, Junghans C, et al. Abnormalities of body fat distribution in HIV-infected persons treated with antiretroviral drugs: The Swiss HIV Cohort Study. J Acquir Immune Defic Syndr, 2002, 31:50-55.
  • 4Lichtenstein KA, Ward D J, Moorman AC, et al. Clinical assessment of HIV-associated lipodystrophy in an ambulatory population. AIDS,2001,15 : 1389-1398.
  • 5Miller J, Carr A, Emery S, et al. HIV lipodystrophy: prevalence, severity and correlates of risk in Australia. HIV Med, 2003, 4 : 293-301.
  • 6Duran S, Saves M, Spire B, et al. Failure to maintain long-term adherence to highly active antiretroviral therapy: the role of lipodystrophy. AIDS, 2001,15:2441-2444.
  • 7d'ArminioA, Sabin CA, Phillips AN, et al. Cardio-and cerebrovascular events in HIV-infected persons. AIDS, 2004, 18: 1811-1817.
  • 8Friis-MФller N, Sabin CA, Weber R, et al. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med, 2003, 349 : 1993-2003.
  • 9Carr A, Emery S, Law M, et al. An objective case definition of lipodystrophy in HIV-infected adults: a case-control study. Lancet, 2003, 361:726-735.
  • 10Schwenk A. Methods of assessing body shape and composition in HIV-associated lipodystrophy. Curt Opin Infect Dis, 2002,15:9- 16.

共引文献28

同被引文献121

引证文献9

二级引证文献39

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部