中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2009年
4期
372-376
,共5页
刘静%张旻%朱谦%何昌宇%胡清海%赵连爽%代娣%丁海波%楚振兴%徐俊杰%姜拥军%尚红
劉靜%張旻%硃謙%何昌宇%鬍清海%趙連爽%代娣%丁海波%楚振興%徐俊傑%薑擁軍%尚紅
류정%장민%주겸%하창우%호청해%조련상%대제%정해파%초진흥%서준걸%강옹군%상홍
HIV感染%肝炎,丙型%抗逆转录病毒治疗,高效%RNA,病毒
HIV感染%肝炎,丙型%抗逆轉錄病毒治療,高效%RNA,病毒
HIV감염%간염,병형%항역전록병독치료,고효%RNA,병독
HIV infections%Hepatitis C%Antiretroviral therapy,highly active%RNA,viral
目的 探讨HCV RNA对HIV和HCV合并感染者接受高效抗反转录病毒治疗(highlyactive antiretroviral therapy,HA.ART)后疗效、肝脏功能和血脂的影响.方法 招募我国河南既往有偿供血人群中接受HAART治疗的HIV/HCV合并感染者275例,每6个月随访一次,定期检测HCVRNA、HIV RNA、CD+4T淋巴细胞计数、肝脏功能指标和血脂等实验室指标,采用卡方检验、成组设计秩和检验比较HCV RNA阳性组和HCV RNA阴性组HAART治疗后HIV病毒抑制率、免疫学应答、肝损伤和血脂的差异.结果 HAART治疗6月以上患者中,HCV RNA阳性组和HCV RNA阴性组HIV完全抑制率差异无统计学意义(45.6%vs.38.5%,x2=1.150,P>0.05);HAART治疗前(286个/μ1 vs.209个/μ1,z=0.734,P=0.463)、治疗后6个月(310个/μ1 vs.362个/μ1,z=0.562,P=0.574)、12个月(378个/μl vs.289个/μ1,Z=1.091,P=0.275)、18个月(363个/μ1 vs.288个/μ1,z=1.435,P=0.151)、24个月(413个/μ1 vs.348个/μ1,z=0.939,P=0.348)CD+4;T淋巴细胞计数在HCV RNA阳性组和HCV RNA阴性组间差异无统计学意义.HCV HNA阳性组血清ALT(55.0 U/L vs 29.5 U/L,Z=6.789,P<0.01)、AST(46.0 U/L vs.33.0 U/L,Z=4.890,P<0.01)、TBIL(9.3 mmol/L vs.7.2 mmol/L,z=3.748,P<0.01)水平显著高于HCV RNA阴性组;HCV RNA阳性组HAART治疗后发生肝损伤的风险显著高于HCV RNA阴性组(调整后优势比aOR=3.8,P<0.01).HIV/HCV合并感染者HCV RNA阳性组TG水平显著低于HCV RNA阴性组(1.2 mmol/Lvs.1.4 mol/L,Z=1.936,P=0.043)、而HDL-C水平显著高于HCV RNA阴性组(1.5 mmol/L vs.1.3 mmol/L,z=2.251,P=0.024).结论 HCV RNA对HIV/HCV合并感染者HAART治疗后HIV病毒抑制率无影响,亦不影响HAART治疗后CD+4淋巴细胞的恢复;HCV RNA是HIV/HCV合并感染者HAART治疗后肝损伤的独立危险因素,但可能减轻HAART治疗引起的血脂异常.
目的 探討HCV RNA對HIV和HCV閤併感染者接受高效抗反轉錄病毒治療(highlyactive antiretroviral therapy,HA.ART)後療效、肝髒功能和血脂的影響.方法 招募我國河南既往有償供血人群中接受HAART治療的HIV/HCV閤併感染者275例,每6箇月隨訪一次,定期檢測HCVRNA、HIV RNA、CD+4T淋巴細胞計數、肝髒功能指標和血脂等實驗室指標,採用卡方檢驗、成組設計秩和檢驗比較HCV RNA暘性組和HCV RNA陰性組HAART治療後HIV病毒抑製率、免疫學應答、肝損傷和血脂的差異.結果 HAART治療6月以上患者中,HCV RNA暘性組和HCV RNA陰性組HIV完全抑製率差異無統計學意義(45.6%vs.38.5%,x2=1.150,P>0.05);HAART治療前(286箇/μ1 vs.209箇/μ1,z=0.734,P=0.463)、治療後6箇月(310箇/μ1 vs.362箇/μ1,z=0.562,P=0.574)、12箇月(378箇/μl vs.289箇/μ1,Z=1.091,P=0.275)、18箇月(363箇/μ1 vs.288箇/μ1,z=1.435,P=0.151)、24箇月(413箇/μ1 vs.348箇/μ1,z=0.939,P=0.348)CD+4;T淋巴細胞計數在HCV RNA暘性組和HCV RNA陰性組間差異無統計學意義.HCV HNA暘性組血清ALT(55.0 U/L vs 29.5 U/L,Z=6.789,P<0.01)、AST(46.0 U/L vs.33.0 U/L,Z=4.890,P<0.01)、TBIL(9.3 mmol/L vs.7.2 mmol/L,z=3.748,P<0.01)水平顯著高于HCV RNA陰性組;HCV RNA暘性組HAART治療後髮生肝損傷的風險顯著高于HCV RNA陰性組(調整後優勢比aOR=3.8,P<0.01).HIV/HCV閤併感染者HCV RNA暘性組TG水平顯著低于HCV RNA陰性組(1.2 mmol/Lvs.1.4 mol/L,Z=1.936,P=0.043)、而HDL-C水平顯著高于HCV RNA陰性組(1.5 mmol/L vs.1.3 mmol/L,z=2.251,P=0.024).結論 HCV RNA對HIV/HCV閤併感染者HAART治療後HIV病毒抑製率無影響,亦不影響HAART治療後CD+4淋巴細胞的恢複;HCV RNA是HIV/HCV閤併感染者HAART治療後肝損傷的獨立危險因素,但可能減輕HAART治療引起的血脂異常.
목적 탐토HCV RNA대HIV화HCV합병감염자접수고효항반전록병독치료(highlyactive antiretroviral therapy,HA.ART)후료효、간장공능화혈지적영향.방법 초모아국하남기왕유상공혈인군중접수HAART치료적HIV/HCV합병감염자275례,매6개월수방일차,정기검측HCVRNA、HIV RNA、CD+4T림파세포계수、간장공능지표화혈지등실험실지표,채용잡방검험、성조설계질화검험비교HCV RNA양성조화HCV RNA음성조HAART치료후HIV병독억제솔、면역학응답、간손상화혈지적차이.결과 HAART치료6월이상환자중,HCV RNA양성조화HCV RNA음성조HIV완전억제솔차이무통계학의의(45.6%vs.38.5%,x2=1.150,P>0.05);HAART치료전(286개/μ1 vs.209개/μ1,z=0.734,P=0.463)、치료후6개월(310개/μ1 vs.362개/μ1,z=0.562,P=0.574)、12개월(378개/μl vs.289개/μ1,Z=1.091,P=0.275)、18개월(363개/μ1 vs.288개/μ1,z=1.435,P=0.151)、24개월(413개/μ1 vs.348개/μ1,z=0.939,P=0.348)CD+4;T림파세포계수재HCV RNA양성조화HCV RNA음성조간차이무통계학의의.HCV HNA양성조혈청ALT(55.0 U/L vs 29.5 U/L,Z=6.789,P<0.01)、AST(46.0 U/L vs.33.0 U/L,Z=4.890,P<0.01)、TBIL(9.3 mmol/L vs.7.2 mmol/L,z=3.748,P<0.01)수평현저고우HCV RNA음성조;HCV RNA양성조HAART치료후발생간손상적풍험현저고우HCV RNA음성조(조정후우세비aOR=3.8,P<0.01).HIV/HCV합병감염자HCV RNA양성조TG수평현저저우HCV RNA음성조(1.2 mmol/Lvs.1.4 mol/L,Z=1.936,P=0.043)、이HDL-C수평현저고우HCV RNA음성조(1.5 mmol/L vs.1.3 mmol/L,z=2.251,P=0.024).결론 HCV RNA대HIV/HCV합병감염자HAART치료후HIV병독억제솔무영향,역불영향HAART치료후CD+4림파세포적회복;HCV RNA시HIV/HCV합병감염자HAART치료후간손상적독립위험인소,단가능감경HAART치료인기적혈지이상.
Objective To investigate the effect of HCV RNA on virological and immunological response to highly active antiretroviral therapy (HAART),liver function and blood lipid levels in HIV/HCV co-infected patients.Methods In a cohort study,275 HIV/HCV co-infected former blood donors receiving HAART were followed up every six month in Henan province in China.HCV RNA,HIV RNA,CD+4 T cell counts,indexes of liver function and lipid levels were periodically tested.The differences of HIV viral load suppression,immunological response,liver injury and blood lipid levels between HCV RNA positive group and negative group were compared by x2 test and two independent-samples tests.Result There was no significant difference of HIV viral load suppression between HCV RNA positive group and HCV RNA negative group six-month treatment (45.6% vs.38.5% ,X2=1.150,P>0.05) and CD+4 T cell counts before (286 cells/μ1 vs.209 cells/μ1,Z=0.734,P=0.463)and after 6-month (310 cells/μ1 vs.362 cells/μl,Z=0.562,P=0.574) ,12-month(378 cells/μ1 vs.289 cells/μ1,Z=1.091,P=0.275),18-month(363 cells/μ1 vs.288 cells/μl,Z=1.435,P=0.151) ,24-month(413 cells/μ1 vs.348 cells/μ1,Z=0.939,P=0.348) HAART.The mean levels of serum ALT (55.0 U/L vs.29.5 U/L,Z=6.789,P<0.01),AST(46.0 U/L vs.33.0 U/L,Z=4.890,P<0.01)、TBIL(9.3 mmol/L vs.7.2 mmol/L,Z=3.748,P<0.01)were significantly higher in HCV RNA positive group than that in HCV RNA negative group.HCV RNA was the independent variables associated with liver injury after HAART (aOR=3.8,P<0.01).The serum triglyceride level was higher in HCV RNA positive group than that in HCV RNA negative group(1.2 mmoL/L vs.1.4 mmol/L,Z=1.936,P=0.043) .The serum HDL level was higher in HCV RNA positive group than that in HCV RNA negative group (1.5 mmol/L vs.1.3 mmol/L,Z=2.251,P=0.024).Conclusions HCV RNA does not affect HIV virological responses to HAART and CD+4 T recovery.HCV RNA is an independent risk factor associated with liver injury in HIV/HCV co-infected patients receiving HAART,but appears to provide significant protection against HAART-ieduced hyperlipidemia.
