CAJ | 학술논문

目的了解我国HIV/艾滋病患者HAART相关脂肪营养不良综合征的发生率并探讨其影响因素.方法采用Cox比例风险模型,前瞻性地对137例接受HAART 2年的艾滋病患者16项临床参数,包括性别、年龄、疾病分期、感染途径、基线实验室指标(体质指数、HIV RNA、CD4+T淋巴细胞、白细胞、空腹血糖、三酰甘油、总胆固醇等)和HAART方案,进行单因素和多因素回归分析,了解其发生HAART相关脂肪营养不良综合征的比例和影响因素.结果多因素Cox回归分析显示,HAART方案与脂肪营养不良综合征的出现显著相关(P=0.031),其余15项指标与脂肪营养不良综合征的出现无明显相关(均P＞0.05).在其他条件一致的情况下,含司他夫定(d4T)治疗组出现脂肪营养不良综合征的风险为含齐多夫定(AZT)治疗组的2.684倍(95％CI:1.302～5.531,P=0.007).含d4T和含AZT治疗组脂肪营养不良综合征的累积发生率均随用药时间延长呈逐渐增高趋势,最早出现在第24周,两组24、48和96周的累积发生率分别为2.7％、1.6％,27.0％、7.9％和37.8％、15.9％,含d4T治疗的脂肪营养不良综合征的累积发生率远高于含AZT,差异有统计学意义(x2=8.285,P=0.004).结论 HAART方案是我国艾滋病患者发生HAART相关脂肪营养不良综合征的独立预测因素,使用d4T和AZT出现脂肪营养不良综合征的累积发生率均较高,以d4T更为严重,建议临床尽量减少或避免使用含d4T的HAART方案.
목적 료해아국HIV/애자병환자HAART상관지방영양불량종합정적발생솔병탐토기영향인소.방법 채용Cox비례풍험모형,전첨성지대137례접수HAART 2년적애자병환자16항림상삼수,포괄성별、년령、질병분기、감염도경、기선실험실지표(체질지수、HIV RNA、CD4+T림파세포、백세포、공복혈당、삼선감유、총담고순등)화HAART방안,진행단인소화다인소회귀분석,료해기발생HAART상관지방영양불량종합정적비례화영향인소.결과 다인소Cox회귀분석현시,HAART방안여지방영양불량종합정적출현현저상관(P=0.031),기여15항지표여지방영양불량종합정적출현무명현상관(균P＞0.05).재기타조건일치적정황하,함사타부정(d4T)치료조출현지방영양불량종합정적풍험위함제다부정(AZT)치료조적2.684배(95％CI:1.302～5.531,P=0.007).함d4T화함AZT치료조지방영양불량종합정적루적발생솔균수용약시간연장정축점증고추세,최조출현재제24주,량조24、48화96주적루적발생솔분별위2.7％、1.6％,27.0％、7.9％화37.8％、15.9％,함d4T치료적지방영양불량종합정적루적발생솔원고우함AZT,차이유통계학의의(x2=8.285,P=0.004).결론 HAART방안시아국애자병환자발생HAART상관지방영양불량종합정적독립예측인소,사용d4T화AZT출현지방영양불량종합정적루적발생솔균교고,이d4T경위엄중,건의림상진량감소혹피면사용함d4T적HAART방안.
Objective To investigate the prevalence and risk factors of highly active antiretroviral therapy (HAART)-associated lipodystrophy syndrome (LD) in patients with acquired immunodeficiency syndrome (AIDS) treated with HAART in China.Methods A total of 137 AIDS patients treated with HAART for more than 2 years were analyzed.Sixteen clinical parameters (including gender,age,baseline body mass index,baseline human immunodeficiency virus [HIV] viral load,stage of disease,routes of HIV transmission,baseline CD4+ T lymphocyte count,white blood cell count,fasting plasma glucose level,serum triglycerides level,serum cholesterol level and other laboratory results,and HAART regimens) that might be associated with HAART-LD occurrence were evaluated using Cox proportional hazards models.Results HAART regimens were significantly correlated with HAART-LD (P=0.031),while the remaining 15 factors were not associated with the risk of HAART-LD (all P＞0.05).Patients who received stavudine d4T)-containing regimen was 2.684 times more likely to develop HAART-LD than patients who received zidovudine (AZT)-containing regimen (95 ％ CI:1.302-5.531,P=0.007) ; HAART-LD prevalence rates were gradually increased with treatment duration in both groups.First HAART-LD was seen at 24 weeks in both d4T group and AZT group,and the prevalence rates were 2.7％,1.6％ at 24 weeks,27.0％,7.9％ at 48 weeks and 37.8％,15.9％ at 96 weeks respectively.The prevalence of HAART-LD in d4T group was much higher than that in AZT group and the difference was statistically significant (x2 =8.285,P=0.004).Conclusions HAART regimen is an independent predictor of HAART-LD.HAART-LD tend to occur more frequently in patients treated with d4T or AZT,especially d4T.Our study recommends to avoid the use of d4T-contained HAART regimen.