不同的抗病毒治疗方案对HIV/AIDS病人治疗48周后估计肾小球滤过率的影响  

Influence on estimated glomerular filtration rate with different antiretroviral regimens of HIV/AIDS patients:A 48-week study

作　　者：张雯[1] 肖江[1] 韩宁[1] 杨涤[1] 李彦媚[1] 黄英秀[1] 田云飞[1] 苏文晶[1] 赵红心[1] 

机构地区：[1]首都医科大学附属北京地坛医院感染一科,北京100015

出　　处：《中国艾滋病性病》2013年第11期795-797,801,共4页Chinese Journal of Aids & STD

基　　金：北京市卫生系统高层次卫生技术人才培养计划;十二五重大专项(2012ZX10004-904);(2012ZX10001003)~~

摘　　要：目的比较国内目前抗艾滋病病毒(HIV)治疗方案,对HIV感染者/艾滋病(AIDS)病人(HIV/AIDS病人)估计肾小球滤过率(eGFR)的影响。方法 2011年3月至2013年3月就诊于北京地坛医院感染一科、初治为接受一线抗病毒治疗方案的HIV/AIDS病人,以及一线治疗失败更换为二线方案的HIV/AIDS病人,收集他们治疗48周的临床资料,分析不同抗病毒治疗方案对HIV/AIDS病人估计肾小球滤过率的影响。结果共收治96名病人,其中初治接受齐多夫定(AZT)+拉米夫定(3TC)+奈韦拉平(NVP)治疗的病人30例,初治接受替诺福韦(TDF)+3TC+依非韦伦(EFV)的病人46例,一线治疗失败更换为TDF+3TC+克力芝(LPV/r)的病人20例。三组病人治疗48周后,血肌酐水平差异无统计学意义(P=0.264),eGFR平均水平差异无统计学意义(P=0.683)。与基线相比,一线治疗失败后更换为TDF+3TC+LPV/r方案的病人治疗48周后,eGFR平均水平差异无统计学意义(P=0.077),但eGFR平均水平与基线相比下降程度明显,为-14.12ml/min/1.73m2。结论三组不同抗病毒治疗方案的病人,均没有发现明显的eGFR的变化,可能需要对HIV/AIDS病人进行长期的肾脏功能指标的监测。Objective To explore the influence on estimated glomerular filtration rate （eGFR） among HIV/ AIDS patients with different antiretroviral regimens. Methods Clinical data of I-IIV/AIDS patients who received first-line antiretroviral therapy based on non-nucleoside reverse transcriptase inhibitors and patients who received second-line antiretroviral therapy based on protease inhibitors after first-line treatment failure had been collected and studied in Department of Infectious Diseases, Beijing Ditan Hospital from March, 2011 to March, 2013. Analysis on estimated glomerular filtration rate was carried out after 48-week follow-up. Results A total of 96 HIV/AIDS patients were included, in which 30 cases received zidovudine （AZT）4- lamivudine （3TC）4- nevirapine （NVP）, 46 cases received tenofovir（TDF） 4- lamivudine （3TC） 4- efavirenz （EFV）, and 20 cases received TDF 4- 3TC 4- Kaletra （LPV/r）. There was no statistically significant difference in serum creatinine level （P=0. 264） and eGFR （P=0. 683） af- ter 48-week follow-up. Compared with baseline, eGFR of patients who received TDF ＋ 3TC ＋LPV/r after 48-week fol- low-up had no statistically significant difference （P= 0. 077）, but the mean decline in eGFR was significantly greater, about -14. 12 mL/min /1. 73 m2. Conclusion Throughout the 48-week studies, no significant changes of eGFR were observed among three groups and it was necessary to conduct long-term follow-up for renal function.

关 键 词：艾滋病病毒感染者 艾滋病病人 高效抗反转录病毒治疗 替诺福韦 估计肾小球滤过率 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]