定量CT评估含替诺福韦高效抗反转录病毒治疗对HIV/AIDS男性患者骨密度的影响  

Using QCT to evaluate the change of bone mineral density in male HIV/AIDS patients with HAART containing TDF

作　　者：周粟[1] 施裕新[1] 袁敏[1] 顾宇国 刘莉[1] 单飞[1] 

机构地区：[1]上海市公共卫生临床中心,上海201508

出　　处：《放射学实践》2017年第7期750-754,共5页Radiologic Practice

摘　　要：目的:采用定量CT(QCT)研究HIV/AIDS男性患者接受含替诺福韦(TDF)高效抗反转录病毒治疗(HAART)后骨密度的变化规律。方法:募集HIV/AIDS男性患者443例,按接受HAART的时间分组:<3月组、3~6月组、6~12月组、12~24月组、>24月组和未治疗组(对照组)。搜集并分析各组患者临床资料及骨密度情况。结果:治疗时间3~6月组[(143.05±32.26)mg/cm3]、6~12月组[(139.47±37.35)mg/cm3]、12~24月组[(142.14±37.05)mg/cm3]的骨密度值均小于未治疗组[(163.61±36.17)mg/cm3](P均<0.05)。治疗组骨密度值明显小于未治疗组骨密度值(P=0.0002);治疗时间3~6月组、6~12月组、12~24月组骨质疏松/骨量减少发生率(27.91%,27.85%,35.19%)均高于未治疗组(12.07%)(P<0.05)。治疗组骨质疏松/骨量减少发生率(24.46%)明显高于未治疗组骨质疏松/骨量减少发生率(24.46%vs 12.07%,P=0.0050)。年龄、体重、HAART时间是本组患者接受本方案后发生骨质疏松/骨量减少的重要危险因素。结论:QCT可监测HIV/AIDS男性患者HAART(含TDF方案)后骨密度变化,表现为骨密度降低,高峰期发生于治疗6~12月,之后骨密度缓慢减低并逐渐稳定后回升,24月后逐步恢复接近治疗前水平。对年龄>50岁、体重<60kg的男性HIV/AIDS患者HRRT治疗后需特别重视定期监测骨密度变化,有利于及时发现骨质疏松/骨量减少并进行临床干预。Objective： Using QCT to study the change pattern of bone mineral density in male patients with HIV/ AIDS who took the treatment program with highly active antiretroviral therapy （HAART） containing tenofovir disoproxil fumarate （TDF）. Methods：443 male patients with HIV/AIDS were recruited and divided into six groups according to the duration of receiving HAART TDF-containing program, including less than 3m, 3 - 6m, 6 -12m, 12 - 24m, over 24 months and control group （untreated patients）. The clinical mterials and bone mineral density of six groups were collected and ana lyzed. Results： The bone mineral density of the 6 groups were as follows： taking HAART TDF program for 3-6m E（143.05±32.26）mg/cm^3,for 6-12m^3（139.47±37.35）mg/cm^3,for 12~24m E（142. 14±37.05）mg/cm^3,which were all statistically lower than that of control group [（163. 61±36. 17）mg/cm^3] （P〈0.05）. The average bone mineral density of treatment groups was obviously lower than that of untreated group （P 0. 0002）. The incidence rate of osteoporosis/osteopenia in taking HAART TDF program for 3-6m was 27. 91%, for 6-12m was 27. 85 %, for 12 -24m was 35.19% ,which were all statistically higher than that of control group （12.07%） （P〈0.05）. The average incidence rate of osteoporosis/osteopenia of all treated groups was obviously higher than that of untreated group （24.46 % vs 12.07%, P= 0. 0050）. The age,body weight and duration of taking HAART TDF program were important risk factors for osteoporosis/ osteopenia. Conclusion：QCT can be used as a monitor to observe the change of bone mineral density of male patients with HIV/AIDS after taking HAART TDF treatment program, mainly showed as osteoporosis/osteopenia. The peak of bone mineral density reducing occurred in 6 to 12m after treatment,then the bone mineral density reduced slowly,stabilized,and gradually recovered. After 24re,the bone mineral density approached the status before taking treatment program. Special attention should be paid to mon

关 键 词：体层摄影术 x线计算机 获得性免疫缺陷综合征 骨密度 

分 类 号：R512.91[医药卫生—内科学] R580[医药卫生—临床医学]