含替诺福韦抗艾滋病毒治疗对HIV/AIDS病人的肾功能影响  

The impact on renal function of Tenofovir-containing anti-retroviral regimen amony HIV-infected anti-retroviral therapy patients

作　　者：陈绛青 朱冬红 胡塔 郑璐[1] 黄美玲[1] 李珊[1] CHEN Jiangqing;ZHU Donghong;HU Ta(Nanchang University Affiliated Infection Hospital,Nanchang No.9 Hospital,330002,China)

机构地区：[1]南昌大学附属感染病院南昌市第九医院,南昌330002

出　　处：《江西医药》2018年第8期779-783,共5页Jiangxi Medical Journal

基　　金：南昌市科技局课题;编号2014SFZC014

摘　　要：目的比较含替诺福韦(TDF)和不含替诺福韦的一线抗病毒治疗(ART)方案在96周对中国初治HIV/AIDS病人的肾功能影响。方法将80例无机会性感染和无心、肾和肝病的18-65岁的HIV/AIDS病人按照ART方案的不同分成两组,每组40例,治疗组:TDF+拉米夫定+依非韦伦或洛匹那韦/利托那韦,对照组:齐多夫定+3TC+依非韦伦或洛匹那韦/利托那韦;定期随访两组在基线和在96周ART期间中的4、8、12、24、36、48、72、96周的尿常规、血肌酐,视黄醇结合蛋白(RBP)、血钙、钾、磷;24、48、72、96周病毒学及免疫学应答,并采用CKD-EPI公式估算肾小球滤过率(eGFR);分析两组病人在96周内的血清肌酐值和eGFR的动态变化。结果两组病人尿蛋白和尿糖分别在ART 8周时恢复正常且稳定,两组无统计学差异(P>0.05);两组在96周ART中钙、钾、磷及RBP无统计学差异(P>0.05);两组病人在96周ART治疗CD4明显上升,HIV RNA明显下降,在96周无统计学差异;治疗组肌酐值各随访点无统计学差异,对照组肌酐值36、48、72、96周组内和与TDF组比较稍有统计学差异(P<0.05),对照组肌酐值随着治疗时间延长有所下降;治疗组基线eGFR的为114ml/min/1.73m^2,96周为115ml/min/1.73m^2,治疗组各随访点eGFR差异均无统计学意义(P>0.05),两组在48、96周随访点比较eGFR稍有统计学差异(P<0.05),但e GFR均在正常范围,其他随访点无统计学差异,未出现1例eGFR较基线下降幅度≥25%的病人。结论含TDF的一线ART方案对肾功能正常的中国初治HIV/AIDS病人在96周治疗期间包括肾小管、肾功能影响极小,由于随访时间有限,还需要延长随访时间以进一步评估TDF的肾毒性。Objective To compare the effects on renal function of Tenofovir Disoproxil Fumarate （TDF）-containing First-line highly active anti-retroviral therapy （HAART） with the non-TDF-containing regimens over 96 weeks in Chinese HIV-1 infected treatment-naive patients. Methods Divided 80 HIV-1 infected adults cases in age of 18-65 years old on first-line HAART with-out opportunistic infection,cardiac disease,renal disease or hepatopathy into two groups equally by different treatment regimens.Treatment group：40 cases treated with TDF＋ Lamivudine （3TC）＋ Efavirdine （EFV） or Aluvia （Lopinavir and Ritonavir ）. Control group： 40 cases treated with Zidoudine （AZT）＋ 3TC＋ Efavirdine （EFV） or Aluvia （Lopinavir and Ritonavir ）.We made regular follow-up of two groups on the due time of baseline.4,8,12,24,36,48,72,96 weeks with Routine urine test,Serum creatinine,Retinol-Binding Protein （RBP）,Serum calcium,kalium and phosphorus. And regular follow up 24,48,72,96 weeks with virology and immunology response,accounted the estimated glomerular filtration rate（eGFR） by the way of CKD Epidemiology Collaboration（CKD-EPI） equation. We also retrospectively analysed CLcr and eGFR changes along 96 weeks both the two groups. Results No statistical difference（P〉0.05） between two groups patents＇ Urine protein and sugar regained normal level stably at 8 weeks with HAART. No statistical difference （P〉0.05） between two groups patents Retinol-Binding Protein （RBP）,serum calcium,and phosphorus at 96 weeks with HAART. No statistical difference （P〉0.05） between two groups patents CD4 rised clearly and HIV RNA declined sharply at 96 weeks with HAART. Each serum creatinine point in treatment group without statistical difference,there is statistical difference（P〈0.05） to each serum creatinine point due time 36,48,72,96 weeks in two groups. Each serum creatinine point in control group fell with the time longer. The baseline of eGFR in treatment group was 114ml/min/1.73m^2,wh

关 键 词：HIV/AIDS病人 替诺福韦 抗病毒药物 肾功能 药物毒性 eGFR 

分 类 号：R512.91[医药卫生—内科学]