昆明地区HIV感染者抗病毒治疗前的肾病及影响因素  

Prevalence of Kidney Disease among Pre-ART Patients with HIV Infection in Kunming and The Influencing Factors

作　　者：李重熙 尹光凤 张瑜书 古善群 张伟 刘俊 田波 LI Chongxi;YIN Guangfeng;ZHANG Yushu;GU Shanqun;ZHANG Wei;LIU Jun;TIAN Bo(Dept.of AIDS/STD,The Third People’s Hospital of Kunming;Dept of Clinical Laboratory,The Third People’s Hospital of Kunming,Kunming Yunnan 650041;Clinic Centrefor Infectious Diseases in Yunnan Province,Kunming Yunnan 650041,China)

机构地区：[1]昆明市第三人民医院性病艾滋病科,云南昆明650041 [2]昆明市第三人民医院检验科,云南昆明650041 [3]云南省传染性疾病临床医学中心,云南昆明650041

出　　处：《昆明医科大学学报》2022年第2期154-159,共6页Journal of Kunming Medical University

基　　金：“十三五”国家科技重大专项基金资助项目(2018ZX10302104);昆明市卫生健康委员会卫生科研课题资助项目(2020-03-08-114)。

摘　　要：目的横断面调查抗病毒治疗前HIV感染者肾病患病率及特征,分析抗病毒治疗前肾病的相关因素。方法纳入2019年6月至2021年3月到昆明市第三人民医院就诊未治疗的HIV感染者,并对研究对象进行尿常规、血清肌酐、尿微量白蛋白/肌酐比、尿α1微球蛋白、肾脏B超筛查,同时检查血脂、血糖、测量体重指数、收集人口学资料及高血压、糖尿病等病史。用SPSS17.0对数据进行单因素及Logistic回归分析。结果468例研究对象平均年龄(43.42±14.66)岁,男:女为1.96,平均体重指数(21.73±3.76)kg/m^(2),15.6%患者体重指数≥25 kg/m^(2),33.3%患者有每天吸烟的习惯,高甘油三脂血症占24.7%,高血压占10.7%,糖尿病占7.7%,合并用药率21.8%。总体肾病检出率20.7%。CKD-EPI评估公式计算eGFR<60 mL,60~90 mL,≥90 mL的患者分别占1.1%、9.6%、89.3%。单纯尿常规检测尿蛋白阳性率3.1%。111例检测尿微量白蛋白/肌酐比≥30 mg/gCr占21.6%,尿α1微球蛋白检测≥12.5 mg/L占63.9%。多因素分析显示年龄≥50岁(OR=2.285,P=0.02)、体重指数≥25(OR=2.029,P=0.025)、高血压(OR=2.334,P=0.017)、糖尿病(OR=2.634,P=0.014)、HIV病毒载量≥1×10^(5)拷贝/mL(OR=2.296,P=0.002)是HIV感染者抗病毒治疗前肾损害的危险因素,女性是HIV感染者抗病毒治疗前肾损害的保护性因素。结论昆明地区总体肾损害检出率高,以尿蛋白异常为主。HIV感染者抗病毒治疗前肾损害主要与性别、年龄、高血压、糖尿病、体重指数及HIV病毒载量相关。在筛查肾损害时,建议联合尿常规、血清肌酐、肾脏B超、尿微量白蛋白/肌酐比、尿α1微球蛋白检查进行充分评估。Objective To investigate the prevalence and characteristics of nephropathy in HIV infected patients before antiviral treatment,and to analyze the related factors of nephropathy before antiviral treatment.Methods Patients with HIV infection who visited the Third People’s Hospital of Kunming from June 2019 to March 2021 were recruited and screened by urine analysis,serum creatinine,urine microalbumin-to-creatinine ratios,urinaryα1 microglobulin,and renal ultrasound.And all patients were screened by triglyceride,total serum cholesterol,fasting plasma glucose test.Body mass index was measured.Demographic data,medical history of hypertension and diabetes were collected.SPSS17.0 was used for univariate analysis and logistic regression analysis.Results The mean age of 468 subjects was 43.42±14.66 years.The male to female ratio was 1.96.The mean body mass index was 21.73±3.76.Body mass index≥25 accounted for 15%of all the subjects.Some patients smoked daily which accounted for 33.3%of all the subjects.Patients with hypertriglyceridemia,hypertension and diabetes accounted for 24.7%,10.7%,7.7%respectively.And 21.8%of patients were taking drugs which were not antiretroviral therapy.The detection rate of kidney disease in total of 468 cases was 20.7%.the CKD-EPI formula was used to calculate and estimate glomerular filtration rate(eGFR).Patients with eGFR<60 mL/min/1.73 m2,60~90 mL/min/1.73 m^(2),≥90 mL/min/1.73 m^(2) accounted for 1.1%,9.6%,89.3%respectively.The positivity rate of urinary protein was 3.1%,which measured just only by urine analysis.The urinary microalbumin/creatinine ratio(ACR)≥30 mg/gCr were occurred in 24/111 cases(21.6%).The Urinaryα1 microglobulin≥12.5 mg/L were occurred in 71/111 cases(63.9%).Multivariate analysis indicated the independent effects of the age≥50 years(OR=2.285,P=0.002),body mass index≥25(OR=2.029,P=0.025),hypertension(OR=2.334,P=0.017),diabetes(OR=2.634,P=0.014),HIV viral load≥1×10^(5) copies/mL(OR=2.296,P=0.002),which significantly associated with kidney disease.Fem

关 键 词：HIV 肾病 影响因素 尿Α1微球蛋白 

分 类 号：R512.91[医药卫生—内科学]