长期使用替诺福韦酯的HIV/AIDS患者尿β2-MG的变化及临床价值  

Changes of Urinaryβ2-Microglobulin and Clinical Value After Long-Term Using Tenofovir Disoproxil-Containing Regimen in HIV/AIDS Patients.

作　　者：谭清 夏仁兴 白一春 杨发成 邓霁红 何盛华 Tan Qing;Xia Renxing;Bai Yichun(Department of Infection Management,Department of Infectious Disease,Guang an Hospital,West China Hospital,Sichuan University,Guang an,Sichuan 638000,China.)

机构地区：[1]四川大学华西广安医院·广安市人民医院感染管理科,感染科,四川广安638000 [2]成都市公共卫生临床医疗中心感染科,四川成都610000

出　　处：《四川医学》2022年第12期1169-1173,共5页Sichuan Medical Journal

基　　金：成都市医学科研课题(编号:2017100)。

摘　　要：目的探讨长期使用含替诺福韦酯(TDF)的初始抗病毒治疗(ART)方案的艾滋病病毒(HIV)感染者/艾滋病(AIDS)患者尿β2微球蛋白(β2-MG)的变化及临床应用价值。方法选取连续ART方案24个月及以上的HIV/AIDS患者100例,收集其临床资料和数据,进行为期12个月的前瞻性观察研究。结果10.00%(10/100)患者出现轻度肾功能损害。各随访点,估算肾小球滤过率(eGFR)中位数值(IQR)波动在115.88(110.04,122.43)~119.13(111.84,123.14)ml/(min·1.73m^(2)),较基线(ART前)eGFR下降125.23(117.01,131.27)ml/(min·1.73m^(2)),差异有统计学意义(P<0.05)。尿β2-MG(>0.3 mg/L)、尿微量白蛋白(>30 mg/L)、尿蛋白异常的发生率分别波动在39.18%~60.20%、9.00%~13.27%、1.00%~4.08%。尿β2-MG持续异常(持续异常组)发生率为25.00%,eGFR110.97(105.75,116.59)~116.28(109.74,120.12)ml/(min·1.73m^(2))较非持续异常组117.18(104.22,113.05)~120.05(114.53,124.22)ml/(min·1.73m^(2))低,两组在随访第6、9、12个月差异均有统计学意义(P=0.036、0.022、0.002)。结论长期接受含TDF的ART方案的HIV/AIDS患者,部分患者出现轻度肾功能损害,尿β2-MG异常率高。尿β2-MG是检测和监测TDF相关肾小管毒性的一种应用价值较高的生物标志物。Objective To study changes of ureaβ2-microglobulin and clinical application value after long-term tenofovir dipivoxil(TDF)-containing initial antiviral therapy(ART)regimen in HIV/AIDS patients.Methods Clinical and laboratory data of HIV/AIDS patients who using ART regime for 24 months or more were selected,and a 12-month prospective observational study was conducted.Results Mild renal impairment occurred in 10.00%(10/100).The eGFR was 60~89 ml/(min·1.73 m^(2)),of which one patients with changed ART on account of renal impairment.Follow-up points,median value of eGFR fluctuated between 115.88(110.04,122.43)and 119.13(111.84,123.14)ml/(min·1.73m^(2)),baseline eGFR(before ART)was 125.23(117.01,131.27)ml/(min·1.73m^(2))with statistically significant difference(P<0.05).The incidence of urinaryβ2-microglobulin(β2-MG>0.3 mg/L),urinary microalbumin(>30 mg/L)and urinary protein abnormalities fluctuated between 39.18%~60.20%,9.00%~13.27%,and 1.00%~4.08%.Urinaryβ2-MG for abnormal incidence of abnormal group(continuous)was 25.00%,which eGFR[110.97(105.75,116.59)~116.28(109.74,120.12)ml/(min·1.73m^(2))]was lower compare to non-continuous abnormal group[eGFR 117.18(104.22,113.05)~120.05(114.53,124.22)ml/(min·1.73m^(2))],there were statistically significant differences between two groups at the 6th,9th and 12th month of follow-up(P=0.036,0.022 and 0.002).Conclusion Some of younger HIV/AIDS patients who received ART regimen of TDF-containing for a long-term had mild renal impairment and a high abnormal rate of urinaryβ2-MG,which was a biomarker with high application value for detecting and monitoring TDF-related renal tubular toxicity.

关 键 词：艾滋病病毒感染者 艾滋病 替诺福韦酯 肾功能 Β2微球蛋白 

分 类 号：R512.91[医药卫生—内科学]