HIV/AIDS患者长期高效抗逆转录病毒治疗后眼底动脉硬化发生及影响因素分析  

Analysis of occurrence and influencing factors of fundus arteriosclerosis in HIV/AIDS patients after long-term highly active antiretroviral therapy

作　　者：陈万 邹俊[2] 黄绍标[2] 李健玲[3] CHEN Wan;ZOU Jun;HUANG Shao-biao;LI Jian-ling(Guangxi Medical University,Nanning,Guangxi 530021,China;The Infectious Disease Hospital Affiliated to Guangxi Medical University(Nanning Fourth People's Hospital),Nanning,Guangxi 530023,China;The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi)

机构地区：[1]广西医科大学,广西南宁530021 [2]广西医科大学附属传染病医院(南宁市第四人民医院),广西南宁530023 [3]广西医科大学第一附属医院,广西南宁530021

出　　处：《中国热带医学》2023年第4期327-332,共6页China Tropical Medicine

基　　金：国家自然科学基金项目(No.81960087);广西自然科学基金项目(No.GXGPMC201908);广西医疗卫生适宜技术研究与开发项目(No.S2018078);广西卫生健康委计划项目(No.Z20211649)。

摘　　要：目的探讨HIV/AIDS患者长期高效抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)后眼底动脉硬化情况及影响因素。方法收集2020年1月—2022年6月南宁市第四人民医院收治的203例HIV/AIDS患者HAART前后临床基本资料和眼底检查资料,评估患者眼底动脉硬化发生情况,并对其影响因素进行分析。结果203例HIV/AIDS患者出现眼底动脉硬化159例,发生率为78.33%,其中Ⅰ级33例(20.75%)、Ⅱ级87例(54.72%)、Ⅲ级28例(17.61%)、Ⅳ级11例(6.92%);HAART前,眼底动脉硬化组及正常组患者CD4^(+)T淋巴细胞计数、CD8^(+)T淋巴细胞计数、病毒载量、白细胞计数、血小板计数、血红蛋白、血肌酐、血尿素氮、三酰甘油、总胆固醇、空腹血糖、谷丙转氨酶、谷草转氨酶及血清总胆红素两组间比较差异无统计学意义(P>0.05);在HAART 6个月后,动脉硬化组CD8^(+)T淋巴细胞计数、甘油三酯、空腹血糖值显著高于正常组,两者比较差异有统计学意义(P<0.05);在HAART 6个月后CD4^(+)、CD8^(+)淋巴细胞计数分层比较中,动脉硬化组CD4^(+)淋巴细胞计数(CD4^(+))<200个/μL患者比例显著高于正常组患者,CD4^(+)淋巴细胞计数CD4^(+)≥500个/μL患者比例显著低于正常组患者;而CD8^(+)淋巴细胞计数CD8^(+)≥800个/μL患者比例显著大于正常组(P均<0.05)。二元Logistic回归分析结果显示,机会性感染、HIV病程、HAART后CD4^(+)T、CD8^(+)T淋巴细胞计数及三酰甘油是影响HIV/AIDS患者发生眼底动脉硬化独立危险因素(P<0.05)。结论HIV/AIDS患者眼底动脉硬化发生率高,>4年HIV病程、合并机会性感染、HAART 6个月后较低的CD4^(+)T淋巴细胞计数,较高的CD8^(+)T淋巴细胞计数和三酰甘油值是患者发生眼底动脉硬化的独立危险因素。应对此类人群在HAART前后均需进行眼底筛查,针对心血管疾病风险,制定HAART方案,并在治疗过程中加强心血管疾病风险管理改善患者结局。Objective To investigate the fundus arteriosclerosis and its influencing factors in HIV/AIDS patients after long-term highly active antiretroviral therapy(HAART).Methods The clinical basic data and fundus examination data of 203 HIV/AIDS patients before and after HAART in the Fourth People's Hospital of Nanning from January 2020 to June 2022 were collected to evaluate the occurrence of fundus arteriosclerosis and analyze its influencing factors.Results Of the 203 HIV/AIDS patients,159 patients developed fundus arteriosclerosis,with an incidence of 78.33%,including 33 patients with gradeⅠ(20.75%),87 patients with gradeⅡ(54.72%),28 patients with gradeⅢ(17.61%),and 11 patients(6.92%)with GradeⅣ.Before HAART,there was no significant difference in CD4^(+)T lymphocyte count,CD8^(+)T lymphocyte count,viral load,white blood cell count,platelet count,hemoglobin,serum creatinine,blood urea nitrogen,triacylglycerol,total cholesterol,fasting blood glucose,alanine aminotransferase,aspartate aminotransferase and serum total bilirubin between the atherosclerosis group and normal group(P>0.05).After 6 months of HAART,CD8^(+)T lymphocyte count,triacylglycerol and fasting blood glucose in atherosclerosis group were significantly higher than those in normal group(P<0.05).In the stratified comparison of CD4^(+)and CD8^(+)lymphocyte counts after 6 months of HAART,the proportion of patients with CD4^(+)lymphocyte count(CD4^(+))<200(cells/μL)in the atherosclerosis group was significantly higher than that in the normal group;the proportion of patients with CD4^(+)lymphocyte count(CD4^(+))≥500(cells/μL)was significantly lower than that in the normal group;the proportion of patients with CD8^(+)lymphocyte count CD8^(+)≥800/μL was significantly higher than that in the normal group(all P<0.05).Binary logistic regression analysis showed that opportunistic infection,HIV course,CD4^(+)T,CD8^(+)T lymphocyte count after HAART and triglyceride were independent risk factors for ocular fundus atherosclerosis in HIV/AIDS patients(all

关 键 词：人类免疫缺陷病毒 获得性免疫缺陷综合征 眼底动脉硬化 心血管 

分 类 号：R512.91[医药卫生—内科学]