河南省接受抗病毒治疗人类免疫缺陷病毒感染/艾滋病患者合并肾损伤的横断面研究  

A cross-sectional study of renal injury in human immunodeficiency virus infection/acquired immunodeficiency syndrome patients after antiviral therapy in Henan Province

作　　者：杨萱[1] 崔中锋 刘朝阳[3] 张林 李全喜 牛玉姣 张雪[7] 张晓华[7] 陈昭云 李琼[8] 刘金瑾 孙燕[1] Yang Xuan;Cui Zhongfeng;Liu Chaoyang;Zhang Lin;Li Quanxi;Niu Yujiao;Zhang Xue;Zhang Xiaohua;Chen Zhaoyun;Li Qiong;Liu Jinjin;Sun Yan(Department of Infectious Diseases II,Zhengzhou University Affiliated Infectious Disease Hospital,Henan Provincial Infectious Disease Hospital,Zhengzhou Sixth People′s Hospital,Zhengzhou 450015,China;Department of Clinical Laboratory,Zhengzhou University Affiliated Infectious Disease Hospital,Henan Provincial Infectious Disease Hospital,Zhengzhou Sixth People′s Hospital,Zhengzhou 450015,China;Department of Infectious Diseases,Anyang Fifth People′s Hospital,Anyang 455000,China;Department of Infectious Diseases III,Hebi Third People′s Hospital,Hebi 458000,China;Infection and Immunity Clinic,Luo Yang Zhoushan Hospital,Luoyang 471003,China;Department of Infectious Diseases,Lankao Central Hospital,Kaifeng 475300,China;Infection and Immunity Clinic,Zhengzhou University Affiliated Infectious Disease Hospital,Henan Provincial Infectious Disease Hospital,Zhengzhou Sixth People′s Hospital,Zhengzhou 450015,China Zhang Xiaohua Infection and Immunity Clinic,Zhengzhou University Affiliated Infectious Disease Hospital,Henan Provincial Infectious Disease Hospital,Zhengzhou Sixth People′s Hospital,Zhengzhou 450015,China;Clinical Medical Research Center,Zhengzhou University Affiliated Infectious Disease Hospital,Henan Provincial Infectious Disease Hospital,Zhengzhou Sixth People′s Hospital,Zhengzhou 450015,China;Translational Medicine Research Center,Zhengzhou University Affiliated Infectious Disease Hospital,Henan Provincial Infectious Disease Hospital,Zhengzhou Sixth People′s Hospital,Zhengzhou 450015,China)

机构地区：[1]郑州大学附属传染病医院河南省传染病医院郑州市第六人民医院感染二科,郑州450015 [2]郑州大学附属传染病医院、河南省传染病医院、郑州市第六人民医院医学检验科,郑州450015 [3]安阳市第五人民医院感染科,安阳455000 [4]鹤壁市第三人民医院感染三科,鹤壁458000 [5]洛阳市周山医院感染与免疫门诊,洛阳471003 [6]兰考县中心医院感染性疾病科,开封475300 [7]郑州大学附属传染病医院、河南省传染病医院、郑州市第六人民医院感染与免疫门诊,郑州450015 [8]郑州大学附属传染病医院、河南省传染病医院、郑州市第六人民医院临床医学研究中心,郑州450015 [9]郑州大学附属传染病医院、河南省传染病医院、郑州市第六人民医院医学转化中心,郑州450015

出　　处：《中华传染病杂志》2024年第7期395-402,共8页Chinese Journal of Infectious Diseases

基　　金：河南省重点研发与推广专项(232102311081)。

摘　　要：目的了解河南省接受抗病毒治疗人类免疫缺陷病毒(HIV)感染/艾滋病合并肾损伤患者的临床特征,探讨其肾损伤的危险因素。方法采用横断面调查法,纳入河南省郑州市第六人民医院、安阳市第五人民医院、鹤壁市第三人民医院、洛阳市周山医院、兰考县中心医院2023年4月1日至9月30日管理的接受抗病毒治疗HIV感染/艾滋病患者。收集患者基本资料、抗病毒治疗方案及合并疾病等临床信息,以及实验室检查结果[血尿素氮、血肌酐、血尿酸、尿常规、尿微量白蛋白、尿α1-微球蛋白(α1-MG)、尿β2-微球蛋白(β2-MG)、尿视黄醇结合蛋白(RBP)、尿肌酐、HIV病毒载量、CD4^(+)T淋巴细胞计数]。采用多因素二元logistic回归分析肾损伤独立危险因素。结果共纳入2526例HIV感染/艾滋病患者,年龄为(45.52±14.28)岁,男2156例(85.4%),传播途径以性传播为主(91.6%,2314/2526),抗病毒治疗时间为5.00(2.92,8.00)年。治疗方案使用替诺福韦+拉米夫定+非核苷类反转录酶抑制剂(NNRTI)占55.3%(1396/2526)。HIV病毒载量<50拷贝/mL者占93.0%(2350/2526),CD4^(+)T淋巴细胞计数为476(337,645)/μL。156例(6.2%)患者合并乙型肝炎和(或)丙型肝炎,205例(8.1%)合并糖尿病,379例(15.0%)合并高脂血症,189例(7.5%)合并高尿酸血症。通过联合检测发现肾损伤患者1040例(41.2%),其中355例(14.1%)表现为估算肾小球滤过率(eGFR)<60 mL/(min·1.73 m^(2))或尿蛋白阳性或尿微量白蛋白/尿肌酐比(UACR)≥30 mg/g,682例(27.0%)为尿α1-MG、尿β2-MG、尿RBP任一项阳性的单纯肾小管损伤。eGFR<60 mL/(min·1.73 m^(2))者71例(2.8%),eGFR为60~89 mL/(min·1.73 m^(2))者509例(20.2%),eGFR≥90 mL/(min·1.73 m^(2))者1946例(77.0%)。发现合并慢性肾脏病(CKD)患者138例(5.5%),其中CKD 1至2期110例(79.7%),尿白蛋白A2级117例(84.8%)。对eGFR<60 mL/(min·1.73 m^(2))或尿蛋白阳性或UACR≥30 mg/g的355例肾损伤患者进行多因素分析显示,年龄�ObjectiveTo understand the clinical characteristics of human immunodeficiency virus(HIV)infection/acquired immunodeficiency syndrome(AIDS)patients with renal injury after antiviral therapy in Henan Province,and to explore the risk factors of renal injury.MethodsA cross-sectional study was conducted to investigate HIV infection/AIDS patients receiving antiviral therapy in Zhengzhou Sixth People′s Hospital,Anyang Fifth People′s Hospital,Hebi Third People′s Hospital,Luo Yang Zhoushan Hospital and Lankao Central Hospital in Henan Province from April 1 to September 30,2023.The clinical information including basic data,antiviral therapy regimens and comorbidities,and laboratory test results(blood urea nitrogen,serum creatinine,blood uric acid,urine routine,urine microalbumin,urineα1-microglobulin(α1-MG),urineβ2-microglobulin(β2-MG),urine retinol binding protein(RBP),urine creatinine,HIV viral load,CD4^(+)T lymphocyte count)were collected.Multivariate binary logistic regression was used to analyze independent risk factors for renal injury.ResultsA total of 2526 HIV infection/AIDS patients were included,with the age of(45.52±14.28)years and 2156(85.4%)males.The main route of transmission was sexual transmission(91.6%,2314/2526).The duration of antiviral therapy was 5.00(2.92,8.00)years.Tenofovir(TDF)+lamivudine(3TC)+non-nucleoside reverse transcriptase inhibitors(NNRTI)accounted for 55.3%(1396/2526)of the current antiviral therapy regimen.The percentage of HIV viral load<50 copies/mL was 93.0%(2350/2526).The CD4^(+)T lymphocyte count was 476(337,645)/μL.There were 156 patients(6.2%)complicated with hepatitis B and/or hepatitis C,205 patients(8.1%)with diabetes,379 patients(15.0%)with hyperlipidemia,and 189 patients(7.5%)with hyperuricemia.A total of 1040 patients(41.2%)with renal injury were found through renal function test,including 355 cases(14.1%)with estimated glomerular filtration rate(eGFR)<60 mL/(min·1.73 m^(2))or urine protein positive or urine albumin creatine ratio(UACR)≥30 mg/g,682 patients(27.

关 键 词：人类免疫缺陷病毒 横断面研究 抗病毒治疗后 肾损伤 

分 类 号：R512.91[医药卫生—内科学]