艾滋病抗病毒治疗引起脂肪营养不良综合征回顾性分析
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摘要
目的分析艾滋病抗反转录病毒治疗(ART)引起脂肪营养不良的临床特点。方法选择某医院2017年1—12月,住院发生114例艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的脂肪营养不良综合征,对临床表现、危险因素和治疗等进行分析。结果 ART引起的114例脂肪营养不良综合征病人表现为四肢和面部的脂肪萎缩43例(37.72%)、项背部脂肪增生18例(15.79%)及脂肪肝、高脂血症和糖尿病等糖、脂代谢异常53例(46.49%)。脂肪萎缩的危险因素为使用司坦夫定、齐多夫定和ART时间长[(5.31±1.87)年];脂肪沉积的危险因素为女性、HIV感染病程长[(11.83±1.98)年]和ART时间长[(6.93±2.37)年]。89例(78.07%)经过对症治疗后病情稳定,2例脂肪沉积切除后复发。结论脂肪营养不良综合征表现为脂肪萎缩、脂肪沉积和糖脂代谢异常,临床表现和危险因素各不相同,长期ART应定期监测血脂和血糖水平。
Objective To analyze clinical characteristics of lipodystrophic syndromes caused by antiretroviral therapy(ART).Methods 114 cases of lipodystrophic syndromes were collected from January 2017 to December2017,and the clinical manifestations,risk factors and treatment were analyzed.Results Out of 114 cases of lipodystrophic syndromes caused by ART,18 cases(15.79%)were lipidosis at the back of neck,43 cases(37.72%)were lipoatrophy in the limbs and face,and 53 cases(46.49%)were abnormal glucose and lipid metabolic disorder,such as hyperlipidemia of fatty liver and diabetes mellitus.The risk factors of lipoatrophy included use of stavudine,zidovudine and long-time of ART(5.31±1.87 years).The risk factors for lipidosis included being female,long-time of HIV infection(11.83±1.98 years)and long-time of ART(6.93±2.37 years).89 cases(78.07%)were stable after symptomatic treatment,and 2 cases of lipidosis recurred after resection.Conclusion Lipodystrophic syndromes is characterized by lipidosis,lipoatrophy,abnormal glucose and lipid metabolic disorder,of which the clinical manifestations and risk factors for each are different.Blood lipid and blood glucose should be monitored regularly for those receiving long-time ART.
Objective To analyze clinical characteristics of lipodystrophic syndromes caused by antiretroviral therapy(ART).Methods 114 cases of lipodystrophic syndromes were collected from January 2017 to December2017,and the clinical manifestations,risk factors and treatment were analyzed.Results Out of 114 cases of lipodystrophic syndromes caused by ART,18 cases(15.79%)were lipidosis at the back of neck,43 cases(37.72%)were lipoatrophy in the limbs and face,and 53 cases(46.49%)were abnormal glucose and lipid metabolic disorder,such as hyperlipidemia of fatty liver and diabetes mellitus.The risk factors of lipoatrophy included use of stavudine,zidovudine and long-time of ART(5.31±1.87 years).The risk factors for lipidosis included being female,long-time of HIV infection(11.83±1.98 years)and long-time of ART(6.93±2.37 years).89 cases(78.07%)were stable after symptomatic treatment,and 2 cases of lipidosis recurred after resection.Conclusion Lipodystrophic syndromes is characterized by lipidosis,lipoatrophy,abnormal glucose and lipid metabolic disorder,of which the clinical manifestations and risk factors for each are different.Blood lipid and blood glucose should be monitored regularly for those receiving long-time ART.
引文
[1]张福杰,尚红,吴昊.艾滋病诊疗学[M].北京:人民教育出版社,2007.
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[3]Heath KV,Hogg RS,Chan KJ,et al.Lipodystrophy-associated morphological,cholesterol and triglyceride abnormalities in a population-based HIV/AIDStreatment database[J].AIDS,2001,15(2):231-239.
[4]Martinez E,Mocroft A,García-Viejo MA,et al.Risk of lipodystrophy in HIV-1-infected patients treated with protease inhibitors:aprospective cohort study[J].Lancet,2001,357(9256):592-598.
[5]Mary-Krause M,Cotte L,Simon A,et al.Increased risk of myocardial infarction with duration of protease inhibitor therapy in HIV-infected men[J].AIDS,2003,17(17):2479-2486.
[6]Hussain I,Garg A.Lipodystrophy Syndromes[J].Endocrinol Metab Clin North Am,2016,45(4):783-797.
[7]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中国实用内科杂志,2018,38(4):292-343.
[8]中国成人血脂异常防治指南修订联合委员会中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-953.
[9]Mulligan K,Tai VW,Algren H,et al.Altered fat distribution in HIV-positive men on nucleoside analog reverse transcriptase inhibitor therapy[J].J Acquir Immune Defic Syndr,2001,26(5):443-448.
[10]金永梅,陈建华,于阂,等.经高效抗反转录病毒治疗的艾滋病患者脂肪营养不良的临床观察[J].中国社区医师,2016,32(5):77-78.
[11]Gallant JE,Staszewski S,Pozniak AL,et al.Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients:a 3-year randomized trial[J].JAMA,2004,292(2):191-201.
[12]Pérez-Molina JA,Domingo P,Martínez E,et al.The role of efavirenz compared with protease inhibitors in the body fat changes associated withhighly active antiretroviral therapy[J].J Antimicrob Chemother,2008,62(2):234-245.
[13]中华医学会感染病分会艾滋病学组.艾滋病诊疗指南[J].中华临床感染病杂志,2015,8(5):385-401.
[14]Brown TT,Chu H,Wang Z,et al.Longitudinal increases in waist circumference are associated with HIV-serostatus,independent of antiretroviral therapy[J].AIDS,2007,21(13):1731-1738.
[15]Lichtenstein KA,Ward DJ,Moorman AC,et al.Clinical assessment of HIV-associated lipodystrophy in an ambulatory population[J].AIDS,2001,15(11):1389-1398.
[16]McDermott AY,Terrin N,Wanke C,et al.CD4+cell count,viral load,and highly active antiretroviral therapy use are independent predictors of body composition alterations in HIV-infected adults:a longitudinal study[J].Clin Infect Dis,2005,41(11):1662-1670.
[17]Panel on Antiretroviral Guidelines for Adults and Adolescents.Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescent s[EB/OL].Department of Health and Human Services.Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.
[2]Mallon PW,Miller J,Cooper DA,et al.Prospective evaluation of the effects of antiretrviral therapy on body composition in HIV-1-infected men starting therapy[J].AIDS,2003,17(7):971-979.
[3]Heath KV,Hogg RS,Chan KJ,et al.Lipodystrophy-associated morphological,cholesterol and triglyceride abnormalities in a population-based HIV/AIDStreatment database[J].AIDS,2001,15(2):231-239.
[4]Martinez E,Mocroft A,García-Viejo MA,et al.Risk of lipodystrophy in HIV-1-infected patients treated with protease inhibitors:aprospective cohort study[J].Lancet,2001,357(9256):592-598.
[5]Mary-Krause M,Cotte L,Simon A,et al.Increased risk of myocardial infarction with duration of protease inhibitor therapy in HIV-infected men[J].AIDS,2003,17(17):2479-2486.
[6]Hussain I,Garg A.Lipodystrophy Syndromes[J].Endocrinol Metab Clin North Am,2016,45(4):783-797.
[7]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中国实用内科杂志,2018,38(4):292-343.
[8]中国成人血脂异常防治指南修订联合委员会中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-953.
[9]Mulligan K,Tai VW,Algren H,et al.Altered fat distribution in HIV-positive men on nucleoside analog reverse transcriptase inhibitor therapy[J].J Acquir Immune Defic Syndr,2001,26(5):443-448.
[10]金永梅,陈建华,于阂,等.经高效抗反转录病毒治疗的艾滋病患者脂肪营养不良的临床观察[J].中国社区医师,2016,32(5):77-78.
[11]Gallant JE,Staszewski S,Pozniak AL,et al.Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients:a 3-year randomized trial[J].JAMA,2004,292(2):191-201.
[12]Pérez-Molina JA,Domingo P,Martínez E,et al.The role of efavirenz compared with protease inhibitors in the body fat changes associated withhighly active antiretroviral therapy[J].J Antimicrob Chemother,2008,62(2):234-245.
[13]中华医学会感染病分会艾滋病学组.艾滋病诊疗指南[J].中华临床感染病杂志,2015,8(5):385-401.
[14]Brown TT,Chu H,Wang Z,et al.Longitudinal increases in waist circumference are associated with HIV-serostatus,independent of antiretroviral therapy[J].AIDS,2007,21(13):1731-1738.
[15]Lichtenstein KA,Ward DJ,Moorman AC,et al.Clinical assessment of HIV-associated lipodystrophy in an ambulatory population[J].AIDS,2001,15(11):1389-1398.
[16]McDermott AY,Terrin N,Wanke C,et al.CD4+cell count,viral load,and highly active antiretroviral therapy use are independent predictors of body composition alterations in HIV-infected adults:a longitudinal study[J].Clin Infect Dis,2005,41(11):1662-1670.
[17]Panel on Antiretroviral Guidelines for Adults and Adolescents.Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescent s[EB/OL].Department of Health and Human Services.Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.