23例抗反转录病毒治疗引起脂肪增生临床特点
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摘要
目的探讨抗反转录病毒治疗(ART)引起脂肪增生的临床特点。方法选择该院2017年1月至2018年6月住院发生的ART后脂肪增生患者23例,就诱导药物、临床表现、危险因素和治疗等进行分析。结果常见的药物为司他夫定、拉米夫定和洛匹那韦利托那韦;主要表现为项背部脂肪增生,进行性增大,23例脂肪增生患者中17例(73.91%)表现为项背部脂肪异常增生,3例(13.04%)背部肿物,乳房脂肪增生、腋窝脂肪增生及双上肢数个脂肪瘤各1例(4.35%);23例患者中合并2型糖尿病6例(26.09%)、高血压6例(26.09%)、脂肪肝5例(21.74%)、高脂血症5例(21.74%)。大部分经过对症治疗后病情稳定;2例(8.70%)复发,分别于3、4年后行二次手术治疗。结论长期ART后可出现脂肪增生,在其治疗过程中应定期监测患者血脂、血糖水平。
Objective To analyze the clinical characteristics of lipidosis caused by antiretroviral therapy(ART).Methods 23 patients with lipidosis from January 2017 to June 2018 were collected which were analyzed for related drugs,clinical manifestations,risk factors and treatments.Results The common drugs were Stavudine,lamivudine and lopinavirinadone;mainly manifested as the back fat hyperplasia,progressive enlargement,of 23 patients with fat hyperplasia 17 cases(73.91%)showed abnormal hyperplasia of the back,3 cases(13.04%)of back mass,breast fat hyperplasia,axillary fat hyperplasia and several upper lip muscles 1 case(4.35%)each;6 cases(26.09%)of type 2 diabetes,6 cases(26.09%)of hypertension,5 cases(21.74%)of fatty liver,5 cases(21.74%)of hyperlipidemia.Most of them were stable after symptomatic treatment;2 cases(8.70%)of recurrence,secondary surgery after 3 and 4 years respectively.Conclusion Lipidosis will occurs after long-term ART.Blood lipid and blood glucose levels should be monitored regularly during the treatment.
Objective To analyze the clinical characteristics of lipidosis caused by antiretroviral therapy(ART).Methods 23 patients with lipidosis from January 2017 to June 2018 were collected which were analyzed for related drugs,clinical manifestations,risk factors and treatments.Results The common drugs were Stavudine,lamivudine and lopinavirinadone;mainly manifested as the back fat hyperplasia,progressive enlargement,of 23 patients with fat hyperplasia 17 cases(73.91%)showed abnormal hyperplasia of the back,3 cases(13.04%)of back mass,breast fat hyperplasia,axillary fat hyperplasia and several upper lip muscles 1 case(4.35%)each;6 cases(26.09%)of type 2 diabetes,6 cases(26.09%)of hypertension,5 cases(21.74%)of fatty liver,5 cases(21.74%)of hyperlipidemia.Most of them were stable after symptomatic treatment;2 cases(8.70%)of recurrence,secondary surgery after 3 and 4 years respectively.Conclusion Lipidosis will occurs after long-term ART.Blood lipid and blood glucose levels should be monitored regularly during the treatment.
引文
[1]MALLON P W,MILLER J,COOPER D A,et al.Prospective evaluation of the effects of antiretroviral therapy on body composition in HIV-1-infected men starting therapy[J].AIDS,2003,17(7):971-979.
[2]HEATH K V,HOGG R S,CHAN K J,et al.Lipodystrophy-associated morphological,cholesterol and triglyceride abnormalities in a population-based HIV/AIDS treatment database[J].AIDS,2001,15(2):231-239.
[3]齐唐凯,卢洪洲.艾滋病相关代谢综合征及其治疗[J].世界临床药物,2012,33(3):137-139.
[4]Study of Fat Redistribution and Metabolic Change in HIVInfection(FRAM).Fat distribution in women with HIVinfection[J].J Acquir Immune Defic Syndr,2006,42(5):562-571.
[5]HUSSAIN I,GARG A.Lipodystrophy syndromes[J].Endocrinol Metab Clin North Am,2016,45(4):783-797.
[6]MARTINEZ E,MOCROFT A,GARCA-VIEJO M A,et al.Risk of lipodystrophy in HIV-1-infected patients treated with protease inhibitors:aprospective cohort study[J].Lancet,2001,357(9256):592-598.
[7]LAKE J E,MCCOMSEY G A,HULGAN T,et al.Switch to raltegravir from protease inhibitor or nonnucleoside reverse-transcriptase inhibitor does not reduce visceral fat in human immunodeficiency virus-infected women with central adiposity[J].Eur J Cult Policy,2015,2(2):341-358.
[8]MULLIGAN K,TAI V W,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.
[9]DONG K L,BAUSSERMAN L L,FLYNN M M,et al.Changes in body habitus and serum lipid abnormalities in HIV-positive women on highly active antiretroviral therapy(HAART)[J].J Acquir Immune Defic Syndr,1999,21(2):107-113.
[10]HOFFMANN C,ROCKSTROH J K,KAMPS B S.艾滋病诊疗学[M].张福杰,尚红,吴昊,译.北京:人民卫生出版社,2009.
[11]GRINSPOON S,CARR A.Cardiovascular risk and bodyfat abnormalities in HIV-infected adults[J].N Engl JMed,2005,352(1):48-62.
[12]BARBARO G.Highly active antiretroviral therapy-associated metabolic syndrome:pathogenesis and cardiovascular risk[J].Am J Ther,2006,13(3):248-260.
[13]金永梅,陈建华,于闵,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.
[14]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.
[15]LAUENROTH-MAI E,SCHLOTE F.HIV-associated lipodystrophy syndrome:LioN-HAART cohort:(lipodystrophy in patients on nucleoside-based HAART).Highly active antiretroviral therapy[J].J Acquir Immune Defic Syndr,2002,31(2):253-255.
[2]HEATH K V,HOGG R S,CHAN K J,et al.Lipodystrophy-associated morphological,cholesterol and triglyceride abnormalities in a population-based HIV/AIDS treatment database[J].AIDS,2001,15(2):231-239.
[3]齐唐凯,卢洪洲.艾滋病相关代谢综合征及其治疗[J].世界临床药物,2012,33(3):137-139.
[4]Study of Fat Redistribution and Metabolic Change in HIVInfection(FRAM).Fat distribution in women with HIVinfection[J].J Acquir Immune Defic Syndr,2006,42(5):562-571.
[5]HUSSAIN I,GARG A.Lipodystrophy syndromes[J].Endocrinol Metab Clin North Am,2016,45(4):783-797.
[6]MARTINEZ E,MOCROFT A,GARCA-VIEJO M A,et al.Risk of lipodystrophy in HIV-1-infected patients treated with protease inhibitors:aprospective cohort study[J].Lancet,2001,357(9256):592-598.
[7]LAKE J E,MCCOMSEY G A,HULGAN T,et al.Switch to raltegravir from protease inhibitor or nonnucleoside reverse-transcriptase inhibitor does not reduce visceral fat in human immunodeficiency virus-infected women with central adiposity[J].Eur J Cult Policy,2015,2(2):341-358.
[8]MULLIGAN K,TAI V W,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.
[9]DONG K L,BAUSSERMAN L L,FLYNN M M,et al.Changes in body habitus and serum lipid abnormalities in HIV-positive women on highly active antiretroviral therapy(HAART)[J].J Acquir Immune Defic Syndr,1999,21(2):107-113.
[10]HOFFMANN C,ROCKSTROH J K,KAMPS B S.艾滋病诊疗学[M].张福杰,尚红,吴昊,译.北京:人民卫生出版社,2009.
[11]GRINSPOON S,CARR A.Cardiovascular risk and bodyfat abnormalities in HIV-infected adults[J].N Engl JMed,2005,352(1):48-62.
[12]BARBARO G.Highly active antiretroviral therapy-associated metabolic syndrome:pathogenesis and cardiovascular risk[J].Am J Ther,2006,13(3):248-260.
[13]金永梅,陈建华,于闵,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.
[14]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.
[15]LAUENROTH-MAI E,SCHLOTE F.HIV-associated lipodystrophy syndrome:LioN-HAART cohort:(lipodystrophy in patients on nucleoside-based HAART).Highly active antiretroviral therapy[J].J Acquir Immune Defic Syndr,2002,31(2):253-255.