摘要
目的应用DXA对男性HIV/AIDS初治患者不同HAART方案体成分变化特点进行测量分析
材料与方法收集2009年3月至2013年12月在我院接受HAART治疗的成年男性HIV感染患者77例,年龄20岁～71岁,平均(38.2±11.1)岁,按初始HAART方案：含司他夫定(d4T)方案、含齐多夫定(AZT)方案、含替诺福韦(TDF)方案不同分为d4T组、AZT组、TDF组。HAART方案另两种药物为拉米夫定(Lamivudine,3TC)和奈韦拉平(nevirapine, NVP)或依法韦仑(efavirenz, EFV),这两种药物在三组间相似。收集基线水平、1年、2年三组不同治疗方案患者基本资料、实验室检查、全身及局部体成分及腰椎、右髋部骨密度数据。
结果三组治疗方案中,d4T方案HIV-LD发生率最高,TDF方案发生率最低,d4T组LD的发生率与AZT组、TDF组间有显著性差异(P<0.05), d4T组LD的发生率大约是AZT组的2倍；治疗后d4T组与AZT组上肢、总脂肪量减低,治疗后2年较基线水平显著减低(P<0.05),治疗后1年、2年下肢脂肪量减少,较基线水平显著减低(P<0.05),TDF组全身及上下肢、躯干脂肪量较基线水平增加,未见显著差异(P>0.05),治疗后2年d4T组、AZT组方案与TDF组方案上下肢脂肪改变量间有显著差异(P<0.05)；多元线性回归分析显示,四肢脂肪量改变量与基线水平体重指数呈负相关,与基线水平病毒载量呈正相关；d4T、AZT组腰椎骨密度较基线水平未见显著差异(P>0.05),治疗后两年股骨颈、右全髋骨密度较基线水平有显著减少(P<0.05),治疗后1年、2年TDF组腰椎、股骨颈、右全髋骨密度较基线水平比较有显著减少(P<0.05),治疗后两年AZT组与TDF组间腰椎骨密度变化量有显著性差异(P<0.05)；股骨颈骨密度改变量、右全髋骨密度改变量与基线水平体重指数成负相关(r=-0.251,P=0.028；r=-0.239,p=0.036)。
结论三组治疗方案中,d4T方案HIV-LD发生率最高,TDF方案发生率最低,d4T组LD的发生率大约是AZT组的2倍；d4T组、AZT组全身及四肢脂肪量较基线水平减少,随时间延长减少量增加,TDF组全身及躯干、四肢脂肪量增加；三组不同治疗方案对骨密度的影响按解剖部位不同,骨密度不同程度减低,治疗后1年,TDF组骨密度较基线水平显著下降,治疗2年,与AZT组比较,TDF组腰椎骨密度下降显著：骨密度变化最明显发生在治疗后1年内。总之,DXA可客观评价不同治疗方案体成分及骨密度变化,有助于及时调整治疗方案,预防并发症的发生。
目的应用DXA分析男性HIV-LD患者HAART治疗方案由含司他夫定(d4T)方案转换为含齐多夫定(AZT)或替诺福韦(TDF)方案后,其体成分变化特点。
材料和方法选取2007年5月至2013年9月在我院接受HARRT(司他夫定)治疗的成年男性HIV-LD患者47例,并进行两次DXA扫描,两次DXA扫描最小间隔时间为12个月,根据d4T转换为含AZT或TDF方案不同分为两组：AZT组、TDF组,应用DXA分析两组体成分变化特点。
结果与基线水平比较,AZT组下肢肌量显著增加(t=2.781,95%C10.02-0.10,P<0.01),有统计学意义,下肢脂肪量减少,未见显著差异,无统计学意义(P=-0.05)；TDF组上肢脂肪量显著增加[(0.6±0.3)Kg、(1.0+0.7)Kg,t=2.422,95%CI0.04～0.74,P<0.05],下肢脂肪量显著增加[(1.8±0.8)Kg、(2.6±1.7)Kg,t=2.369,95%C10.08～1.66,P<0.05],有统计学意义；第二次DXA检查时,AZT组下肢脂肪量较基线水平减少了0.04Kg(4.55%),TDF组下肢脂肪量较基线水平增加了0.463Kg(27.41%),两组间下肢脂肪量变化量有统计学意义(U=2.954,P<0.01)。
结论DXA检查显示男性HIV-LD患者,TDF治疗方案与AZT治疗方案比较下肢脂肪量显著增加,TDF治疗方案较AZT治疗方案能明显改善HIV-LD。但AZT组与换药前比较HIV-LD未见加重,且肌量增加,所以目前临床上也用于替代d4T治疗。DXA可客观评价男性HIV-LD不同治疗方案的体质成分变化,有助于及时调整治疗方案。
Objective Objective To evaluate the characteristics of change in the body composition of HIV-infected male patients by Dual X-ray absorptiometry (DXA) under different HAART regimens.
Materials and methods Body composition was measured by DXA from77HIV-infected male patients who were on trentment-naive subjects, aged20-71years, mean age38.2±11.1years, from Mar.,2009to Dec.,2013.The patients were divided into3groups (d4T arm, AZT arm and TDF arm) according to whether they were contained d4T, AZT, or TDF. Lamivudine(3TC) and either nevirapine(NVP) or efavirenz(EFZ) were the other two drugs, which were contained in the antiretroviral regimens equally. The patients enrolled in HAART regimens, who were taking the DXA scan on the treatment of baseline,1year and2years. Data of laboratory tests, body composition, bone mineral density of the right hip and lumbar spine were collected.
Results HIV-infected male patients in d4T arm have the highest prevalence of lipodystrophy, and have the lowest prevalence of lipodystrophy in TDF arm. In the group of d4T arm, the prevalence of LD was twice as much as in AZT-containing regimes.There was a significant decrease in the Fat mass(FM) of total body and limbs after two years of HAART in the group of d4T and AZT arms(P<0.05), compared with baseline. In the group of TDF arm (P>0.05), there was no significant increase in the FM of limbs, compared with baseline. There was a significant increase in the FM of limbs in the group of TDF arm(P<0.05), compared with d4T arm and AZT arm, after two years' HAART. Multiple linear regression results showed that change of limbs FM had a negative correlation with BMI of baseline and had a positive correlation with viral load of baseline. In d4T and AZT arms, changes were generally small in lumbar bone mineral density (BMD)(P>0.05), compared with baseline. After2years HAART, there were significant decreases in the BMD of femoral neck and right hip (P<0.05); changes of spine and hip BMD decreases significantly in TDF arm (P<0.05), compared with baseline. There was a significant difference in median changes of spine BMD between AZT arm and TDF arm after2years HAART (P<0.05). Changes of femoral neck and right hip BMD were correlated negatively with the BMI in baseline(r=-0.251, P =0.028; r=-0.239, P=0.036, respectively).
Conclusions Conclusions HIV/AIDS male patients in d4T arm have high prevalence of LD, and have a lower prevalence of LD in TDF arm. The prevalence of LD in d4T arm was twice as much as AZT-containing regimes. In the d4T and AZT, the FM of total body and limbs decreases significantly, compared with baseline; and the amount of decrease was increasing with HAART over time; there was small increase in the FM in TDF arm. The study showed that the effect of HAART varies by different anatomic sites, different decrease of BMD. Compared with baseline, there was significant decrease of lumber BMD in TDF arm after1year HAART. There was significant decrease of lumber BMD in TDF arm, compared with AZT arm after2years HAART. The most obvious changes of BMD appeared in the first year of HAART. In conclusion, changes of BMD and body composition over time in male patients with different regimens can be evaluated by DXA, which contributes to the adjustment of the treatment regimens and prevention of complications.
Objective To evalute the changes of body composition in men patients with human immunodeficiency (HIV)-related lipodystrophy(LD) synodrome (HIV-LD) switching from stavudine(d4T) to zidovudine(AZT) or tenofovir(TDF) by Dual-Energy X-Ray Absorptiometry(DXA).
Methods Total47men with HIV-LD who had been exposed to stavudine(d4T) befor the first of two DXA assessments. After diagnosed HIV-LD, they received two different treatment regimens, AZT group:switching from d4T to zidovudine (AZT), TDF group: switching from d4T to TDF, changes of body composition in two groups evaluated by Dual-Energy X-Ray Absorptiometry (DXA).
Results Compared with baseline, lower limb lean mass showed a significant increase (t=2.781,95%CI0.02～0.10, P<0.01) and lower limb fat mass had a small decrease(P=0.05) in AZT group; In TDF group, There were significant increases in upper limb fat mass[(0.6±0.3)Kg、(1.0±0.7)Kg, t=2.422,95%CI0.04±0.74, P<0.05]and lower limb fat mass[(1.8±0.8)Kg、(2.6±1.7)Kg, t=2.369,95%CI0.08±1.66, P<0.05]. In AZT group, Changes from baseline were generally small in Lower limb fat mass,(median-0.04kg,-4.55%), In TDF group, increases above the baseline value in lower limb fat mass and percentage of lower limb fat gain were even greater(median0.463Kg,27.41%). In a visual comparison of DXA results between AZT and TDF recipients, more fat gain in the legs fat mass in patients who switched from d4T to TDF (U=2.954, P<0.01).
Conclusions Compared with AZT group, Switching from d4T to TDF led to more increases in legs fat mass. Replacing d4T with TDF resulted in improvement in lipodystrophy. But LD did not worsened and lean mass increased in AZT group, which can be replaced d4T in clinical treatment. Changes in body composition over time in men patients with HIV-LD can be evaluated by DXA, which contributes to the adjustment of the treatment regimens.
引文
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