23例HIV/AIDS病人HAART致乳酸酸中毒临床分析

目的探讨艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人在高效抗反转录病毒治疗(HAART)过程中,出现乳酸酸中毒的情况,其临床表现、诊断、治疗和预后,以进一步采取预防措施,降低其发生率和致死率。方法采用回顾性分析的方法,分析HAART时间及不同方案发生乳酸酸中毒的情况。结果 2010年1月-2011年8月收治的住院病人中,已经进行HAART的共1 115例,出现高乳酸血症者74例,占6.64%;发生乳酸酸中毒的病人23例,发生率2.06%。所有发生乳酸酸中毒的病人都采用含司他夫定(D4T)的方案。经过综合治疗的18例治愈,死亡5例,总死亡率21.74%(5/23)。HAART 6个月以上及应用含D4T方案的病人发生率最高,为4.41%(23/521)。结论乳酸酸中毒的发生率虽低,致死率高,且临床表现多不典型,易被误诊、漏诊;危险因素包括肥胖、女性、合并HCV应用干扰素利巴韦林治疗的病人、以及同时合并其他机会性感染病人等。

The clinical report of 23 cases of HAART-related lactic acidosis in HIV/AIDS patients

Objective To investigate the lactic acidosis in Human immunodeficiency virus(HIV)/Acquired immune deficiency syndrome(AIDS)patients in the process of highly active antiretroviral therapy(HAART),and its possible clinical manifestations,diagnosis,treatment and prognosis,so as to take preventive measures to reduce its incidence and mortality.Methods Clinical data of the HIV/AIDS cases with hyperlactacidemia or lactic acidosis in different stages and different schemes of HAART were retrospectively analyzed.Results Of the 1 115 hospitalized HIV/AIDS cases receiving HAART from January 2010 to August 2011,74 were complicated with hyperlactacidemia,accounting for 6.64%(74/1 115),and 23 with lactic acidosis,accounting for 2.06%(23/1 115).All cases with lactic acidosis took therapeutic scheme containing stavudine(D4T).After treatment,18 cases were cured,5 cases died.The total mortality was 21.74%(5/23).The highest incidence was 4.41%(23/521) in patients receiving HAART for more than 6 months and taking D4T.Conclusion The incidence of lactic acidosis was low,but the fatality rate was high,and the clinical manifestations was not typical,and misdiagnosed and missed diagnosis were rather common.The risk factors for lactic acidosis included obesity,femininity,co-infection with HCV,treatment with interferon ribavirin,and complications with opportunistic infections.