高效抗逆转录病毒治疗对艾滋病患者机体代谢的影响

目的探讨高效抗逆转录病毒治疗（HAART）后艾滋病患者代谢状态的临床及流行病学特征。方法选择本院收治的HAART后的高脂血症艾滋病患者42例与未经HAART治疗的艾滋病患者41例,就基线血脂水平、高脂血症类型、心血管事件的风险、非酒精性脂肪肝、高血压、高血糖、代谢综合征以及心脏结构和功能进行横断面研究,对两组患者的上述指标进行比较。结果在艾滋病患者未进行HAART治疗组中,血脂异常以高密度脂蛋白（HDL）降低为主（24.32%）,14.63%（6/41）患者评估为心血管病事件低危组;在HAART治疗组中,临床分型以混合性高脂血症为主,其中高TG＋高TC血症者占42.86%,高TG＋高TC＋低HDL血症者占11.90%,高TG＋低HDL血症者占23.81%,35.71%的患者评估为心血管病事件低危组,中危和高危组患者各占11.90%。HAART治疗组与未治疗组患者中,非酒精性脂肪肝（NAFLD）比例分别为78.58%和4.88%;分别有1例（2.44%）和16例（38.10%）患者诊断为代谢综合征;分别有19.05%和21.95%的患者出现心脏舒张功能减退。结论在未治疗的艾滋病患者中,血脂异常以低HDL血症为主,部分患者出现非酒精性脂肪肝、高血压、糖尿病、代谢综合征和心脏舒张功能不全等的临床表现;随着HAART的应用,血脂异常向混合高脂血症转化,且心血管事件的危险性明显增加,代谢综合征的临床特征表现得更加明显。本研究结果提示,艾滋病患者在HAART治疗前后应检测引起代谢综合征和心血管事件的危险因素,以便早期进行干预治疗。

Analysis on metabolic consequences in patients with HIV infection after highly active antiretrovirus therapy

Objective To discuss the metabolic consequences in patients with HIV infection after highly active antiretrovirus therapy（HAART）.Methods Clinical data of 42 patients with HIV infection treated with HAART and 41 patients with HIV infection without HAART had been collected and studied.Cross-sectional study on clinical features,hyperlipemia,nonalcoholic fatty liver disease（NAFLD）,hypertension,hyperglycaemia,cardiac structure and functions were carried out.Results AIDS patients without HAART mainly manifested HDL reduced in lipid metabolism,14.63% of whom were evaluated to occur low-risk cardiovascular events.AIDS patients with HAART manifested mixed hyperlipemia and the rate of high TG and TC was 42.86%,high TG and TC and low HDL occured 11.90% and high TG and low HDL occured 23.81%;35.17% patients were evaluated to occur low-risk cardiovascular events,and the rates of moderate-risk and high-risk cardiovascular events were both 11.90%,respectively.In the groups of patients with HAART and without HAART,prevalence of NAFLD were 78.58% and 4.88%;LDL in 16.67% and 12.20% cases in AIDS patients with and without HAART were abnormal,while HDL in 35.71% and 34.15% of the cases were reduced significantly;19.05% and 21.95% of AIDS patients with and without HAART manifested diastolic dysfunction.Conclusions Some patients with HIV infection without HAART manifested clinical features of metabolic syndrome,such as hyperlipemia,NAFLD,hypertension,hyperglycaemia and diastolic dysfunction.As HAART being applied,more patients with HIV infection manifests metabolic conditions alterations,which indicated that among patients with or without HAART,risk factors causing metabolic syndrome should be regularly supervised for early intervention and treatment.