86例HIV感染患者的肾功能状态与危险因素分析

目的：分析HIV患者肾功能状态与危险因素，深化对该人群肾损害风险的认识。方法收集HIV患者临床资料，包含年龄、性别、高血压和糖尿病病史、感染途径、抗逆转录病毒治疗（ ART）等，检测血常规，完善外周血CD4淋巴细胞计数、乙肝表面抗原定性、抗丙型肝炎病毒抗体定性和HIV?RNA定量分析，运用血肌酐值估算肾小球滤过率（ eGFR），Logistic回归分析各因素与肾功能状态的相关关系。结果86例黑人HIV患者，女性20例（23．3％），年龄（45．3±10．7）岁，eGFR水平（74．9±23．4）mL／（min·1．73m2）。肾功能损害25例，肾功能正常61例。肾功能损害组患者年龄、高血压与糖尿病比例、WHO临床分期和基线HIV?RNA定量均显著高于肾功能正常组患者，而Hb、入院CD4淋巴细胞计数和eGFR水平均显著低于肾功能正常组患者（P均＜0．05）。肾功能正常组含替诺福韦（TDF）方案的患者eGFR水平显著低于未含 TDF方案的患者（P＜0．05）。多因素Logistic回归分析显示HIV患者肾功能损害的独立相关因素为年龄≥50岁、合并糖尿病和WHO临床分期。结论除传统危险因素外，HIV感染及某些ART药物均可能与HIV患者肾功能损害有关。

Risk factors for abnormal renal function in HIV-positive individuals

Objective To evaluate the prevalence and risk factors for impaired renal function in HIV?positive population. Methods A cross?sectional study of HIV?positive patients was conducted. Baseline clinical characteristics such as gender, age, dia?betes, blood pressure, route of transmission, antiretroviral therapy ( ART ) regimens were obtained. Serum creatinine, hemoglobin ( Hb) , CD4 lymphocytes( CD4 cell) counts, HBV antigen, HCV antibody, and viral load were measured by standard laboratory tech?niques. Estimated glomerular filtration rate ( eGFR) was calculated using the Modification of Diet and in Renal Disease ( MDRD) e?quation. Risk factors for abnormal renal function, as defined by eGFR<60 mL/(min·1.73m2) were assessed by Logistic regression model. Results A total of 86 patients were recruited, among them 25 patients with impaired renal function and 61 patients with normal renal function. There were 20(23.3%) female patients. The mean age was (45.3±10.7) years. The mean eGFR was (74.9±23.4) mL/( min·1.73m2 ) . Age, prevalence of hypertension and diabetes, WHO clinical stage and baseline HIV?RNA load were significantly higher in the patients with abnormal renal function, while Hb levels, admission CD4 cell counts and eGFR levels were lower in the patients with abnormal renal function( all P<0.05) . eGFR levels in individuals with normal renal function and exposure to tenofovir were significant lower than those without exposure ( P<0.05) . Multivariate logistic regression revealed older age, diabetes mel?litus and WHO clinical stage were associated with impaired renal function. Conclusion Both traditional and HIV?related risk factors ( HIV infection, ART regimens that included tenofovir) were associated with impaired renal function in HIV?positive patients.