艾滋病患者HAART致高乳酸血症及乳酸酸中毒10例临床分析

Analysis on 10 AIDS Patients who have HAART which Occurred High Lactatemia and Lactic Acidosis

目的分析艾滋病患者高效抗逆转录病毒治疗(HAART)过程中出现高乳酸血症或乳酸酸中毒的病例特点,进一步认识HAART的毒副作用,探究处理办法。方法对本院2008年以来收治的10例正在接受HAART治疗的艾滋病患者的临床表现、HAART方案、服用时间、乳酸水平、阴离子间隙(AG)、酸碱值(pH值)及治疗转归进行分析。结果 10例患者服用的HAART方案主要是司他夫定(d4T)、拉米夫定(3TC)、奈韦拉平(NVP),服用时间均在8个月以上。主要临床表现为:乏力3例,食欲不振2例,恶心呕吐1例,双下肢麻木及疼痛5例,体重明显下降2例,且临床表现有交叉。乳酸2.7～10.8mmol/L,AG均升高,pH值<7.35的1例,其余均在正常范围。死亡3例,死亡原因主要是呼吸衰竭1例,循环衰竭2例;好转5例;自动出院2例。结论以d4T为主的HAART方案容易发生线粒体毒性,表现为高乳酸血症或乳酸酸中毒,一旦发生乳酸酸中毒,死亡率较高,因此应该重视HAART线粒体毒性的副作用,早发现,早治疗,以便改善患者预后。

Objective To retrospectively analyzed the case characteristics of high lactatemia and lactic acidosis in 10 HIV/AIDS patients who have HAART in Beijing Ditan hospital,so as to further understand side effects of HAART,and explore treatment methods.Methods A total of 10 HIV/AIDS inpatients since 2008 were enrolled.Clinical manifestation,HAART regimen,medication time,lactic level,anion gap（AG）,PH value and treatment outcome were retrospectively analyzed.Results These patients had the same HAART regimen,mainly including d4T,3TC and NVP,their medication time were much more 8 months.The main clinical manifestations were fatigue,loss of appetite,nausea and vomiting,numbness and pain in lower limbs,body weight decreased significantly,and multiple clinical manifestations might be seen in one patient;lactic level was between 2.7 and 10.8 mmol/L,AG were increased,only one patients whose PH value was less than 7.35,others were at the normal level.Three cases were dead,the cause of death were mainly respiratory failure and circulation failure.Five cases were improved,two cases were automatically discharged.Conclusion HAART regimen including d4T is easy to occur mitochondrial toxicity,which showed high lactatemia and lactic acidosis.Once occurred lactic acidosis,there is higher mortality.The side effects of HAART such as mitochondrial toxicity should be pay more affention so as to make early detection,early treatment,and improve patients＇ prognosis.