长期应用核苷类逆转录酶抑制剂对HIV／AIDS患者脂肪代谢的影响

The influence of long-term nucleotide reverse transcriptase inhibitors on lipids metabolism in HIV/ AIDS patients

目的探讨长期应用含核苷类逆转录酶抑制剂（NRTIs）的高效抗逆转录病毒治疗（HAART）对HIV／AIDs患者脂肪代谢的影响及相关因素。方法招募118例HIV／AIDs患者，其中未治疗组40例，治疗1—2年组37例，治疗〉5年组41例，以20名健康志愿者作为对照组。临床评估是否存在脂肪代谢障碍（LD）。经双能X线骨密度吸收仪（DxA）测量全身、躯干、上肢及下肢脂肪量（FM）。结果治疗〉5年组与治疗1—2年组患者临床评估LD发生率分别为51．2％和40．5％，组间比较差异无统计学意义。应用司他夫定（d4T）出现LD发生率（63．6％）为应用齐多夫定（AZT）者（26．5％）的2．4倍，差异有统计学意义（P=0．001）。DXA检测显示：治疗〉5年组患者全身及四肢FM[（9778±3758）g和上肢（960±449）g，下肢（2096±1141）g]均显著低于健康对照组[（13317±5825）g和上肢（2333±1422）g，下肢（3890±1567）g]、未治疗组[（14280±6416）g和上肢（1655±1251）g，下肢（4032±1822）g]及治疗1—2年组[（13750±5910）g和上肢（1220±634）g，下肢（3276±1890）g]（P〈0．05），其躯干FM显著低于未治疗组及治疗1—2年组（P〈0．05）。治疗〉5年组中无LD患者，其全身及躯干FM亦显著低于治疗1～2年组无LD患者（P〈0．05）。全身、躯干和四肢FM与体重（r=0．140—0．568，P=0．04或〈0．01）及BMI（r=0．292—0．742，P值均〈0．01）呈正相关，四肢FM与血TG呈负相关（r=-0．240，P=0．011）。结论应用NRTIs的HIV／AIDs患者易出现LD，主要在治疗1—2年出现，应用d4T后LD发生率显著高于应用AZT。治疗1—2年组与治疗〉5年组患者LD发生率差异无统计学意义，但FM随HAART时间延长逐渐减低。DXA有助于客观定量评估FM变化，能早期发现LD并指导临床治疗。

Objective To evaluate the influence of long-term nucleotide reverse transcriptase inhibitors （NRTIs） on lipids metabolism in HIV/AIDS patients and correlating clinical factors. Methods A total of 118 HIV/AIDS patients were divided into 3 groups：untreated group （40 patients） , highly active antiretroviral therapy（HAART） for 1-2 years group （37 patients） and HAART over 5 years group （41 patients） ,with 20 healthy individuals as the control group. Clinical lipodystrophy （LD） was defined as concordance between patient＇s report of change and physical examination. Fat mass （FM） was measured by dual-energy X-ray absorptiometry （DXA）. Results There was no significant difference in the incidence of LD between HAART for 1-2 years group and HAART over 5 years group （51.2% vs 40. 5% ,P =0. 345）. The prevalence of LD was 2.4 folds with strvudine （d4T） treatment compared with zidovudine （AZT）- containing regimens （61.6% vs 23.5% , P =0. 001 ）. Based on DXA measurements, FM of total body and limbs were significantly lower in the HAART over 5 years group than that in the control group, the untreated group and the HAART for 1-2 years group （ P 〈 0. 05 ）. Trunk FM was significantly lower in the HAART over 5 years group than the untreated group and the HAART for 1-2 years group （ P 〈 0. 05）. FM of total body and trunk were significantly lower in patients without LD in the HAART over 5 years group than patients without LD in the HAART for 1-2 years group （P 〈 0. 05 ）. FM was correlated positively with body weight and BMI. Limbs FM was correlated negatively with peripheral blood triglyceride concentration. Conclusions HIV/AIDS patients with NRTIs therapy have high prevalence of LD, which mainly occurs 1-2 years after therapy, and increases with d4T treatment compared with AZT-containing regimens. There was no significant difference in the incidence of LD between the HAART for 1-2 years group and the HAART over 5 years group. FM was significantly decreased after long-term HAART in the patients with or without LD. DXA can evaluate LD objectively and guide further clinical treatment.