HIV/AIDS病人ART相关性高乳酸血症的预测因素分析

Predictive factors for hyperlactacidemia in HIV/AIDS patients receiving antiretroviral therapy

目的探讨艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人进行抗反转录病毒治疗(ART)中,发生高乳酸血症(LAHL)的预测因素分析。方法回顾性分析2005年1月-2012年5月,门诊进行ART的随访AIDS病人出现LAHL的临床资料,对相关性数据进行统计学分析。结果在191例门诊进行ART随访的AIDS病人中,有71例发生LAHL,其中女性34例(χ2=6.147,P<0.01),服用D4T的42例(χ2=7.784,P<0.01),服用核苷类反转录酶抑制剂(NRTIs)药物超过1年以上59例(χ2=18.100,P<0.01)。发生LAHL病人相比未发生LAHL病人更容易出现丙氨酸转氨酶(ALT)、天冬氨酸转氨酶、乳酸脱氢酶(LDH)、γ-谷酰转肽酶(GGT)升高,差异有统计学意义(P<0.01)。在多因素非条件Logistic回归分析中,女性[比值比(OR)10.923,95%可信区间(CI):1.067～111.836]、ALT升高(OR1.09,95%CI:1.017～1.168)、LDH升高(OR1.025,95%CI:1.007～1.043),均为发生LHAL的预测因素。在ART中CD4T淋巴细胞计数升高病人中LAHL发生率低(OR0.991,95%CI:0.983～0.999)。结论 AIDS病人服用NRTIs药物,尤其是服用D4T、女性、服药时间超过1年以上,是发生LAHL的预测因素。在ART过程中出现ALT、GGT、LDH升高,要高度警惕是否存在LAHL风险,避免进一步发展成致死性的乳酸酸中毒。

Objective To investigate predictive factors for hyperlactacidemia in HIV/AIDS patients receiving an-tiretroviral therapy（ART）. Methods Retrospective analysis was performed in 191 HIV/AIDS patients receiving an- tiretroviral therapy from January 2005 to May 2012, and related data were statistically analyzed. Results Of the 191 patients followed up at the clinic, 71 had an elevated plasma venous lactate. Among them 34 cases were female （X^2 =6. 147, P〈0.01）, 42 cases took D4T （X^2 =7. 784, P〈0.01）and 59 cases took NRTIs for more than 1 year （X^2= 18. 100 ,P〈0.01）, who all were more likely to develop LAHL. Besides, the patients with hyperlactacidemia had higher alanine aminotransferase（ALT）, gamma-glutamyl transpeptidase （GGT） and lactate dehydrogenase （LDH） than the ones without hyperlactacidemia （P〈0.01）. As shown by multivariable iogistic regression analysis, female sex[-odds ratio （OR） 10. 923,95% confidence interval（CI） ： 1. 067 -- 111. 836）, higher ALT（OR 1.09,95CI; 1. 017--1. 168）and higher LDH （OR 1. 025,95% CI： 1. 007--1. 043）were associated with higher LAHL rate, whereas higher CD4 cell counts after ART（OR 0. 991,95% CI： O. 983 -- 0. 999） were associated with lower LAHL rate. Conclusion In the process of taking NRTIs medication, predictive factors for hyperlactacidemia associated with stavudine exposure, female sex and taking NRTIs for more than 1 year. For HIV/ AIDS patients exposed to ART, it is suggested that in case of higher GGT and DH, attention should be paid to the risks of LAHL, so that fetal lactic acidosis might be prevented.