Ⅱ型单纯疱疹病毒／人类免疫缺陷病毒-1共感染者肾功能损伤危险因素的分析

Risk factors of renal dysfunction in patients with herpes simplex virus 2/human immunodeficiency virus-1 coinfection

目的揭示Ⅱ型单纯疱疹病毒（HSV-2）／HIV1共感染对HIV-1感染者肾功能的影响，分析肾损伤相关危险因素。方法收集2011年10月至2014年2月广州市第八人民医院就诊的HIV-1阳性者302例，分为HIV阳性HSV-2阳性组和HIV阳性HSV-2阴性组，选取同期HIV阴性HSV-2阳性者作为对照组。比较3组患者肾功能指标的差异，Pearson相关分析HSV-2DNA定量与肾功能受损程度的相关性，多因素Logistic回归筛选肾损伤相关危险因素。结果HIV-1阳性HSV-2阳性组128例，HIV-1阳性HSV-2阴性组174例，HIV-1阴性HSV2阳性组143例。与HIV1阴性HSV-2阳性组相比，HIv_1阳性HSv-2阳性组和HIV-1阳性HSV-2阴性组血肌酐（F=14．37，P〈0．01）、BUN（F=12．54，P〈0．01）、24h尿蛋白定量（F=16．58，P〈0．01）和尿蛋白／肌酐比值（F=6．37，P=0．018）均显著升高，而肾小球滤过率（eGFR）显著下降（F=11．96，P〈0．01）。同时，与HIV-1阳性HSV-2阴性组相比，HIV1阳性HSV-2阳性组HIV1RNA定量水平（t=5．876，P〈0．01）、血肌酐（t=2．315，P=0．012）、24h尿蛋白定量（t=3．648，P=0．004）和尿蛋白／肌酐比值（t=2．312，P=0．012）均升高，而CD4＋T淋巴细胞计数（t=4．903，P〈0．01），eGFR（t=2．275，P=0．016）则降低，差异均有统计学意义。HSV-2DNA与HIV-1RNA定量水平（r=0．626，P=0．002）、血肌酐（r=0．798，P〈0．01）、24h尿蛋白定量（r=0．702，P〈0．01）、尿蛋白／肌酐比值（r=0．686，P〈0．01）呈正相关，而与CD4＋T淋巴细胞计数（r=0．796，P〈0．01）、eGFR（r=0．656，P〈0．01）呈负相关。HSV-2DNA定量（OR=1．166，P=0．021）、HIV-1RNA定量（OR=1．581，P〈0．01）、CD4＋T淋巴细胞计数〈200／μL（OR=1.762，P〈0．01）、年龄（OR=1．472，P〈0．01）、≥1项并发症（OR=1．062，P=0．032）、糖化血红蛋白（OR=1．124，P=0．015）是患者肾损伤的独立危险因素。结论HSV-2／HIV-1共感染可能加重HIV-1感染者肾损伤，且HSV2DNA定量是肾损伤潜在危险因素之一。

Objective To explore the effects of herpes simplex virus 2 （HSV-2） co-infection on the renal function in human immunodeficiency virus-1 （HIV-1） infected patients, and to screen the risk factors of renal dysfunction. Methods A total of 302 HIV1 infected patients were included at The Eighth People＇s Hospital of Guangzhou from October 2011 to February 2014, which were divided into two groups： HIV（＋）HSV（＋） group and HIV（＋）HSV（-） group. At the same time, 143 patients With HIV（- ）HSV（＋） were included as controls. The measurements of renal function were tested and compared among groups. Pearson correlation analysis was used to explore the relationship between HSV 2 DNA level and the severity of renal dysfunction. Multivariate Logistic regression analysis was used to determine the risk factors of renal dysfunction. Results There were 128 cases in HIV-1（＋）HSV 2（＋） group, 174 in HIV-1（＋）HSV 2（-） group and 143 in HIV-1（ -）HSV-2（＋）. Compared to HIV（-） HSV（＋） group, the level of serum creatinine （F=14.37, P〈0.01）, BUN （F=12. 54, P〈0.01）,24 h urine protein （F=16.58, P%0.01） and urine protein/creatinine ratio （F=6.37, P=0. 018） in both HIV（＋） HSV （ ＋ ） group and HIV （ ＋ ） HSV （ - ） group were significantly increased, while estimated glomerular filtration rate （eGFR） in these two groups were significantly decreased （F= 11.96, P〈0.01）. Meanwhile, compared to HIV（＋）HSV（ -） group, HIV-1 RNAlevel （t=5.876, P%0.01）, serum creatinine （t=2. 315, P=0. 012）, 24 h urine protein （t=3. 648, P=0. 004）, and urine protein/ creatinine ratio （t=2. 312, P=0. 012） in HIV（＋）HSV（-） group were significantly increased, while CD4＋ T lymphocyte counts （t=4. 903, P〈0.01） and eGFR （t=2. 275, P=0. 016） were significantly decreased. Pearson correlation analysis indicated that HSV-2 DNA level was positively correlated with HIV-1 RNAlevel （r=0. 626, P=0. 002）, serum creatinine level（r=0. 798, P〈0. 01）, 24 h urine protein level （r=0. 702, P〈0.01）, and urine protein/creatinine ratio （r=0. 686, P〈0.01）, whereas negatively correlated with CD4＋ T lymphocyte counts （r=-0. 796, P〈0.01） and eGFR （r= -0. 656, P〈0.01）. Multivariate Logistic regression analysis showed that HSV-2 DNA level （odds ratio [OR] = 1. 166, P=0. 021）, HIV-1 RNA level （OR= 1. 581, P〈0.01）, CD4＋ T lymphocyte counts〈200/μL （OR=1. 762, P〈0.01）, age （OR=1. 472, P〈0.01）, ≥1 complication （OR=1.062, P=0. 032）, and glycosylated hemoglobin level （OR = 1. 124, P = 0. 015） were independent risk factors of renal dysfunction. Conclusions HSV-2 co-infection might aggravate the renal dysfunction of HIV-1 patients, and HSV-2 DNA level might be one of the potential risk factors of renal dysfunction.