中老年人类免疫缺陷病毒感染者抗反转录病毒治疗后的代谢变化

Change of metabolic parameters in middle-aged HIV patients after antiretroviral therapy

目的评估抗反转录病毒治疗(ART)对中老年人类免疫缺陷病毒(HIV)感染者代谢的影响及变化特点。方法随机选择51例接受ART的40岁以上HIV感染者,监测治疗1年后患者的体质量指数、血压、空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白等常用代谢及相关指标变化,分析其原因及应对措施。结果 51例中老年HIV感染者接受ART后1年,患者上述检测指标都有不同程度的变化,主要表现为高三酰甘油、高胆固醇、高低密度脂蛋白及低高密度脂蛋白血症等脂代谢紊乱,部分患者出现糖代谢异常及高血压。其中,以三酰甘油、低密度脂蛋白异常变化较为常见。导致代谢紊乱的疾病谱中,单一指标异常14例(27.4%),代谢综合征5例(9.8%),混合型高脂血症4例(7.8%),2项及以上指标异常但未达到代谢综合征诊断标准者19例(37.2%)。以上变化统计显示差异有统计学意义(P<0.05)。结论中老年HIV感染者接受ART后,受药物、社会、心理和生活方式等多种因素的影响,代谢紊乱的发生率明显增加。

Objective To evaluate the effect of antiretroviral therapy（ART）on metabolism in middle-aged patients infected with HIV.Methods Fifty-one patients（40 years or older）receiving ART were selected randomly in this study.Metabolic indexes were evaluated,including body mass index（BMI）,blood pressure（BP）,fasting blood glucose（FBG）,triglyceride（TC）,total cholesterol（TG）,low density lipoprotein（LDL）and high density lipoprotein（HDL）.The changing pattern of BMI,BP,FBG,TC,TG,LDL and HDL after ART were analyzed.Results All patients received ART for 1 year.The major pattern of metabolic parameters showed high level of TC,TG and LDL and low level of HDL.Disturbance of carbohydrate metabolism and hypertension were identified in some patients.Change of TC and HDL was more common than other parameters.Of the metabolic disorders,abnormality of single parameter was found in 14（27.4 %）patients,metabolic syndrome in5（9.8%）patients,and mixed hyperlipidemia in4 patients（7.8%）.Nineteen patients had abnormal findings for at least three parameters but not satisfying the criteria of metabolic syndrome.All the above changes were statistically significant（P〈0.05）.Conclusions ART can induce various metabolic changes in middle-aged HIV patients,which may be the result of interaction between social factors,psychological state and life style.