HIV相关性肾病患者左心结构及功能的变化及高效抗反转录病毒治疗的意义

The changes of left ventricular structure and function and significance of highly active antiretroviral therapy in patients with HIV-associated nephropathy

目的观察HIV相关性肾病(HIVAN)患者心肾功能指标的变化及高效抗反转录病毒治疗(HAART)对其影响。方法检测HIVAN患者(观察组,50例)和正常体检者(对照组,50例)HAART前及6个月后心肾功能相关指标的变化。其主要指标包括血清胱抑素C和肿瘤相关糖类抗原125(CA-125)、血肌酐清除率(Ccr)、肾小球滤过率(GFR)水平和左心结构及功能指标[左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室心肌质量指数(LVMI)、左心室射血分数(LVEF)]以及CD4^+T细胞数、CD4^+/CD8^+T细胞比值。结果观察组血清胱抑素C、CA-125水平和LAD、LVEDD和LVMI均高于对照组(P<0.01);而血Ccr、GFR水平和LVEF低于对照组(P<0.01)。与HAART前比较,观察组治疗6个月后的血清CA-125水平和LAD、LVEDD、LVMI下降,血Ccr、GFR水平和LVEF、CD4^+T细胞数、CD4^+/CD8^+T细胞比值上升(P<0.05或P<0.01)。结论 HIVAN患者血清胱抑素C、CA-125水平和LAD、LVEDD、LVMI升高,LVEF下降,存在心肾功能损害;HAART可促进HIVAN患者免疫重建,延缓肾功能损害,改善左心功能与重构。

Objective To observe the changes of left ventricular structure and function and significance of highly active antiretroviral therapy（HAART）in the patients with HIV-associated nephropathy（HIVAN）.Methods The cardiac and renal function-related indicators were observed in HIVAN patients（group A,50cases）and healthy people（group B,50cases）,which included serum levels of cystatin C and CA-125,creatinine clearance rate（Ccr）,glomerular filtration rate（GFR）,left atrial diameter（LAD）,left ventricular end diastolic dimension（LVEDD）,left ventricular mass index（LVMI）,left ventricular ejection fraction（LVEF）and CD4^＋T cells count,CD4^＋/CD8^＋T cells ratio.The changes of the indicators were compared between two groups and between before and 6 months after HAART in group A.Results Serum levels of cystatin C and CA-125,LAD,LVEDD and LVMI were higher,while Ccr,GFR and LVEF were lower,in group A than those in group B（P〈0.01）.Compared with before HAART,serum levels of CA-125,LAD,LVEDD and LVMI were decreased,while Ccr,GFR,LVEF,CD4^＋T cells count and CD4^＋/CD8^＋T cells ratio were increased,in 6months after HAART in group A（P〈0.05 or P〈0.01）.Conclusion HIVAN patients have cardiac and renal function damage with higher serum levels of cystatin C and CA-125,LAD,LVEDD,LVMI and lower LVEF.The HAART is able to promote immune reconstitution,delay the impairment of renal function and improve the left ventricular function and reconsitution in HIVAN patients.