两种非核苷类逆转录酶抑制剂治疗艾滋病的不良反应分析

Clinical observation on side-effects associated with two kinds of non-nucleoside reverse transcriptaseinhibitors among AIDS patients with antiretroviral therapy

目的了解艾滋病患者接受两种非核苷类逆转录酶抑制剂进行抗逆转录病毒治疗发生不良反应的情况。方法回顾性分析2015年6月至2016年6月在武汉大学中南医院就诊的126例使用依非韦伦（E—FV）和150例使用奈韦拉平（NVP）进行联合抗逆转录病毒治疗的艾滋病患者的临床资料，统计不良反应发生率。结果EFV组的总体不良反应发生率为87-3％（110／126），高于NVP组的44．0％（66／150），差异有统计学意义（χ2=55．573，P〈0．01）。EFV组不良反应以头晕多梦（64．3％，81例）和皮疹（9．5％，12例）为主，NVP组以皮疹（18．0％，27例）和肝损害（16．7％，25例）为主；但EFV组患者出现精神障碍4例（其中2例自杀死亡），癫痫1例，男性乳腺增生3例，NVP组则未见。EFV组83．6％（92例）和NVP组74．2％（49例）的不良反应发生在用药的前6周内；且前者69．1％（76例）可逐渐耐受，而后者仅4．5％（3例），差异有统计学意义（χ2=69．468，P〈0．01），但NVP组停药或换药后90．9％（60例）的患者不良反应消失。结论EFV和NVP的不良反应各具特点，前者以早期轻微的神经系统症状为主，且能逐渐耐受，后者以早中期出现的皮疹和肝损害为主，常需停药或换药得以恢复。临床上对于EFV相关的精神障碍宜早期进行干预，以免发生意外。

Objective To investigate the side-effects among AIDS patients treated with two kinds of non- nucleostide reverse transeriptase inhibitors. Methods From June 2015 to June 2016, 276 AIDS patients （126 with EFV and 150 with NVP based cART regimen） were enrolled, and a retrospective study about EFV-association side- effects was conducted. Results The total incidence rate of side-effects in EFV group was 87.3% （ 110/126）, which was higher than 44.0% （66/150） of NVP group, the difference had statistical significance （χ2=55.573 ,P〈0.01 ）. The main adverse reactions were dizziness and dreaminess （64.3%, 81 cases） and rash （9.5%, 12 cases） in EFV group, while occurrences of rash （18.0%, 27 cases） and liver damage （16.7% ,25 cases） in NVP group. Four cases with mental disorders （2 cases suicide because of weak supervision）, 1 epilepsy and 3 male cases with hyperplasia of mammary glands were in EFV greup, while none in NVP group. 83.6% （92 cases） in EFV group and 74.2% （49 cases） in NVP group had side-effect within 6 weeks. 69.1% （76 cases） in EFV group were gradually tolerant, while only 4.5% （3 cases） in NVP group. The difference had statistical significance （χ2=69.468, P〈0.01）. However, the side-effects in 90.9% of patients （60 cases） disappeared after drug withdrawal or change. Conclusions The adverse reactions of EFV and NVP are different. The nervous system side-effectS induced by EFV occurr early and mild, and can be gradually tolerated. The rash and liver damage caused by NVP often occurr in the early and middle medication use, of which the recovery often needs to withdraw or change medicine. Mental disorders induced by EFV are particularlyappropriate to early medical intervention, so as to avoid accidents.