cARV治疗对艾滋病患者糖代谢、脂质代谢及胰岛素抵抗的影响

Effects of c ARV therapy on glucose metabolism,lipid metabolism and insulin resistance in AIDS patients

目的了解联合抗反转录病毒(cARV)治疗对人类免疫缺陷病毒感染及艾滋病(HIV/AIDS)人群糖代谢、脂质代谢及胰岛素抵抗的影响。方法收集2007年9月至2017年3月HIV/AIDS患者病历资料,将信息完整的603例患者纳入研究,分析影响HIV/AIDS人群糖尿病发生的因素;对比观察HIV/AIDS人群与HIV阴性人群胰岛素抵抗(IR)情况并分析影响IR发生的因素;动态观察HIV/AIDS患者cARV治疗前后血脂(指甘油三酯、总胆固醇)的变化情况。结果随着cARV治疗服药时间的延长累计糖尿病发生率逐年增加,D4T、基线血糖异常是影响糖尿病发生的危险因素,而含NVP的方案较含EFV的方案发生糖尿病风险低。含LPV/r的二线方案组高甘油三酯血症发生率明显高于一线方案组及未开始cARV治疗组(t=5.17,P<0.05),而一线方案组与未开始cARV治疗组比较高甘油三酯血症发生率差异无统计学意义(t=0.32,P>0.05)。无论一线方案组还是二线方案组高胆固醇血症发生率均明显高于未开始cARV治疗组(F=8.85,P<0.05)。体重指数(BMI)≥23kg/m2(OR=3.81,95%CI:1.26-11.47)是影响胰岛素抵抗发生的危险因素。结论对具有发生糖尿病危险因素的患者应避免使用D4T;对服用LPV/r的患者应监测血脂,发生高脂血症时应作适当处理;对BMI≥23kg/m2的患者即使空腹血糖正常,也应监测血胰岛素水平或行口服葡萄糖耐量试验。

Objective To investigate the effect of combined antiretroviral therapy（ cARV） on glucose metabolism,lipid metabolism and insulin resistance in HIV/AIDS patients（ HIV/AIDS）. Methods From September 2007 to 2017 03 months with HIV/AIDS medical records,603 cases complete information were included in the study,comparative observation of insulin resistance in HIV/AIDS group and HIV negative group（ IR） and analysis of influencing factors IR; dynamic observation of patients with HIV/AIDS before and after cARV treatment of blood lipids（ triglycerides,total cholesterol to change）. Results With the extension of cARV treatment time,the cumulative incidence of diabetes increased year by year. D4T,baseline blood glucose abnormality was a risk factor for the occurrence of diabetes,while NVP containing scheme had lower risk of diabetes than EFV containing scheme. The incidence of hypertriglyceridemia in the second-line group containing LPV/r was significantly higher than that in the first line group and the non cARV treatment group（ t = 5. 17,P〈0. 05）,while there was no significant difference in the incidence of hypertriglyceridemia between the first line group and the cARV group without treatment（ t = 0. 32,P〉0. 05）. The incidence of hypercholesterolemia in both the first line group and the second line group was significantly higher than that in the non cARV group（ F = 8. 85,P〈0. 05）. Body mass index（ BMI） = 23 kg/m^2（ OR = 3. 81,95% CI： 1. 26-11. 47） are the risk factors of insulin resistance. Conclusion With diabetes risk factors of patients should avoid the use of D4T; for patients taking LPV/r should be monitored for blood lipids,hyperlipidemia should be appropriate; on BMI more than 23 kg/m^2 even in patients with normal fasting blood glucose,should also be monitoring of blood levels of insulin or oral glucose tolerance test.