艾滋病抗病毒治疗引起脂肪营养不良综合征回顾性分析

Retrospective analysis of lipodystrophic syndromes caused by antiretroviral therapy

目的分析艾滋病抗反转录病毒治疗(ART)引起脂肪营养不良的临床特点。方法选择某医院2017年1—12月,住院发生114例艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的脂肪营养不良综合征,对临床表现、危险因素和治疗等进行分析。结果 ART引起的114例脂肪营养不良综合征病人表现为四肢和面部的脂肪萎缩43例(37.72%)、项背部脂肪增生18例(15.79%)及脂肪肝、高脂血症和糖尿病等糖、脂代谢异常53例(46.49%)。脂肪萎缩的危险因素为使用司坦夫定、齐多夫定和ART时间长[(5.31±1.87)年];脂肪沉积的危险因素为女性、HIV感染病程长[(11.83±1.98)年]和ART时间长[(6.93±2.37)年]。89例(78.07%)经过对症治疗后病情稳定,2例脂肪沉积切除后复发。结论脂肪营养不良综合征表现为脂肪萎缩、脂肪沉积和糖脂代谢异常,临床表现和危险因素各不相同,长期ART应定期监测血脂和血糖水平。

Objective To analyze clinical characteristics of lipodystrophic syndromes caused by antiretroviral therapy(ART).Methods 114 cases of lipodystrophic syndromes were collected from January 2017 to December2017,and the clinical manifestations,risk factors and treatment were analyzed.Results Out of 114 cases of lipodystrophic syndromes caused by ART,18 cases(15.79%)were lipidosis at the back of neck,43 cases(37.72%)were lipoatrophy in the limbs and face,and 53 cases(46.49%)were abnormal glucose and lipid metabolic disorder,such as hyperlipidemia of fatty liver and diabetes mellitus.The risk factors of lipoatrophy included use of stavudine,zidovudine and long-time of ART(5.31±1.87 years).The risk factors for lipidosis included being female,long-time of HIV infection(11.83±1.98 years)and long-time of ART(6.93±2.37 years).89 cases(78.07%)were stable after symptomatic treatment,and 2 cases of lipidosis recurred after resection.Conclusion Lipodystrophic syndromes is characterized by lipidosis,lipoatrophy,abnormal glucose and lipid metabolic disorder,of which the clinical manifestations and risk factors for each are different.Blood lipid and blood glucose should be monitored regularly for those receiving long-time ART.