核酸逆转录酶抑制剂治疗397例艾滋病患者发生神经病理性疼痛的影响因素分析

Analysis of the influencing factors of neuropathic pain in 397 AIDS patients treated by nucleic acid reverse transcriptase inhibitors

目的探讨艾滋病(AIDS)患者使用核酸逆转录酶抑制剂(NRTIs)治疗后引起神经病理性疼痛(NP)的影响因素。方法采用回顾性队列研究方法,选取2014年8月至2016年3月于首都医科大学附属北京地坛医院接受NRTIs类药物治疗的AIDS患者共计400例,排除信息缺失患者3例,共计患者397例,记录年龄、性别、身高、体重、民族、吸烟史、饮酒史、精神健康状况、高血压史、糖尿病史、带状疱疹史、结核病史、巨细胞病毒感染史,通过Logistic回归模型分析这些因素对NP发生的影响。结果Logistic回归分析显示,年龄、性别、身高、体重、民族、吸烟史、饮酒史、精神健康状况、高血压史、糖尿病史、带状疱疹史、结核病史、巨细胞病毒感染史均不是NRTIs治疗NP发生的危险因素(Waldχ^2=2.60、0.18、0.40、0.35、0.00、2.55、2.17、0.00、3.10、0.05、0.14、0.13、0.06,P=0.11、0.67、0.53、0.56、1.00、0.11、0.14、1.00、0.08、0.83、0.71、0.72、0.80);对于使用NRTIs引起NP的患者,在采取镇痛药物或者把NRTIs药物更换为替诺福韦(TDF)后,疼痛缓解率达到54.55%。结论年龄、性别、身高、体重、民族、吸烟史、饮酒史、精神健康状况、高血压史、糖尿病史、带状疱疹史、结核病史、巨细胞病毒感染史均不是NP发生的危险因素。接受NRTIs治疗后的AIDS患者如果出现NP,可以通过使用镇痛药物或者把NRTIs药物更换为替诺福韦缓解疼痛,从而继续进行高效抗反转录病毒治疗,以提高患者生存质量。

Objective To explore the influencing factors of Neuropathic Pain(NP)in patients with Acquired Immune Deficiency Syndrome(AIDS)after using Nucleoside analog Reverse Transcriptase inhibitors(NRTIs).Methods This was a retrospective cohort study.A total of 400 cases of AIDS patients treated with NRTIs drugs from August 2014 to March 2016 were selected,and 3 patients were excluded for missing information,therefore,a total of 397 cases of patients were included.Age,gender,height,weight,nation,history of smoking,drinking,mental health history,history of hypertension,diabetes mellitus,history of herpes zoster,history,history of tuberculosis(TB),cytomegalovirus infection were recorded,and Logistic regression model was performed to analyze the influence of these factors on NP.Results Logistic regression analysis showed that age,gender,height,weight,nation,history of smoking,drinking,mental health history,history of hypertension,diabetes mellitus,history,history of tuberculosis,herpes zoster cytomegalovirus infection history are not risk factors for NP(Wald chi-square was 2.60,0.18,0.40,0.35,0.00,2.55,2.17,0.00,3.10,0.05,0.14,0.13,0.06 respectively,and P=0.11,0.67,0.53,0.56,1.00,0.11,0.14,1.00,0.08,0.83,0.71,0.72,0.80,respectively).For patients with NP induced by NRTIs,the pain relief rate reached 54.55%after taking analgesics or replacing NRTIs with tenofovir(TDF).Conclusion Age,sex,height,weight,ethnicity,smoking history,drinking history,mental health status,hypertension history,diabetes history,herpes zoster history,tuberculosis history and cytomegalovirus infection history were not risk factors for NP occurrence.In patients with AIDS after NRTIs treatment,analgesics or replacing NRTIs with tenofovir can be used to relieve NP,so that highly effective antiretroviral therapy can be continued to improve the quality of life of patients.