抗病毒治疗4~5年的治疗效果及相关不良反应分析

Efficacy and adverse drug reactions of antiretroviral therapy for 4-5 years

目的观察接受抗病毒治疗(ART)的艾滋病(AIDS)病人的临床疗效,并分析药品不良反应的发生率、类型及相关危险因素。方法对2013-2014年在宜州区人民医院接受ART的AIDS病人进行回顾性队列分析,采用SPSS 24.0统计软件进行数据处理。结果133例患者平均随访4.16年,报告药品不良反应(ADR)208例,93例患者(69.9%)至少出现一次ADR,多发生在治疗的3个月内。最常见的ADR为胃肠道反应32例(15.4%)、皮疹30例(14.4%)、疲倦29例(13.9%)、头晕24例(11.5%)、肝毒性20例(9.6%)、骨髓抑制19例(9.1%)、肾毒性19例(9.1%)。接受含齐多夫定方案的患者容易出现胃肠道反应、骨髓抑制,而接受含替诺福韦酯方案的患者易出现头晕和肾毒性。经多因素Logistic回归分析显示,与其他年龄组相比,18~40岁的患者ADR发生率较高。长期治疗后,CD4^+T淋巴细胞数显著增高,与基线比较差异有统计学意义(P<0.05)。总体病毒学失败发生率随着治疗时间延长而下降,启动ART 12个月后,94.1%的患者HIV病毒载量低于检测下限。截至观察终点,总死亡率为11.5%,死亡多发生在治疗的半年内。结论ART的治疗效果显著,但ADR发生率比较高,应密切监测和定期随访病人。

Objective To observe the clinical efficacy of AIDS patients receiving antiretroviral therapy(ART),and to analyze the incidence,types and related risk factors of adverse drug reaction(ADR).Methods A retrospective cohort analysis was conducted among the AIDS patients receiving ART in Yizhou people’s hospital from 2013 to 2014.SPSS24.0 statistical software was used for data analysis.Results 133 patients were followed-up for an average of 4.16 years with 208 cases of ADRs reported.Among them,69.9%patients had at least one time of ADR occurred,and most of them happened within 3 months of the ART.The most common ADRs were gastrointestinal reaction(n=32,15.4%),skin rashes(n=30,14.4%),fatigue(n=29,13.9%),dizziness(n=24,11.5%),liver damage(n=20,9.6%),bone marrow depression(n=19,9.1%)and kidney damage(n=19,9.1%).Patients on AZT-containing regimens were prone to gastrointestinal reactions and bone marrow suppression,while patients taking TDF regimen were prone to dizziness and nephrotoxicity.Multivariate logistic regression analysis showed that compared with other age groups,the 18-40 age group had higher incidence of ADRs.The CD4^+T cell counts increased significantly in various time points after the treatment,compared with the baseline value(P<0.05).The HIV viral load of 94.1%patients was less than the detection limit after 12 months.The virological failure decreased with the increased time of treatment.By the end of the observation,the total mortality rate was 11.5%and most of the deaths occurred within six months of the treatment.Conclusion Long-term ART is effective,but incidence of ADR is relatively high.Patients should be monitored closely and followed up regularly during the treatment.