长期高效抗逆转录病毒治疗对HIV感染者骨密度及骨小梁分数的影响

Effect of long-term antiretroviral therapy on bone mineral density and trabecular bone score in Chinese HIV-infected individuals

目的研究人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者接受长期抗逆转录病毒治疗(antiretroviral therapy,ART)后骨密度(bone mineral density,BMD)及骨小梁分数(trabecular bone score,TBS)的变化。方法回顾性收集在北京协和医院感染内科随诊的HIV感染者中,有基线BMD及TBS数据、ART治疗时间在1年及以上的HIV感染者数据,分析入组患者基线及第1~5年的BMD与TBS。结果本研究共纳入459例HIV感染者,平均年龄(36.1±11.3)岁,男性占91.7%。在68例年龄≥50岁的患者中,BMD正常但TBS减低者占19.1%。与基线相比,第1~4年腰椎BMD均低于基线BMD,第5年腰椎BMD与基线BMD无明显差异[(1.183±0.144)vs.(1.168±0.161)g/cm 2,P=0.118]。腰椎BMD第1、2年分别下降3.0%及2.4%(P=0.196),第3年以后腰椎BMD变化百分比维持稳定。股骨颈BMD第1年下降3.5%,第2年下降4.6%,随后股骨颈BMD变化百分比保持稳定。全髋BMD与股骨颈BMD变化趋势相似。TBS第1年下降1.6%,随后维持稳定。结论在接受ART治疗前,仅凭BMD评价骨质量将忽略近20%存在骨微结构损伤的HIV感染者。长期ART治疗后各部位BMD及TBS均可维持稳定。

Objective To evaluate the long-term changes in bone mineral density(BMD)and trabecular bone score(TBS)among Chinese patients with human immunodeficiency virus(PLWH)treated with antiretroviral therapy(ART).Methods We conducted a retrospective chart review of adult PLWH at Peking Union Medical College Hospital.Patients who had a DXA scan prior to ART and at least one follow-up DXA after≥1-year ART were included.Results Totally 459 PLWH were included.Among 68 patients≥50 yrs,13 patients(19.1%)had a normal BMD but partially degraded or degraded TBS.The mean lumbar spine(LS)BMD decrease was significant from baseline to every follow-up year except the fifth year[(1.183±0.144)vs.(1.168±0.161)g/cm 2,P=0.118].The mean percent decreases in LS BMD at the first year and the second year were similar(3.0%vs.2.4%,P=0.196).Then the mean percent decreases in LS BMD remained stable at the 3rd and 4th year.The BMD of the femoral neck decreased by 3.5%in the first year and 4.6%in the second year.Subsequently,the percentage change in the BMD of the femoral neck remained stable.The change trend of total hip BMD and femoral neck BMD was similar.TBS decreased by 1.6%in the first year and then remained stable.Conclusions Before ART,approximately 20%of patients has a normal BMD,but had impaired bone microstructure based upon TBS.There is a stabilization of BMD and TBS after long ferm treatment of ART.