初治HIV感染者代谢水平的调查研究

Investigation on metabolic levels of antiretroviral-naive HIV-infected patients

目的了解初治HIV感染者的代谢水平,初步探索与HIV疾病进展的关系。方法收集我院2018年7月—12月期间确诊的163例初治HIV感染者的临床资料以及代谢相关指标,分析其代谢水平以及与HIV疾病进展的关系。结果163例初治HIV感染者全部为男性,年龄中位数为28(25,32)岁,其中高血压的发生率为14.11%,常表现为舒张压增高(12.27%);高脂血症的发生率为58.28%,血脂异常多表现为低HDL-C血症(56.44%);高血糖血症发生率为12.27%;高尿酸血症发生率为47.24%;超重(24 kg/m^(2)≤身体质量指数<28 kg/m^(2))发生率为21.47%,肥胖(身体质量指数≥28 kg/m^(2))的发生率为7.36%;高脂血症合并高血压发生率为11.04%;高血压合并高尿酸血症发生率为9.20%;高脂血症合并高血糖血症发生率为7.98%;高血压合并高血糖血症发生率为4.91%;腹部彩超提示脂肪肝发生率为25.15%;颈部血管超声出现异常发生率为35.58%;GFR介于60~89 ml/(min·1.73m^(2))之间者占2.45%;与HDL正常患者相比,低HDL患者CD4+T细胞计数较低,病毒载量(viral load,VL)水平较高(P均<0.05);血清HDL与CD4+T细胞计数呈正相关(r=0.248,P=0.017),与VL呈负相关(r=-0.286,P=0.000)。结论HIV可以引起患者多种代谢紊乱,其中血脂和尿酸代谢紊乱最为多见;尽早启动抗病毒治疗利于提升血浆HDL浓度,有助于延缓HIV疾病进展;患者颈部动脉血管异常发生率高,选择合适的抗病毒治疗方案避免心血管疾病的发生尤为重要。

Objective To investigate the metabolic level of antiretroviral-naive HIV-infected patients,and preliminarily explore the relationship with the progression of HIV disease.Methods Clinical data and metabolism-related indicators of 163 antiretroviralnaive HIV-infected patients were collected from July 2018 to December 2018,to analyze their metabolic level and the relationship with HIV disease progression.Results All 163 antiretroviral-naive HIV-infected patients were male,with a median age of 28(25,32)years old.In these patients,the incidence of hypertension was 14.11%,often manifested by increased diastolic blood pressure(12.27%).The incidence of hyperlipidemia was 58.28%,and dyslipidemia was mainly manifested as low HDL-C(56.44%).The incidence of hyperglycemia was 12.27%.The incidence of hyperuricemia was 47.24%.The incidence of overweight(24 kg/m^(2)≤BMI<28 kg/m^(2))was 21.47%,and that of obese(BMI≥28 kg/m^(2))was 7.36%.The incidence of hyperlipidemia combined with hypertension was 11.04%.The incidence of hypertension combined with hyperuricemia was 9.20%.The incidence of hyperlipidemia combined with hyperglycemia was 7.98%.The incidence of hypertension combined with hyperglycemia was 4.91%.The incidence of fatty liver suggested by color abdominal ultrasound was 25.15%.The incidence of abnormal cervical vascular ultrasound was 35.58%.The patients with a GFR ranging 60-89 ml(min·1.73 m^(2))accounted for 2.45%.Compared with normal HDL patients,low HDL patients had a lower CD4+T cell count and a higher VL level(P<0.05).Serum HDL was positively correlated with CD4+T cell count(r=0.248,P=0.017),and negatively correlated with VL(r=-0.286,P=0.000).Conclusions HIV can cause a variety of metabolic disorders in the infected patients,predominantly the disorders of lipid and uric acid metabolism.Early initiation of antiretroviral therapy is beneficial to increase plasma HDL concentration and delay the progression of HIV disease.The incidence of abnormal cervical arteries is high,and appropriate antiretroviral therapy is of great importance to avoid the occurrence of cardiovascular disease.