AIDS患者肝功能异常的原因及预后分析

Analysis of causes and prognosis of abnormal liver function in AIDS patients

目的探讨AIDS患者发生肝功能异常的原因及预后情况。方法收集2008年4月—2013年3月北京地坛医院感染一科确诊为AIDS并在住院期间诊断肝功能异常的165例患者的临床资料,分析患者的一般情况、合并症、用药情况、CD4+T淋巴细胞计数、HIV载量、肝脏生化指标、肝损伤持续时间及处理措施、预后转归等。结果AIDS合并肝功异常患者中以男性、性传播病例居多;主要临床表现为食欲不振、恶心、皮疹、乏力、呕吐、腹泻等;肝功能转氨酶峰值为ALT 93.20(60.05~135.55)U/L,AST 65.10(43.60~113.80)U/L,肝功能异常程度多为轻度肝损伤;以磺胺类、抗HIV药、抗结核药及抗真菌药为主诱发的药物性肝损伤(141例,85.45%)为主要病因。132例(80.00%)患者肝功能恢复,平均恢复时间为8(5~13)d。结论AIDS患者用药复杂,药物性肝损伤多发,临床须全面了解AIDS患者的用药情况,定期监测肝功变化,评估肝毒性的发生风险,保证用药安全。

Objective To investigate the causes and prognosis of abnormal liver function in AIDS patients.Methods Clinical data of 165 patients with confirmed AIDS and abnormal liver function diagnosed during hospitalization in First Infection Department of Beijing Ditan Hospital from April 2008 to March 2013 were collected.The general condition,complications,medication,CD4+T lymphocyte count,HIV viral load,liver biochemical indicators,duration and treatment measures of liver injury,prognosis and turnover of patients were analyzed.Results Male and sexual transmission cases were predominant in AIDS patients with abnormal liver function.The main clinical manifestations were anorexia,nausea,skin rash,fatigue,vomiting and diarrhea.The average peak value of liver function transaminase was ALT 93.20(60.05-135.55)U/L and AST 65.10(43.60-113.80)U/L,and the severity of abnormal liver function was mostly mild liver injury.The main cause of disease was drug-induced liver injury(141 cases,85.45%),dominated by sulfonamides,anti-HIV drugs,anti-tuberculosis drugs and antifungal drugs.One hundred and thirty-two patients(80.00%)recovered their liver function.The average recovery time of liver function was 8(5-13)days.Conclusions Drug use in AIDS patients is complicated and druginduced liver injury occurs frequently.It is necessary to fully understand the medications of AIDS patients,regularly monitor the changes of liver function,assess the risk of hepatotoxicity and ensure the medication safety.