多替阿巴拉米片治疗HIV感染的短期疗效及不良反应分析

Analysis of short-term efficacy and adverse reactions of dolutegravir sodium,abacavir sulfate and lamivudine tablets in the treatment of HIV infection

目的 分析多替阿巴拉米片(商品名:绥美凯)治疗人类免疫缺陷病毒(HIV)感染患者的疗效与药物不良反应发生情况,指导其临床使用。方法 回顾性分析69例明确诊断为HIV感染初始采用多替阿巴拉米片进行抗逆转录病毒治疗(ART)患者的临床资料,观察患者治疗2、4、12周时的临床疗效与不良反应发生情况。结果 69例患者治疗4周时的人类免疫缺陷病毒核糖核酸(HIV-RNA)由治疗前的(5.34±1.13)×log10 IU/ml明显下降至(1.88±0.76)×log10 IU/ml,差异具有统计学意义(P<0.05);患者治疗12周时的HIV-RNA下降至(1.75±0.76)×log10 IU/ml,与治疗前比较差异具有统计学意义(P<0.05)。治疗4周时, 64例(92.8%)患者HIV-RNA<200拷贝/ml。患者治疗4周时的CD+T淋巴细胞计数上升至118.0(86.0, 238.0)个/μl,治疗12周时上升至172.0(89.5, 287.0)个/μl,与治疗前的66.5(19.0, 204.0)个/μl比较差异均有统计学意义(P<0.05);患者治疗12周时的CD+T淋巴细胞计数高于治疗4周时,差异具有统计学意义(P<0.05)。与治疗前、治疗4周时比较,患者治疗12周时CD4/CD8明显升高,差异具有统计学意义(P<0.05)。患者治疗4周时肝功能异常发生率8.7%较治疗前的26.1%明显降低,差异有统计学意义(P<0.05)。患者治疗2、4、12周时肌酐(Cr)水平均高于治疗前,差异有统计学意义(P<0.05);患者治疗2周后Cr水平逐渐回落,治疗2、4、12周时Cr水平比较无明显差异(P>0.05)。患者治疗2、4、12周时甘油三酯(TG)、总胆固醇(TC)水平均高于治疗前,高密度脂蛋白胆固醇(HDL-C)水平高于治疗前,差异具有统计学意义(P<0.05)。结论 多替阿巴拉米片具有高效抑制HIV病毒复制、快速提升免疫应答的特点,用药早期观察到Cr水平升高,但随着时间延长,逐渐回落;同时观察到随着用药时间延长,TC水平趋于上升。

Objective To investigate the efficacy and adverse drug reactions of dolutegravir sodium,abacavir sulfate and lamivudine tablets(trade name:Triumeq)in the treatment of human immunodeficiency virus(HIV)infection and provide guidance for its clinical application.Methods The clinical data of 69 patients diagnosed with HIV infection who initially received antiretroviral therapy(ART)with dolutegravir sodium,abacavir sulfate and lamivudine tablets were retrospectively analyzed,and the clinical efficacy and adverse reactions of the patients at 2,4 and 12 weeks of treatment were observed.Results Human immunodeficiency virus ribonucleic acid(HIV-RNA)of 69 patients at 4 weeks of treatment decreased significantly from(5.34±1.13)×log10 IU/ml before treatment to(1.88±0.76)×log10 IU/ml,and the difference was statistically significant(P<0.05);HIV-RNA at 12 weeks of treatment decreased to(1.75±0.76)×log10 IU/ml,and the difference was statistically significant(P<0.05)when compared with that before treatment.At 4 weeks of treatment,64 patients(92.8%)had HIV-RNA+<200 copies/ml.CD^(+)T lymphocyte counts rose to 118.0(86.0,238.0)cells/μl at 4 weeks of treatment,and 172.0(89.5,287.0)cells/μl at 12 weeks of treatment,and the difference was statistically significant(P<0.05)when compared with 66.5(19.0,204.0)cells/μl+before treatment.CD^(+)T lymphocyte counts at 12 weeks of treatment were higher than that at 4 weeks of treatment,and the difference was statistically significant(P<0.05).CD4/CD8 was significantly higher at 12 weeks of treatment when compared with those before treatment and at 4 weeks of treatment,and the difference was statistically significant(P<0.05).The incidence of liver function abnormality at 4 weeks of treatment was 8.7%,which was significantly lower than 26.1%before treatment,and the difference was statistically significant(P<0.05).The creatinine(Cr)levels at 2,4 and 12 weeks of treatment were higher than those before treatment,and the difference was statistically significant(P<0.05).Cr levels gradually decreased after 2 weeks of treatment,and there was no significant difference in the comparison of Cr levels at 2,4 and 12 weeks of treatment(P>0.05).The triglyceride(TG)and total cholesterol(TC)levels at 2,4 and 12 weeks of treatment were higher than those before treatment,and the high-density lipoprotein cholesterol(HDL-C)level was higher than that before treatment.The difference was statistically significant(P<0.05).Conclusion Dolutegravir sodium,abacavir sulfate and lamivudine tablets have the characteristics of highly efficient inhibition of HIV viral replication and rapid improvement of the immune response.Cr is observed to increase at the early stage of medication,but gradually decreases as time went on.Meanwhile,TC level has a tendency to rise with the extension of time.