摘要
目的观察依非韦伦(EFV)、奈韦拉平(NVP)或洛匹那韦/利托那韦(LPV/r)方案对艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)血脂代谢的长期影响。方法采用回顾性队列研究的方法,以南京市第二医院2013年3月至2018年12月启动抗逆转录病毒治疗(ART)的成年HIV/AIDS病人为研究对象,收集其人口学、临床基线和治疗随访数据,分析纳入对象在随访期间三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)以及TC/HDL-C的检测水平及异常率的变化情况。结果与EFV相比,NVP组在具体随访期间有较高TG异常率和较低的HDL-C、FPG和TC/HDL-C异常率,两组总的血脂异常率随时间增加有明显变化;相较EFV,LPV/r组在具体随访期间有较低的FPG异常率和较高的TG、TC以及TC/HDL-C异常率,两组异常TG、TC、HDL-C、FPG和TC/HDL-C百分率随时间增加有明显变化。结论与EFV相比,NVP可能与有利的脂质谱相关但LPV/r可能对血脂危害更大,另外,EFV对血糖的影响高于其他两药,糖尿病病人应谨慎选择并做好监测。临床医生需要高度警惕HIV/AIDS病人启动ART治疗相关高脂血症所带来的潜在风险。
Objective To observe the long-term effects of efavirenz(EFV),nevirapine(NVP),or lopinavir/ritonavir(LPV/r)regimens on lipid metabolism in HIV-infected/AIDS patients(referred to as HIV/AIDS patients).Methods A retrospective cohort study was con⁃ducted to collect demographic,clinical baseline and treatment follow-up data from adult HIV/AIDS patients who initiated antiretroviral therapy(ART)in Nanjing Second Hospital from March 2013 to December 2018,and to analyze triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),and low-density lipoprotein cholesterol(LDL-C)in the included subjects during the follow-up period.(HDL-C),low-density lipoprotein cholesterol(LDL-C),fasting glucose(FPG),and TC/HDL-C levels and abnormalities during the follow-up period.Results Compared with EFV,the NVP group had higher TG abnormality rates and lower HDL-C,FPG and TC/HDL-C abnormalities during specific follow-up periods,and the overall dyslipid⁃emia rates of the two groups increased significantly with time.Compared with EFV,the LPV/r group had lower rates of FPG abnormali⁃ties and higher rates of TG,TC and TC/HDL-C abnormalities during the specific follow-up period,and the percentages of TG,TC,HDLC,FPG and TC/HDL-C abnormalities increased significantly over time in both groups.Conclusions Compared with EFV,NVP may be related to favorable lipid profile,but LPV/r may be more harmful to blood lipids,in addition,the effect of EFV on blood glucose is higher than that of the other two drugs,and diabetic patients should be carefully selected and monitored.Clinicians need to be vigilant about the potential risks of hyperlipidemia associated with initiation of ART therapy in patients with HIV/AIDS.
作者
祁明雪
苏一帆
陈晨
钟明丽
魏洪霞
QI Mingxue;SU Yifan;CHEN Chen;ZHONG Mingli;WEI Hongxia(Department of Infectious Diseases,Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine,Nanjing Second Hospital,Nanjing,Jiangsu 211103,China;School of Public Health,Nanjing Medical University,Nanjing,Jiangsu 211166,China)
出处
《安徽医药》
CAS
2024年第5期1017-1024,共8页
Anhui Medical and Pharmaceutical Journal
基金
江苏省卫生健康委科研项目(ZDA2020014)
南京市卫生科技发展专项资金项目(ZKX22040)。
