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浙江大学学报（医学版）
浙江大学学报（医学版）  2016, Vol. 45 Issue (3): 228-235    DOI: 10.3785/j.issn.1008-9292.2016.05.02
艾滋病专题     
高效抗逆转录病毒治疗对人类免疫缺陷病毒感染者骨代谢的影响
王炬峰, 许利军, 黄莺, 解奕瑞, 孙佳, 苏俊威, 朱彪
浙江大学医学院附属第一医院感染科 传染病诊治国家重点实验室, 浙江 杭州 310003
Impact of long-term highly active antiretroviral therapy on bone metabolism in AIDS patients
WANG Jufeng, XU Lijun, HUANG Ying, XIE Yirui, SUN Jia, SU Junwei, ZHU Biao
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
全文: PDF(1054 KB)  
摘要: 

目的：评价长期不同高效抗逆转录病毒治疗（HAART）方案对HIV感染者骨代谢的影响及发生时间。方法：选取2012年1月至2016年5月在浙江大学医学院附属第一医院进行HAART的82例HIV感染者的临床资料，按照HAART方案中含替诺福韦（tenofovirdisoproxil）或叠氮胸苷（azidothymidine）的不同分为替诺福韦组（41例）和叠氮胸苷组（41例），分析两组在服药后6、12、18、24、30个月患者肾小球滤过率（GFR）和血钙、血磷、血ALP浓度变化趋势，比较两组的差异。结果：两种方案均能提高患者CD4+T细胞数，差异无统计学意义（P>0.05）。相比治疗前，替诺福韦组患者在治疗6个月时GFR[（120.71±62.85）mL/min与（110.08±39.18）mL/min]、血磷浓度[（1.25±0.19）mmol/L与（1.22±0.21）mmol/L]差异均无统计学意义（均P>0.05），而血钙浓度[（2.32±0.12）mmol/L与（2.25±0.17）mmol/L]、血ALP浓度[99.0（79.5～124.0）U/L与80.0（60.5～96.0）U/L]增加均有统计学意义（均P<0.05）；随着治疗时间延长，GFR、血钙浓度、血磷浓度逐渐下降，血ALP浓度继续升高。替诺福韦组患者在治疗30个月后比治疗前血钙浓度[（2.16±0.15）mmol/L与（2.25±0.17）mmol/L]、血磷浓度[（1.06±0.17）mmol/L与（1.22±0.21）mmol/L]、GFR[（98.13±30.43）mL/min与（110.08±39.18）mL/min]减少、血ALP浓度[110.0（98.5～120.5）U/L与80.0（60.5～96.0）U/L]增加均有统计学意义（均P<0.05）。叠氮胸苷组患者随HAART时间延长血钙浓度、血ALP浓度增加，GFR减少，差异均有统计学意义（均P<0.05），而血磷浓度变化差异无统计学意义（P>0.05）。与叠氮胸苷组比较，替诺福韦组GFR、血钙浓度、血磷浓度减少和血ALP浓度增加更明显。结论：我国目前的免费抗病毒治疗药物对患者疗效显著，含替诺福韦的HAART方案会影响患者的骨代谢，导致GFR、血钙和血磷浓度减少，血ALP浓度增加。临床治疗过程中要密切监测，及时干预和尽早调整方案。
关键词 ： 获得性免疫缺陷综合征/药物疗法,  抗逆转录病毒治疗,高效,  副作用,  叠氮化合物/治疗应用,  核苷类/治疗应用,  CD4淋巴细胞计数,  肾小球滤过率/血液,  碱性磷酸酶/血液,  钙/血液,  磷/血液    
Abstract：

Objective: To evaluate the influence of long-term highly active antiretroviral therapy (HAART) on bone metabolism in patients with acquired immune deficiency syndrome (AIDS). Methods: A total of 82 AIDS patients who received HAART in the First Affiliated Hospital of Zhejiang University Medical School during January 2012 and May 2016 were enrolled in the study. Patients were divided into TDF group (n=41) and AZT group (n=41), and glomerular filtration rate (GFR), serum calcium, serum phosphate and serum ALP levels in 6, 12, 18, 24 and 30-month during the treatment were analyzed in both groups. Results: Both TDF-based and AZT-based therapies significantly improved CD4+ T-cell levels of the patients, and no significant difference was observed between the groups. Compared with the baseline, GFR [(120.71±62.85) vs(110.08±39.18) mL/min] and serum phosphate [(1.25±0.19) vs(1.22±0.21) mmol/L] levels rose after 6-month treatment in TDF group, but the difference was not statistically significant (P>0.05); Serum ALP [99.0(79.5-124.0) U/L vs 80.0(60.5-96.0) U/L] and serum calcium [(2.32±0.12) vs(2.25±0.17) mmol/L] levels rose significantly (P<0.05). As treatment continued, the levels of GFR, serum calcium and serum phosphate declined, while the serum ALP number was still increasing. After 30 months of HAART, the level of serum calcium [(2.16±0.15) vs(2.25±0.17) mmol/L], serum phosphate [(1.06±0.17) vs(1.22±0.21) mmol/L], GFR [(98.13±30.43) vs (110.08±39.18) mL/min] declined significantly (P<0.05) in TDF group, while serum ALP [110.0(98.5-120.5) U/L vs 80.0(60.5-96.0) U/L, P<0.05] increased. In AZT group, serum calcium and serum ALP levels rose and GFR level was declined (P<0.05), while serum phosphate level was not significantly changed during the treatment (P>0.05). Compared with AZT group, there were greater changes on the levels of GFR, serum calcium, serum phosphate and serum ALP in TDF group. Conclusion: HAART is effective for patients with AIDS, and TDF-based therapy may have significant impact on bone metabolism of the patients, which needs close monitoring and timely intervention or adjustment if necessary.
Key words： Acquired immunodeficiency syndrome/drugtherapy    Antiretroviral therapy, highly active    Azides/therapeutic use    Nucleosides/therapeutic use    CD4 lymphocyte count    Glomerular filtration rate/blood    Alkaline phosphatase/blood    Calcium/blood    Phosphorus/blood
收稿日期: 2016-01-15
CLC:  R512.91  
基金资助:

“十二五”艾滋病和病毒性肝炎等重大传染病防治科技重大专项（2013ZX10001004-002-003，2014ZX10001002-002-002）
通讯作者: 朱彪(1965-),男,博士,主任医师,硕士生导师,从事艾滋病及相关疾病的研究;E-mail:zhubiao1207@zju.edu.cn;http://orcid.org/0000-0001-8423-2447     E-mail: zhubiao1207@zju.edu.cn
作者简介: 王炬峰(1983-),男,硕士研究生,主治医师,从事艾滋病及相关疾病的研究;E-mail:148249278@qq.com;http://orcid.org/0000-0003-0599-2953
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引用本文:

王炬峰 等. 高效抗逆转录病毒治疗对人类免疫缺陷病毒感染者骨代谢的影响[J]. 浙江大学学报（医学版）, 2016, 45(3): 228-235.
WANG Jufeng, XU Lijun, HUANG Ying, XIE Yirui, SUN Jia, SU Junwei, ZHU Biao. Impact of long-term highly active antiretroviral therapy on bone metabolism in AIDS patients. Journal of ZheJiang University(Medical Science), 2016, 45(3): 228-235.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2016.05.02      或      http://www.zjujournals.com/xueshu/med/CN/Y2016/V45/I3/228

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