HIVAIDS联合抗病毒治疗药物对肾脏的影响张立成，马剡芳，万钢，杨松.doc

基金项目：北京市朝阳区艾滋病和病毒性肝炎等重大传染病综合防治示范区建设研究（2012ZX10004-904） 通信作者：杨涤，E-mail:yadio25184@ HIV/AIDS联合抗病毒治疗药物对肾脏的影响 张立成，马剡芳，万钢，杨松，张铭，李蔚丽，杨涤 （首都医科大学附属北京地坛医院急诊科，北京100015） 摘要：目的 通过对不同抗病毒治疗方案治疗效果的临床观察，了解各方案对肾小球滤过率的影响，通过分析eGFR的变化作为肾脏功能评定的指标，找出影响因素。为今后更合理的制定抗病毒方案提供依据。方法 采用回顾性分析收集首都医科大学附属北京地坛医院2010-2014年以来确诊HIV/AIDS并给予抗病毒治疗的门诊及住院患者的临床资料，初治患者给予一线抗病毒治疗方案（AZT+3TC+NVP和TDF+3TC+EFV）。之前接受过一线抗病毒治疗，病毒学检测确定为治疗失败者更换二线治疗方案（TDF+3TC+LPV/r）。使用eGFR作为肾脏功能评定的指标。比较各组抗病毒治疗方案治疗前后及组间eGFR的变化特点。结果 随着用药时间延长，AZT+3TC+NVP组eGFR值总体是呈上升趋势，TDF+3TC+EFV组和TDF+3TC+LPV/r组eGFR值是逐渐下降的，TDF+3TC+LPV/r组下降程度大于TDF+3TC+EFV组（P0.013）。在抗病毒治疗过程中，药物因素外引起肾功能损伤相关危险因素中年龄因素是最主要的。结论 抗病毒治疗方案AZT+3TC+NVP对肾脏功能具有一定的改善作用，对于初治伴肾损伤的患者可考虑该方案治疗。随着用药时间延长，TDF+3TC+EFV和TDF+3TC+LPV/r方案对肾功能下降的影响是逐渐加重的，其中TDF+3TC+LPV/r方案影响最显著，对于基线肾功能受损患者，不建议首选该方案治疗。选择抗病毒治疗方案时除肾功能因素外，患者的年龄因素也是需要重点关注的。 关键词：HIV/AIDS；CD4+T细胞；估计肾小球滤过率 中图分类号：R512.91；R373.9　　文献标志码：A The influence of the combined anti-virus treatment of HIV/AIDS on the kidney ZHANG Licheng，MA Yanfang，WAN Gang，YANG Song，ZHANG Ming，LI Weili，YANG Di，（Department of Eergengcy，Beijing Ditan Hospital，Capital Medical University，Beijing 100050，China） Abstract: Objects To compare the influence of different anti-virus treatments of AIDS on GFR. To analyze the changes of eGFR which is an indicator of renal function and find the reason. Provide the evidences for more reasonable methods of anti-HIV treatment. Methods Retrospective investigating the clinical data of AIDS patients who were diagnosed and treated by anti-virus medicine in Beijing Ditan Hospital from 2011 to 2014. The patients who were treated for the first time were treated by AZT+3TC+NVP and TDF+3TC+EFV.The patients who were treated for the first time but failed and the dosage of virus were still positive were treated by TDF+3TC+LPV/r. Using the eGFR as an indicator evaluating the renal function. Compared the change characteristics of eGFR between the three groups before and after the antiviral treatment. Results As the time of the treatment became lon