HIV感染者进行高效抗反转录病毒治疗过程中发生非酒精性脂肪性肝病的相关因素分析

摘要

目的：分析HIV感染者进行高效抗反转录病毒治疗（HAART）后非酒精性脂肪性肝病（NAFLD）的发生情况及影响因素。方法选择2013年至2015年于本院门诊领取国家免费抗病毒药物2年并规律随访的HIV感染者，所有患者HAART治疗前均无NAFLD。回顾性分析不同年龄、性别和HAART方案患者NAFLD的发生情况及HAART 2年时的相关指标。统计患者肝功能、肾功能、血糖、血脂、乳酸、CD4+T淋巴细胞计数及BMI等数据，并对其与NAFLD的关系进行横断面分析。结果共收集99例患者，其中发生NAFLD 29例，占29.3%。发生NAFLD和未发生NAFLD患者的CD4+T淋巴细胞计数、ALT、甘油三酯、总胆固醇及乳酸水平差异有统计学意义（P均＜0.05）。单因素分析显示，不同HAART方案中含TDF组合可减少NAFLD的发生率，不同年龄及性别发生NAFLD的风险无统计学差异（P均＜0.05）。结论 HAART治疗过程中NAFLD发生率较高，可能与抗病毒药物所致的脂代谢紊乱及线粒体损伤等有关，使用TDF组合可能减少NAFLD的发生率，HAART过程中CD4+T淋巴细胞计数、ALT、甘油三酯、总胆固醇及乳酸水平可能对NAFLD的发生有提示作用，需要在临床中予以监测。%Objective To investigate the prevalence and risk factors of non-alcoholic fatty liver disease in patients with HIV-infection after receiving highly active antiretroviral therapy (HAART).Methods HIV-infected patients who received a government free anti-retroviral drugs and were followed-up regularly for 2 years in our hospital from 2013 to 2015 were selected. All the patients had no non-alcoholic fatty liver disease (NAFLD) before HAART. The occurrence of NAFLD between different age, gender and HAART were analyzed retrospectively. Liver functions, renal functions, serum glucose levels, serum fat levels, lactic acid levels, CD4+ T cell and BMI were recorded and the relationship with NAFLD was evaluated with cross-sectional study. Results Total of 99 HIV-infected patients were enrolled in this study and 29 (29.3%) of them were diagnosed as NAFLD. The levels of CD4+ T cell, serum ALT, triglyceride, total cholesterol and lactic acid had statistically significant differences between patients with or without NAFLD (P< 0.05). Single factor analysis showed that, antiretroviral regimens with TDF could reduce the incidence of NAFLD, and gender and age were not associated with NAFLD in this study (P< 0.05).Conclusions The higher prevalence of NAFLD was found in HIV-infected patients receiving HAART in this study, which may be associated with fat metabolic dysfunction and mitochondrial damage when receiving HAART. The CD4+ T cell, serum ALT, triglyceride, total cholesterol and lactic acid levels in process of receiving HAART may be related with NAFLD, which should be closely monitored in clinical work. The combined use of TDF may reduce the incidence of NAFLD.