10例HIV/AIDS患者HAART后继发高乳酸血症或乳酸酸中毒临床分析

摘要

目的 探讨HIV/AIDS患者高效抗反转录病毒治疗(highly active antiretroviral therapy,HAART)后继发高乳酸血症或乳酸酸中毒的临床表现和治疗方案.方法 回顾性分析10例HIV/AIDS患者HAART后继发高乳酸血症或乳酸酸中毒的临床表现、实验室检测结果和治疗效果等资料.结果 10例在继发高乳酸血症或乳酸酸中毒前均服用过含有核苷类反转录酶抑制剂(nucleoside reverse transcriptase inhibitors,NRTIs)组合的HAART方案,临床症状以乏力、恶心、腹胀、肌肉酸痛和呼吸困难多见,血乳酸浓度为5.14～10.74mmol/L,其中8例出现高乳酸血症或乳酸酸中毒的相关症状,2例未出现.6例经换药或停药处理后好转,4例死亡.结论 引起高乳酸血症或乳酸酸中毒的主要原因是使用含有NRTIs的组合方案,其中司他夫定最为常见,其次为齐多夫定.治疗时应立刻换药或停药.%Objective To investigate the clinical manifestations and treatment of HIV/AIDS patients who are affected with hy-perlactacidemia/lactic acidosis after receiving highly active antiretroviral therapy (HAART). Methods The clinical manifestations, laboratory findings and treatment efficacy were retrospectively analyzed in 10 HIV/AIDS patients who were affected with hyperlacta-cidemia/lactic acidosis after receiving HAART. Results All the 10 HIV/AIDS patients had received HAART regimens including nu-cleoside reverse transcriptase inhibitors (NRTIs) before being affected with hyperlactacidemia/lactic acidosis. The common clinical symptoms were fatigue, nausea, abdominal distension, muscle aches and difficulty of breathing. The blood lactic acid level of the 10 patients was 5.14-10.74 mmol/L, symptoms related to hyperlactacidemia/lactic acidosis occurring in 8 patients. Six patients were improved on cessation or switching to another medication, and 4 died. Conclusions The major cause that leads to hyperlactacidemia/ lactic acidosis is receiving HAART including NRTIs, especially stavudine and zidovudine. Once hyperlactacidemia/lactic acidosis occurs, it is critical to stop the medication or switch to another.