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目的 调查正在接受抗逆转录病毒治疗的人类免疫缺陷病毒(human immunodeficiency virus, HIV)/艾滋病(acquired immune deficiency syndrome, AIDS)患者肾小球滤过率异常发生情况及影响因素，为HIV/AIDS患者慢性肾脏病防治提供科学依据。方法 纳入云南省传染病医院正在接受抗逆转录病毒治疗的HIV/AIDS患者，基于国家艾滋病免费抗病毒治疗数据库，收集患者人口学资料、实验室检查结果及HIV相关资料。采用χ2检验和二元Logistic回归分析HIV/AIDS患者肾小球滤过率异常的影响因素。结果 共纳入4 078例研究对象，肾小球滤过率<60 mL·min-1·(1.73 m2)-1的有311例(7.6%)。多因素分析显示，年龄≥50岁(OR=4.333,95%CI:3.260～5.761,P<0.001)、服用过富马酸替诺福韦酯(OR=1.472,95%CI:1.107～1.957,P=0.008)、CD4~+T淋巴细胞计数<200 cells/μL(OR=1.931,95%CI:1.107～3.371,P=0.021)、葡萄糖水平<3.9 mmol/L(OR=5.201,95%CI:1.057～25.601,P=0.043)和葡萄糖水平6.1～11.1 mmol/L(OR=1.397,95%CI:1.060～1.840,P=0.018)、总胆固醇水平≥5.2 mmol/L(OR=1.300,95%CI:1.014～1.668,P=0.038)是肾小球滤过率异常的危险因素；已经停用富马酸替诺福韦酯6个月及以上(OR=0.093,95%CI:0.053～0.165,P<0.001)是其保护因素。结论 接受抗逆转录病毒治疗的HIV/AIDS患者肾小球滤过率异常主要与年龄、是否服用过富马酸替诺福韦酯、是否已经停用富马酸替诺福韦酯、CD4~+T淋巴细胞计数、总胆固醇水平以及葡萄糖水平相关。临床实践中需针对这些因素制定个体化管理策略，包括优化ART方案、监测代谢指标及早期干预肾功能下降。
Abstract：Objective To investigate the incidence and influencing factors of decreased estimated glomerular filtration rate(eGFR) in people living with HIV/AIDS(PLWHA) undergoing combination antiretroviral therapy(cART), and to provide evidence for the prevention and treatment of chronic kidney disease in this populaton. Methods HIV/AIDS patients who were receiving antiretroviral therapy in Yunnan Provincial Infectious Disease Hospital were included. Based on the National Free antiviral treatment database for AIDS, demographic data, laboratory test results and HIV clinical data of the patients were collected. Chi-square test and binary logistic regression were used to identify factors associated with decreased eGFR using SPSS 27.0. Results A total of 4 078 participants were included in the study. Among them, 311 cases(7.6%) had a glomerular filtration rate of less than 60 mL·min-1·(1.73 m2)-1. Multivariate analysis showed that age≥50 years(OR=4.333, 95%CI: 3.260～5.761, P<0.001), having taken tenofovir disoproxil fumarate(OR=1.472, 95%CI: 1.107～1.957, P=0.008), CD4+ T lymphocyte count<200 cells/μL(OR=1.931, 95%CI: 1.107～3.371, P=0.021), glucose level<3.9 mmol/L(OR=5.201, 95%CI: 1.057～25.601, P=0.043), glucose level 6.1～11.1 mmol/L(OR=1.397, 95%CI: 1.060～1.840, P=0.018), and total cholesterol level≥5.2 mmol/L(OR=1.300, 95%CI: 1.014～1.668, P=0.038) were risk factors for abnormal glomerular filtration rate; having discontinued tenofovir disoproxil fumarate for 6 months or more(OR=0.093, 95%CI: 0.053～0.165, P<0.001) was a protective factor. Conclusion Decreased eGFR in PLWHA receiving cART is independently associated with age, TDF exposure, TDF discontinuation, CD4+ T lymphocyte count, blood glucose, and total cholesterol. Individualized strategies including optimized cART regimens, regular monitoring of metabolic parameters, and early intervention for renal function decline are recommended in clinical practice.
[1]WHO. HIV/AIDS[EB/OL].(2024-07-22). https://www.who.int/newsroom/fact-sheets/detail/hiv-aids.
[2]Marcus JL, Leyden WA, Alexeeff SE, et al. Comparison of overall and comorbidity-free life expectancy between insured adults with and without HIV infection, 2000-2016[J]. JAMA Netw Open, 2020,3(6):e207954. DOI:10.1001/jamanetworkopen.2020.7954.
[3]Górriz JL, Gutiérrez F, Trullas JC, et al. Consensus document on the management of renal disease in HIV-infected patients[J]. Nefrologia,2014, 34:1-81. DOI:10.3265/Nefrologia.pre2014.Jul.12674.
[4]兰玲鲜，苏春雄. HIV/AIDS相关性肾脏疾病患者免疫功能变化及预后分析[J].中国免疫学杂志，2019, 35(18):2258-2261+2266.DOI:10.3969/j.issn.1000-484X.2019.18.016.
[5]Lucas GM, Ross MJ, Stock PG, et al. HIV Medicine Association of the Infectious Diseases Society of America. Clinical practice guideline for the management of chronic kidney disease in patients infected with HIV:2014 update by the HIV Medicine Association of the Infectious Diseases Society of America[J]. Clin Infect Dis, 2014,59(9):e96-138. DOI:10.1093/cid/ciu617.
[6]Zhao Y, Zhang M, Shi CX, et al. Renal function in Chinese HIV-positive individuals following initiation of antiretroviral therapy[J]. PLoS One, 2015, 10(8):e0135462. DOI:10.1371/journal.pone.0135462.
[7]Fiseha T, Gebreweld A. Renal function in a cohort of HIV-infected patients initiating antiretroviral therapy in an outpatient setting in Ethiopia[J]. PLoS One, 2021, 16(1):e0245500. DOI:10.1371/journal.pone.0245500.
[8]Levey AS, Stevens LA, Schmid CH, et al. CKD-EPI(Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate[J]. Ann Intern Med, 2009, 150(9):604-612.DOI:10.7326/0003-4819-150-9-200905050-00006.
[9]李重熙，尹光凤，张瑜书，等.昆明地区HIV感染者抗病毒治疗前的肾病及影响因素[J].昆明医科大学学报，2022,43(2):154-159.DOI:10.12259/j.issn.2095-610X.S20220208.
[10]Mwanjala MN, Urio LJ, Mtebe MV. Prevalence and predictors of renal dysfunction among people living with HIV on antiretroviral therapy in the Southern Highland of Tanzania:a hospital-based cross-sectional study[J]. Pan Afr Med J, 2022, 41:137. DOI:10.11604/pamj.2022.41.137.27025.
[11]Ojeh BV, Abah IO, Ugoagwu P, et al. Incidence and predictors of tenofovir disoproxil fumarate-induced renal impairment in HIV infected Nigerian patients[J]. Germs, 2018, 8(2):67-76. DOI:10.18683/germs.2018.1133.
[12]Labarga P, Barreiro P, Martin-Carbonero L, et al. Kidney tubular abnormalities in the absence of impaired glomerular function in HIV patients treated with tenofovir[J]. AIDS, 2009, 23(6):689-696. DOI:10.1097/QAD.0b013e3283262a64.
[13]袁媛，何盛华，刘欢霞，等.尿β2微球蛋白与HIV感染者长期服用富马酸替诺福韦酯致肾脏损伤的相关性分析[J].四川医学，2022,43(3):213-217. DOI:10.16252/j.cnki.issn1004-0501-2022.03.001.
[14]刘恒丽，杨欣平，李侠，等. HIV感染/艾滋病患者富马酸替诺福韦二吡呋酯相关范可尼综合征临床特征分析[J].药物不良反应杂志，2023,25(1):21-27. DOI:10.3760/cma.j.cn114015-20220603-00491.
[15]da Silva DR, Gluz IC, Kurz J, et al. Multiple facets of HIV-associated renal disease[J]. Braz J Med Biol Res, 2016, 49(4):e5176. DOI:10.1590/1414-431X20165176.
[16]Garza Tovar OA, Pérez AAM, Pérez MEG, et al. Serum electrolytes and renal alterations in HIV-seropositive Mexican subjects[J].Medicine(Baltimore), 2021, 100(20):e26016. DOI:10.1097/MD.0000000000026016.
[17]Kitambala EV, Amani D, Njiro BJ, et al. Burden and factors associated with renal dysfunction among people living with HIV in Dar es Salaam, Tanzania[J]. Glob J Health Sci, 2024, 16(6):37-37. DOI:10.5539/gjhs.v16n6p37.
[18]Tamuno I, Emem-Chioma P, Tamunobelema IT. Renal dysfunction in HIV-infected patients commencing antiretroviral therapy in a treatment centre in southern Nigeria[J]. Babcock Univ Med J, 2024, 7(1):96-106. DOI:10.38029/babcockuniv.med.j..v7i1.327.
[19]Hara M, Yanagisawa N, Ohta A, et al. Increased non-HDL-C level linked with a rapid rate of renal function decline in HIV-infected patients[J]. Clin Exp Nephrol, 2017, 21(2):275-282. DOI:10.1007/s10157-016-1281-9.
[20]Lee CL, Li TC, Lin SY, et al. Dynamic and dual effects of glycated hemoglobin on estimated glomerular filtration rate in type2 diabetic outpatients[J]. Am J Nephrol, 2013, 38(1):19-26. DOI:10.1159/000351803.
[21]Rai P, Singh T, Lederman R, et al. Hyperglycemia enhances kidney cell injury in HIVAN through down-regulation of vitamin D receptors[J]. Cell Signal, 2015, 27(3):460-469. DOI:10.1016/j.cellsig.2014.12.011.
基本信息:
中图分类号:R512.91
引用信息:
[1]钟吉青,王婷,李春梅,等.接受抗逆转录病毒治疗的HIV/AIDS患者肾小球滤过率异常发生情况及影响因素研究[J].传染病信息,2026,39(02):131-137.
基金信息:
云南省科技厅科技计划项目重大科技专项计划（202405AJ310002）
2026-04-30
2026-04-30