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目的探讨替诺福韦(TDF)+拉夫米定(3TC)+依非韦伦(EFV)方案,对初治艾滋病病毒(HIV)感染者代谢参数的动态影响。方法 52例初治HIV感染者,依据基线CD+4T淋巴细胞(CD4细胞)计数<200个/μL、200~350个/μL及>350个/μL分为A(28例)、B(10例)、C(14例)三组,分析三组病人接受高效抗反转录病毒治疗(HAART)(TDF+3TC+EFV)前及治疗后4、12、24周各组代谢参数的动态变化。结果 A组去脂体重(47.25kg)及尿酸(UA)(329.08umol/L)低于B组(分别为53.30kg、352.61umol/L)及C组(分别为53.54kg、398.44umol/L),组间比较差异有统计学意义(P<0.05);A组甘油三酯(TG)升高(2.35mmol/L),高密度脂蛋白胆固醇(HDLc)降低(0.99mmol/L),HAART后此改变逐渐恢复正常(24周时TG及LDL-c分别为1.61mmol/L、1.17mmol/L);HAART后4周,A、B组空腹血糖(FPG)升高(A组4周、0周FPG 5.93mmol/L vs 5.68mmol/L,B组4周、0周FPG 5.92mmol/L vs 5.58mmol/L),升高的FPG于12周恢复正常(分别为5.66mmol/L、5.57mmol/L);HAART后三组UA均降低,最低时(A组12周270.83umol/L,B组24周290.63umol/L,C组4周315.10umol/L)与基线比较差异有统计学意义(P<0.05),降低的UA 24周时亦未恢复正常(三组24周UA分别为320.63umol/L、290.63umol/L、350.50umol/L)。结论低CD4细胞计数者去脂体重、UA及HDL-c降低,TG升高;HAART早期可导致糖代谢、嘌呤代谢障碍,对异常的脂代谢有改善的趋势。
Objective To investigate the dynamic effects of tenofovir (TDF) plus rammitin (3TC) + efavirenz (EFV) on the metabolic parameters of HIV-infected individuals. Methods Fifty-two newly diagnosed HIV-infected individuals were divided into A (n = 28), B (n = 10) according to the baseline count of CD4 + CD25 + T lymphocytes (CD4) (14 cases). The dynamic changes of metabolic parameters in each group before and after treatment with HAART (TDF + 3TC + EFV) and 4, 12, and 24 weeks after treatment were analyzed. . Results In group A, the levels of lean body mass (47.25 kg) and uric acid (UA) (329.08umol / L) were lower than those in group B (53.30kg, 352.61umol / L and 53.54kg, 398.44umol / L, (P <0.05). In group A, triglyceride (TG) increased 2.35mmol / L, HDLc decreased 0.99mmol / L, and after HAART The change gradually returned to normal (TG and LDL-c were 1.61mmol / L and 1.17mmol / L respectively at 24 weeks). After 4 weeks of HAART, fasting blood glucose (FPG) in groups A and B increased Week FPG 5.93mmol / L vs 5.68mmol / L, B group 4 weeks, 0 week FPG 5.92mmol / L vs. 5.58mmol / L), elevated FPG returned to normal at 12 weeks (5.66mmol / L, 5.57mmol / L). After the HAART, the levels of UA decreased in all three groups, with the lowest at baseline (270.83umol / L in group A at 12 weeks, 290.63umol / L in group B at 24 weeks and 315.10umol / L at 4 weeks after group C) (P <0.05). The decreased UA also did not return to normal at 24 weeks (UA was 320.63umol / L, 290.63umol / L, 350.50umol / L respectively at 24 weeks in three groups). Conclusions Low CD4 count, lean body mass, lower UA and HDL-c and higher TG may lead to glucose metabolism, purine metabolism disorder and abnormal lipid metabolism in early stage of HAART.