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目的探讨含替诺福韦酯方案的抗反转录病毒治疗(ART)对不同CD4+T淋巴细胞水平人类免疫缺陷病毒(HIV)感染患者肾功能的影响。方法收集HIV感染者共114例,其中启用ART时CD4+<200/μL患者45例(A组),CD4+200~<350/μL患者37例(B组),CD4+≥350/μL患者32例(C组)。每3~6个月进行1次肾功能检查,估算肾小球滤过率(eGFR),比较治疗48周时eGFR较基线的变化情况及各组间的eGFR下降幅度。结果 A组患者ART48周后eGFR水平较治疗前下降,差异有统计学意义(P<0.001);B组、C组eGFR治疗前后比较差异无统计学意义。A组治疗后eGFR下降幅度也较B组、C组大,差异有统计学意义(均P<0.001)。eGFR下降的例数也较B、C组多,差异有统计学意义(均P<0.05)。治疗后eGFR改变<-20%的患者例数也是A组最多,与B、C组比较差异有统计学意义(均P<0.05)。结论我国HIV感染者使用替诺福韦酯过程中,CD4+<200/μL HIV感染者更容易发生GFR下降,比CD4+≥200/μL的患者有更高发生肾脏功能损害的风险,而早期启动包含替诺福韦酯的ART则可以降低肾脏不良事件发生的风险。
Objective To investigate the effects of anti-retroviral therapy with tenofovir dipivoxil on renal function in HIV-infected patients with different CD4 + T lymphocyte levels. METHODS: A total of 114 patients with HIV infection were enrolled, among which 45 patients with CD4 + <200 / μL (Group A), 37 patients with CD4 + -200 ~ <350 / μL (Group B) and 32 patients with CD4 + (C group). The renal function test was performed once every 3 to 6 months to estimate the glomerular filtration rate (eGFR). The change of eGFR from baseline and the decrease of eGFR between the groups were compared 48 weeks after treatment. Results The eGFR levels of ART group after 48 weeks of treatment in ART group were significantly lower than those before ART (P <0.001). There was no significant difference between before and after eGFR treatment in group B and C group. The decrease of eGFR in group A was also greater than that in group B and group C, with significant difference (all P <0.001). The number of cases with decreased eGFR was also higher than those in group B and C (all P <0.05). The number of patients with eGFR changes <-20% after treatment was also the highest in group A, and there was significant difference between group B and C (all P <0.05). Conclusions In people with HIV infection in China, tenofovir dipivoxil is more susceptible to GFR decline in HIV-infected patients with CD4 + <200 / μL than patients with CD4 + ≥200 / μL, whereas those with early initiation include Tenofovir disoproxil can reduce the risk of adverse renal events.