非核苷类抗反转录酶抑制剂引起的肝毒性及相关风险因素分析

Liver toxicity and associated risks induced by Non-nucleoside reverse transcriptase inhibitors

关键词:  获得性免疫缺陷综合征  高效抗反转录病毒治疗  肝毒性

Key words:  [Key words]　acquired immunodeficiency syndrome  highly active antiretroviral therapy  liver toxicity

摘要:

[摘要]　目的　分析使用非核苷类反转录酶抑制剂进行高效抗反转录病毒治疗(HAART)肝毒性的发生率以及相关风险因素。　方法　回顾性分析2004年1月—2010年12月在中国医科大学附属第一医院红丝带门诊接受HAART治疗的102例AIDS病人，分析抗病毒治疗前后ALT、AST、GGT、TB、AP变化情况，比较奈韦拉平（NVP）和依非韦伦（EFV）的肝毒性发生率，多因素分析非核苷类反转录酶抑制剂治疗引起肝毒性的风险因素。　结果　基于NVP的HAART治疗其肝毒性发生率为35.6%（26/73），基于EFV的HAART治疗其肝毒性发生率为13.8% (4/29)，两种药物肝毒性发生率差异有显著性意义（χ2=4.761，P=0.029）。肝毒性相关风险因素分析显示，基于NVP的HAART用药方案、合并丙型肝炎病毒(HCV)感染、基线ALT升高为出现肝毒性的独立风险因素（P<0.05）。抗病毒治疗前后患者的酶学指标值结果提示GGT异常最明显。　结论　接受含NVP的HAART治疗的患者比接受含EFV的HAART治疗的患者更易出现肝毒性；用药方案、合并HCV感染、基线ALT升高为HAART治疗出现肝毒性的独立风险因素。

Abstract:

[Abstract] Objective〖WTBZ〗 To investigate the incidence of liver toxicity and associated risks in patients receiving non-nucleoside reverse transcriptase inhibitors as highly active antiretroviral-therapy (HAART). 〖WTHZ〗Methods　A retrospective study was conducted from January, 2004 to December, 2010 on 102 patients with AIDS from Red Ribbon Outpatients in the First Affiliated Hospital of Chinese Medical University. We compared the levels of ALT、AST、GGT、TB and AP in patients before and after treatment, compared the liver toxicity incidence between NVP and EFV, and analyzed the risk of liver toxicity caused by treatment with non-nucleoside reverse transcriptase inhibitors. 〖WTHZ〗Results〖WTBZ〗 Hepatotoxicity incidence was 35.6%（26/73）in NVP-based HAART, and was 13.8%（4/31）in EFV-based HAART. Liver toxicity incidence of two treatment methods were significantly different (χ2=4.761，P=0.029). By risk factor analysis, we found that different regimens, co-infection with HCV, baseline ALT elevations were independent risk factors of HAART treatment (P<0.05). The most obvious change was GGT before and after therapy. 〖WTHZ〗Conclusion　Patients who receive HAART treatment containing NVP are more likely to have liver toxicity than patients who receive HAART treatment containing EFV. Different regimens, co-infection with HCV, baseline ALT elevations are independent risk factors of HAART.