上海市抗艾滋病药物的药物不良反应研究

发布时间：2018-10-17 13:36

【摘要】：研究背景艾滋病又称获得性免疫缺陷综合征(AIDS)，是由艾滋病病毒(HIV)感染引起的以免疫系统损害和感染为主要特征的一组综合征。所有的抗病毒药物都会引起药物的不良反应,严重时会影响患者服药依从性,甚至导致抗病毒治疗的中断，部分药物不良反应在治疗开始后短时间内即会发生,因而要达到治疗效果,必须始终关注,及时采取包括更换治疗方案等在内的应对措施,帮助患者减轻症状,提高治疗依从性。研究目的 1、通过对上海市2009-2013年纳入免费ART项目的872例艾滋病患者资料进行分析，了解该市艾滋病流行现状，结合本市实际情况，预测今后流行趋势，为科学制定防控措施提供依据。 2、分析上海市艾滋病患者抗病毒治疗情况，评价抗病毒治疗效果，为今后开展规范化抗病毒治疗提供科学依据。 3、总结上海市艾滋病患者接受国家免费抗逆转录病毒治疗后药物不良反应的发生情况，并分析其影响因素，指导临床合理用药。研究方法采用描述性流行病学的研究方法，对上海市公共卫生临床中心2009年1月1日至2013年6月30日纳入免费ART项目的872例艾滋病患者资料进行研究，所有患者定期进行药物不良反应临床和实验室评估。资料采用SPSS17.0统计软件包和EXCEL表格进行统计分析。研究结果 1、共收集艾滋病患者报告872份，其中男性735例，女性137例，男女比例接近5.3:1；年龄集中于30~49岁段人群，低龄和高龄者有增多的趋势；职业以娱乐服务行业最多（23.74%），其次为家政待业（16.97%）；感染途径以性传播为主，其中同性传播占54.93%，提示MSM人群的高危险性，值得关注。 2、872例接受免费ART的艾滋病患者中，死亡52例，79例合并其他慢性感染，服药依从性为74.66%，治疗方案以AZT+3TC+EFV为主（53.95%），197例更换治疗方案，绝大多数病例CD4+T淋巴细胞计数明显上升，治疗12个月、18个月和24个月后CD4+T淋巴细胞计数水平高于治疗前。 3、在872例艾滋病患者中有722例（82.80%）在整个治疗过程中出现药物相关不良反应，常见的短期不良反应有消化系统症状（35.67%）、皮疹（15.14%）、骨髓抑制（11.14%）、疲倦（5.05%）和中枢神经系统症状（7.80%）等，中长期不良反应有脂肪重新分布（5.62%）、外周神经炎（6.88%）、肝毒性（5.50%）等。其中含AZT的治疗方案以消化系统症状、贫血的发生率较高，含D4T的治疗方案主要不良反应为体形改变、脂肪重新分布，含EFV和NVP的治疗方案与皮疹、肝毒性间有一定的特异关联性。结论 1、上海市艾滋病的流行现状以同性性传播感染途径为主，感染例数逐年迅速上升，应引起政府和各参与防治人员的高度重视，对MSM人群制定有针对性的防治策略，扩大艾滋病咨询检测服务覆盖面，，提高MSM人群的主动检测意识。 2、上海市艾滋病免费抗病毒治疗的规模逐年扩大，多数患者的CD4+T淋巴细胞计数上升明显，抗病毒治疗的效果较好，多数患者具有较好的免疫重建效果，但存在不同程度的药物不良反应，艾滋病的治疗工作仍然任重道远。提示采取提高抗病毒治疗患者的依从性、降低漏服药物的次数、减少中途停药的时间、及时开展免疫细胞的检测、适时更换治疗方案等措施，就可能增加治疗成功的概率，降低病死率，延长患者的生存时间。 3、上海市艾滋病患者接受免费抗病毒治疗后的相关药物不良反应发生率较高，轻微的药物不良反应经对症处理后能够好转，大多数不良反应在可耐受范围内；比较严重的不良反应，如骨髓抑制、皮疹及肝功能损害等，给患者造成痛苦，甚至危及生命，需即时更换药物。提示应加强抗病毒治疗药物不良反应的监测，及时处理，保证抗病毒治疗顺利进行。
[Abstract]:background of study AIDS, also known as Acquired Immune Deficiency Syndrome (AIDS), is one of the main features of immune system damage and infection caused by HIV infection. All antiviral drugs will cause adverse reactions to the drug, which will affect the patient's compliance and even cause the interruption of antiviral therapy. Some adverse drug reactions will occur in a short time after the start of treatment. Therefore, the treatment effect must always be achieved. Pay attention to timely take the response measures including the replacement treatment plan and so on, to help the patient to alleviate the symptoms and improve the treatment. from sex. Objective 1 To study the prevalence of AIDS in the city by analyzing 872 cases of AIDS patients included in the free ART project in 2009-2013, and to predict the trend of AIDS in the future according to the actual situation of the city. To provide the basis for prevention and control measures, analyze the anti-virus treatment situation of AIDS patients in Shanghai, evaluate the effect of anti-virus treatment, and standardize the prevention and control measures in the future. To provide a scientific basis for antiviral therapy. 3. To sum up the occurrence and analysis of adverse drug reactions after receiving free antiretroviral therapy in Shanghai. Its impact is due to In this study, a descriptive epidemiology study was used to study 872 cases of AIDS patients included in the free ART project from January 1, 2009 to June 30, 2013, and all patients were determined. The clinical and laboratory assessments of adverse drug reactions were performed in the phase. The data were counted by SPSS1.7. Software package and Results A total of 872 patients with AIDS were collected, including 735 males and 137 females, and females were close to 5. 3: 1. The age concentration was from 30 to 49 years of age, and there was an increase in low age and old age. Trends in professional entertainment services (23.74%), followed by domestic hospitality (16,97%); infection routes dominated by sexually transmitted infections, of which same-sex communications accounted for 5 4.93% showed the high risk of MSM population. Of the 872 AIDS patients who received free ART, 52 of them died, 79 patients were combined with other chronic infections, the compliance of drug administration was 74. 66%, and the treatment regimen was dominated by AZT + 3TC + EFV (53. 95%) and 197 cases were replaced. The number of CD4 + T lymphocytes increased significantly in most cases, 12 months, 18 months after treatment. In 872 cases of AIDS, 722 cases (82. 80%) experienced adverse drug-related adverse reactions throughout the course of treatment, and common short-term adverse reactions had digestive system symptoms (35 67%), rash (15. 14%), bone marrow suppression (11.14%), fatigue (5. 05%) and central nervous system symptom (7. 80%), and medium and long term adverse reaction had fat redistribution (5). 62%), peripheral neuritis (6.88%), hepatotoxicity (5. 50%), etc. Among them, the treatment regimen containing AZT was characterized by digestive system symptoms and anemia, and the main adverse reactions of the treatment regimen containing AZT were changes in body shape, redistribution of fat, EF (EF) Conclusion 1. The prevalence of AIDS in Shanghai is mainly based on the same-sex transmission of sexually transmitted infections, and the number of infections rises rapidly. Special attention should be paid to the government and the people involved in the prevention and control of the disease, and the MSM population should be targeted "Prevention and control strategy, expand the coverage of AIDS consultation and detection service, improve the active detection awareness of MSM population." 2. The scale of free anti-virus treatment in Shanghai is increasing year by year, and the CD4 + T lymphocyte count of most patients has increased obviously, and anti-virus is anti-virus. "The effect of treatment is good, and most patients have a better effect. Good immune reconstitution effect, but there is a different degree of adverse drug reaction, and the treatment of AIDS still has a long way to go. It is suggested to take the measures to improve the compliance of patients with anti-virus treatment, reduce the number of drug leakage, reduce the time of stopping the drug withdrawal, and carry out the treatment in a timely manner. Detection of immune cells, timely It is possible to increase the probability of success of treatment, reduce the case fatality rate and prolong the survival time of the patients. 3. The incidence of adverse drug reactions after free antiviral therapy in Shanghai AIDS patients is high, and slight adverse drug reactions occur. It can improve after symptomatic treatment, and most adverse reactions are within tolerable range; serious adverse effects. Response, such as bone marrow suppression, rash and liver function impairment, cause pain to the patient, even life threatening, immediate
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.91

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