接受抗逆转录病毒治疗的艾滋病患者脂肪营养不良的现况研究

发布时间：2018-04-28 09:08

本文选题：艾滋病 + 高效抗逆转录病毒治疗　；参考：《安徽医科大学》2013年硕士论文

【摘要】：目的：描述接受抗逆转录病毒治疗的AIDS患者脂肪营养不良（LD）的现患率及其人群分布特征；分析LD与膳食、体力活动、体成分以及药物治疗的关系；探讨LD的主要影响因素，为预防LD的发生提供参考依据。方法：本研究为现况研究，从我省艾滋病流行较为严重的皖北地区抽取两个县为研究现场。选择2012年5月25日-5月31日期间，在当地疾病预防控制中心艾滋病随访门诊接受定期集中随访的艾滋病人作为研究对象。采用面对面问卷调查方法收集研究对象的社会人口学特征、行为和饮食习惯等信息，以国际体力活动问卷（短卷）评价其体力活动水平。采用体格测量方法获取研究对象的身高、体重、腰围、臀围、上臂围、皮脂厚度（包括腹部、肱三头肌、肩胛下皮脂厚度）数据，并根据上述指标计算体质指数（BMI）、腰臀比（WHR）、体密度、体脂率和瘦体重等。从安徽省疾病预防控制中心的艾滋病管理信息系统中提取研究对象的确诊感染HIV的时间、开始治疗时间、治疗方案及其变动情况、疾病目前临床分期以及最近一次的病毒载量、CD4+细胞计数水平等临床资料。用Epidata3.1对数据进行双录入，运用SPSS16.0进行数据处理。结果：现场共调查艾滋病患者264人，获得完整的问卷和体格检查资料261份，有效率98.86%，其中男145例（55.6%），女116例（44.4%）。261例患者中共检出LD患者147例，现患率为56.3%，其中脂肪萎缩95例（36.4%），脂肪堆积17例（6.5%），混合型35例（13.4%）。按不同特征分组比较发现，女性较男性LD检出率高（69.0%vs46.2%，P0.01）；不同年龄组间LD检出率不同，差异有统计学意义（P0.05），随年龄增加LD检出率增加（趋势χ~2=5.014，P0.05）；不同经济状况组LD检出率差异有统计学意义（P0.05），且经济状况越差LD检出率越高（趋势χ~2=4.248，P0.05）；吸烟组较不吸烟/戒烟组LD检出率高（46.2%vs38.2%，P0.01）；而其他方面如上学年限、婚姻状况、职业、饮酒和运动等，组间差异均无统计学意义（P0.05）。多数艾滋病患者膳食结构不合理，，以谷类为主，蔬菜、水果及奶类、肉类等优质蛋白类食物摄入普遍较低。LD组谷类日均摄入量和肉类的摄入频率较非LD组（NLD组）低，差异有统计学意义（P0.01）。两组间体力活动水平差异无统计学意义（P0.05）。LD组上臂肌围和瘦体重均低于NLD组，差异具有统计学意义（P0.05），BMI、WHR、体脂率等其他指标如组间均无统计学差异（P0.05）。 LD组的患病时间、治疗时间、最近方案使用时间均较NLD组长（P0.01）；HIV临床分期在两组分布中也有差异（P0.05），但CD4+细胞计数和病毒载量组间未见统计学差异。无论是初始治疗方案还是最近治疗方案，两组使用情况均存在差异（P0.01），其中LD组的最近治疗方案除3TC+NVP+AZT构成比低于NLD组，其余方案均高于NLD。LD组D4T和DDI的暴露率高于NLD组，ZDV暴露率低于NLD组，差异均有统计学意义（P0.01）。除ZDV外，LD组的NVP、3TC、D4T和DDI的使用时间均较NLD组长（P0.01）。单因素Logistic回归分析显示：年龄、性别、经济状况、体重、治疗时间、患病时间、药物D4T、ZDV、DDI暴露和D4T、ZDV、DDI、NVP、3TC的使用时间与LD有关联；多因素Logistic回归分析显示女性、D4T使用时间长和3TC使用时间长是LD的独立危险因素。结论：LD在接受抗逆转录病毒治疗的AIDS患者中较为常见，且与患者性别、年龄、治疗时间及某些药物特别是D4T的使用等因素有关。减少使用D4T或者用其他药物代替D4T有可能降低艾滋病人发生LD的风险。多数接受抗逆转录病毒治疗的AIDS患者膳食结构不合理，LD患者各类营养素尤其是优质蛋白摄入不足，其体成分改变主要表现为瘦体重降低和肌肉萎缩，因此应增加该人群富含优质蛋白质的食物以及蔬菜水果的摄入。
[Abstract]:Objective: to describe the prevalence of adipose malnutrition (LD) and its population distribution in AIDS patients receiving antiretroviral therapy, and to analyze the relationship between LD and diet, physical activity, body composition and drug therapy, and discuss the main influencing factors of LD, and provide a reference for preventing the occurrence of LD.
Methods: in this study, two counties were selected from the north of Anhui Province, which was more serious in the area of AIDS epidemic in our province. In the period of May 25, 2012 -5 month 31, aids people who received regular and centralized follow-up in the follow-up clinic of the local disease control and prevention center were selected as the research object. The method collected the social demographic characteristics, behavior and dietary habits of the subjects, and evaluated the physical activity level by the international physical activity questionnaire (short volume). The body height, weight, waist circumference, hip circumference, upper arm circumference and sebum thickness (including the abdomen, triceps, sebum thickness) were obtained by the physical measurement. According to the above indicators, the body mass index (BMI), waist to hip ratio (WHR), body density, body fat rate and lean body weight were extracted from the AIDS management information system of the center for Disease Control and prevention in Anhui province. The time of diagnosis, treatment time, treatment plan and changes, the current clinical stages and the latest time of the disease were obtained. Viral load, CD4+ cell count and other clinical data. Epidata3.1 was used for data entry and SPSS16.0 was used for data processing.
Results: a total of 264 AIDS patients were investigated on the site, and 261 complete questionnaires and physical examination data were obtained. The effective rate was 98.86%, of which 145 were male (55.6%) and 116 (44.4%) in women (44.4%).261 patients were detected in 147 cases. The prevalence rate was 56.3%, including 95 fatty atrophy (36.4%), fat accumulation 17 (6.5%) and mixed 35 cases.
The positive rate of LD was higher than that of male (69.0%vs46.2%, P0.01), and the positive rate of LD was different in different age groups, and the difference was statistically significant (P0.05), and the detection rate of LD increased with age (trend Chi ~2=5.014, P0.05), and the difference of LD detection rate in different economic groups was statistically significant (P0.05), and the poorer L in the economic situation was L. The higher the detection rate of D (trend Chi ~2=4.248, P0.05), the smoking group had higher LD detection rate than non smoking / smoking group (46.2%vs38.2%, P0.01), while other aspects such as school years, marital status, occupation, drinking and exercise were not statistically significant (P0.05).
The dietary structure of most AIDS patients was not reasonable. The intake of high quality protein foods, such as vegetables, fruits, milk and meat, was generally lower in the lower.LD group than that in the non LD group (group NLD). The difference was statistically significant (P0.01). There was no statistical difference between the two groups (P0.05).LD. The upper arm muscle circumference and lean weight were lower in group NLD than those in group NLD (P0.05), BMI, WHR, body fat rate and other indicators were not statistically significant (P0.05).
The duration of disease, the time of treatment and the time for the treatment of the LD group were longer than that of the NLD group (P0.01); the clinical staging of HIV was also different in the two groups (P0.05), but there was no statistical difference between the CD4+ cell count and the viral load group. Both the initial treatment and the recent treatment regimen were different (P0.01), of which LD was used (P0.01). The composition ratio of 3TC+NVP+AZT was lower than that of group NLD, and the other schemes were higher than that of group NLD.LD, D4T and DDI were higher than that of group NLD. The exposure rate of ZDV was lower than that of NLD group, and the difference was statistically significant (P0.01).
Single factor Logistic regression analysis showed that age, sex, economic status, weight, time of treatment, time of treatment, drug D4T, ZDV, DDI exposure and D4T, ZDV, DDI, NVP, and 3TC were associated with LD; multifactor Logistic regression analysis showed that the length of the use of D4T and the long time of use were independent risk factors.
Conclusion: LD is more common in AIDS patients receiving antiretroviral therapy, and is related to sex, age, time of treatment and the use of certain drugs, especially D4T. Reducing the use of D4T or using other drugs instead of D4T may reduce the risk of LD in AIDS. Most of the AIDS patients receiving antiretroviral therapy The diet structure of the LD patients is not reasonable. The nutrients of all kinds, especially the high quality protein, are insufficient. The changes of body composition are mainly manifested in the decrease of lean body weight and muscle atrophy. Therefore, the diet of high quality protein and the intake of vegetables and fruits should be increased.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R153.9;R512.91

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