| 450例HIV/AIDS合并肾功能损害患者临床病因与预后评价分析 |
| 投稿时间：2016-12-12 修订日期：2017-02-22 点此下载全文 |
| 引用本文：冯润川,兰玲鲜,谢志满,梁茂裕,葛利辉,罗向佳,何琦.450例HIV/AIDS合并肾功能损害患者临床病因与预后评价分析[J].医学研究杂志,2017,46(10):96-100 |
| DOI：
10.11969/j.issn.1673-548X.2017.10.025 |
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| 基金项目:广西壮族自治区卫生与计划生育委员会自筹经费科研项目（Z2015168） |
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| 中文摘要:目的 探讨HIV/AIDS合并肾功能损害患者临床特征及预后。方法 对广西艾滋病临床治疗中心450例HIV/AIDS合并肾功能损害患者流行病学资料及临床特征等相关资料进行回顾性分析，记录住院期及出院随访6个月的主要临床事件、全因死亡和再入院率。结果 （1）2013年1月~2015年12月就诊HIV/AIDS患者4328例中，合并肾功能损害450例，急性肾损害90例（20%），慢性肾病360例（80%），发生率10.4%，HAART率62%。临床预后监测指标结果：心血管事件发生率29.3%、终末期肾病率12.2%、再次住院率30.4%，全因病死率11.8%。（2）病理、病因及影像学异常表现分类：肾小球疾病136例，血管疾病123例，肾小管间质疾病105例，囊性疾病58例，浸润性疾病及其他28例。（3）360例慢性肾脏病患者肾功能分级越高，HIV-1 RNA定量、24h尿蛋白定量、血清胆固醇、CysC、CA-125指标升高，而CD4+ T淋巴细胞计数及血清白蛋白定量下降。结论 HIV/AIDS合并肾功能损害患者肾脏结构或功能异常表现形式多样，病因复杂，常出现病理、影像学异常，以慢性肾病为主。HIV-1 RNA定量、CD4+ T淋巴细胞计数、血清白蛋白定量、血清胆固醇、CysC、CA-125指标与肾功能损害程度有关。治疗上以内科综合治疗为主，HAART治疗及透析治疗可降低终末期肾病病死率。 |
| 中文关键词:艾滋病 艾滋病相关性肾病 肾损害 临床病因 预后 |
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| Analysis on Clinical Etiology and Prognostic Evaluation in 450 Patients with HIV/AIDS and Renal Function Damage |
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| Abstract:Objective To analysis the clinical characteristic and prognosis in 450 patients with HIV/AIDS and renal function damage. Methods We retrospectively analyzed the data of epidemiology and clinical characteristic in 450 patients with HIV/AIDS and renal function damage who were hospitalized in Guangxi Center of HIV/AIDS Clinical Treatment. We recorded the critical clinical events, all-cause mortality and readmission rate. Results (1)Among the 4328 cases of HIV/AIDS inpatients during January 2013 to December 2015, 450 cases were complicated by renal function damage. 90 cases(20%) were with acute renal damage, and 360 cases (80%)were with chronic kidney diseases, with an incidence of 10.40%. The rate of highly active antiretroviral therapy (HAART) was 62%. The monitoring indexes of clinical prognosis were as follows:the incidence of cardiovascular event was 29.3%, the incidence of the renal diseases in terminal stage was 12.2%, the readmission rate was 30.4%, the all-cause mortality was 11.8%.(2)The classification of abnormal manifestation by pathology, etiology and radiology was as follows:136 cases of glomerular disease, 123 cases of vascular disease, 105 cases of tubulointerstitial disease, 58 cases of cystic disease, 28 cases of infiltrated disease and miscellaneous disease. During the 360 cases, classification of chronic kidney disease increased as the increasing levels of HIV-1 RNA, 24-hour urinary protein, serum cholesterol, Cys C and CA-125. While the the CD4+ T lymphocyte count and serum albumin decreased. Conclusion The patients with HIV/AIDS and renal dysfunction varied by abnormal structure or function. The causes were complicated. Pathological and radiology abnormalities were often seen, mainly shown in chronic kidney disease. It was related between renal function damage and HIV-1 RNA quantification, CD4+ T lymphocyte count, serum albumin quantification, serum cholesterol, Cys C, CA-125. The treatment mainly contained of comprehensive therapy of internal medicine. HAART and dialysis could reduce mortality in terminal stage of renal disease. |
| keywords:Acquired immune deficiency syndrome (AIDS) Human immunodeficiency virus associated nephropathy (HIVAN) Renal damage Clinical etiology Prognosis |
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