Prevalence of Kidney Disease among Pre-ART Patients with HIV Infection in Kunming and The Influencing Factors
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摘要:
目的 横断面调查抗病毒治疗前HIV感染者肾病患病率及特征，分析抗病毒治疗前肾病的相关因素。 方法 纳入2019年6月至2021年3月到昆明市第三人民医院就诊未治疗的HIV感染者，并对研究对象进行尿常规、血清肌酐、尿微量白蛋白/肌酐比、尿α1微球蛋白、肾脏B超筛查，同时检查血脂、血糖、测量体重指数、收集人口学资料及高血压、糖尿病等病史。用SPSS17.0对数据进行单因素及Logistic回归分析。 结果 468例研究对象平均年龄（43.42±14.66）岁，男：女为1.96，平均体重指数（21.73±3.76）kg/m2，15.6%患者体重指数≥25 kg/m2，33.3%患者有每天吸烟的习惯，高甘油三脂血症占24.7%，高血压占10.7%，糖尿病占7.7%，合并用药率21.8%。总体肾病检出率20.7%。CKD-EPI评估公式计算eGFR < 60 mL，60～90 mL，≥90 mL的患者分别占1.1%、9.6%、89.3%。单纯尿常规检测尿蛋白阳性率3.1%。111例检测尿微量白蛋白/肌酐比 ≥ 30 mg/gCr占21.6%，尿α1微球蛋白检测≥12.5 mg/L占63.9%。多因素分析显示年龄≥50岁（OR = 2.285，P = 0.02）、体重指数 ≥ 25（OR = 2.029，P = 0.025）、高血压（OR = 2.334，P = 0.017）、糖尿病（OR = 2.634，P = 0.014）、HIV病毒载量≥1 $ \times $ 105拷贝/mL（OR = 2.296，P = 0.002）是HIV感染者抗病毒治疗前肾损害的危险因素，女性是HIV感染者抗病毒治疗前肾损害的保护性因素。结论 昆明地区总体肾损害检出率高，以尿蛋白异常为主。HIV感染者抗病毒治疗前肾损害主要与性别、年龄、高血压、糖尿病、体重指数及HIV病毒载量相关。在筛查肾损害时，建议联合尿常规、血清肌酐、肾脏B超、尿微量白蛋白/肌酐比、尿α1微球蛋白检查进行充分评估。 Abstract:Objective To investigate the prevalence and characteristics of nephropathy in HIV infected patients before antiviral treatment, and to analyze the related factors of nephropathy before antiviral treatment. Methods Patients with HIV infection who visited the Third People’ s Hospital of Kunming from June 2019 to March 2021 were recruited and screened by urine analysis, serum creatinine, urine microalbumin-to-creatinine ratios, urinary α1 microglobulin, and renal ultrasound. And all patients were screened by triglyceride, total serum cholesterol, fasting plasma glucose test . Body mass index was measured.Demographic data , medical history of hypertension and diabetes were collected. SPSS17.0 was used for univariate analysis and logistic regression analysis. Results The mean age of 468 subjects was 43.42±14.66 years. The male to female ratio was 1.96. The mean body mass index was 21.73±3.76. Body mass index ≥25 accounted for 15% of all the subjects . Some patients smoked daily which accounted for 33.3% of all the subjects. Patients with hypertriglyceridemia, hypertension and diabetes accounted for 24.7%, 10.7%, 7.7% respectively. And 21.8% of patients were taking drugs which were not antiretroviral therapy. The detection rate of kidney disease in total of 468 cases was 20.7%. the CKD-EPI formula was used to calculate and estimate glomerular filtration rate （eGFR）. Patients with eGFR < 60 mL/min/1.73 m2, 60～90 mL/min/1.73 m2, ≥ 90 mL/min/1.73 m2 accounted for 1.1%, 9.6%, 89.3% respectively. The positivity rate of urinary protein was 3.1%, which measured just only by urine analysis. The urinary microalbumin/creatinine ratio （ACR） ≥ 30 mg/gCr were occurred in 24/111 cases （21.6%）. The Urinary α1 microglobulin ≥ 12.5 mg/L were occurred in 71/111 cases （63.9%）. Multivariate analysis indicated the independent effects of the age ≥ 50 years （OR = 2.285, P = 0.002）, body mass index ≥25 （OR = 2.029, P = 0.025）, hypertension （OR = 2.334, P = 0.017）, diabetes （OR = 2.634, P = 0.014）, HIV viral load ≥1×105 copies /mL （OR = 2.296, P = 0.002）, which significantly associated with kidney disease. Female is a protective factor for kidney disease in HIV infected persons before antiviral therapy. Conclusions The detection rate of kidney disease is high and mainly abnormal urinary protein in Kunming area.Gender, age, hypertension, diabetes, body mass index and HIV viral load are significantly associated with the kidney disease in HIV patients before antiviral treatment. When screening for kidney disease, it is recommended to fully evaluate the results with urine analysis, serum creatinine, renal ultrasound, urinary microalbumin/creatinine ratio, and urinary α1 microglobulin. -
Key words:
- HIV /
- Kidney disease /
- Risk factors /
- Urinary alpha1-microglobulin
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表 1 HIV感染者基线特征[n = 468，n（%）]
Table 1. Baseline characteristics of patients with HIV infection [n = 468，n（%）]
特征 组别 例数 特征 组别 例数 性别 男
女310（66.2）
158（33.8）高血压 是
否50（10.7）
418（89.3）民族 汉族
其他403（86.1）
65（13.9）糖尿病 是
否36（7.7）
432（92.3）文化程度 高中及以上
高中以下170（36.3）
298（63.7）合并肿瘤 是
否12（2.6）
456（97.4）年龄 ≥50岁
< 50岁156（33.3）
312（66.7）合并用药 是
否102（21.8）
366（78.2）感染途径 吸毒
异性
同性20（4.3）
381（81.4）
67（14.3）CD4+T细胞计数（个/μL） ≤200
> 200195（41.7）
273（58.3）体重指数（kg/m2） ≥25
< 2573（15.6）
395（84.4）HIV-RNA
（拷贝/mL）≥1×105
< 1×105
未做157（33.5）
216（46.2）
95（20.3）吸烟 是
否156（33.3）
312（66.7）合并乙肝
合并丙肝是
是35（7.5）
36（7.7）
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表 2 HIV感染者治疗前肾损害的相关因素分析[n（%）]
Table 2. Analysis of related factors of renal damage in patients with HIV infection before treatment [n（%）]
特征 分组 肾损害例数 χ2 P 性别 男
女73（23.5）
24（15.2）4.450 0.035 民族 汉族
少数民族10（15.4）
87（21.6）1.311 0.252 文化程度 高中及以上
高中以下28（16.5）
69（23.2）2.943 0.086 年龄 ≥50岁
< 50岁51（32.7）
46（14.7）20.391 < 0.001 感染途径 吸毒
性6（30.0）
91（20.3）0.583 0.445 体重指数（kg/m2） ≥25
< 2522（30.0）
75（19.0）4.662 0.031 吸烟 是
否32（20.5）
65（20.8）0.007 0.936 高血压 是
否22（44.0）
75（17.9）18.455 < 0.001 糖尿病 是
否17（47.2）
80（18.5）16.663 < 0.001 合并肿瘤 是
否3（25.0）
94（20.6）0.137 0.711 合并用药 是
否30（29.4）
67（18.3）5.988 0.014 CD4+T细胞计数（个/μL） ≤200
> 20045（23.1）
52（19.1）1.124 0.289 HIV-RNA
（拷贝/mL）≥1$ \times $105
< 1$ \times $105
未做49（31.2）
34（15.7）
14（14.7）15.844 < 0.001 合并乙肝 是
否4（11.4）
93（21.5）1.990 0.158 合并丙肝 是
否87（20.1）
10（27.8）1.180 0.277
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表 3 HIV感染者治疗前肾损害多因素Logistic回归分析
Table 3. Multivariate logistic regression analysis of renal damage in patients with HIV infection before treatment
因素（变量赋值低的为参考） β 标准误 OR（95%CI） P 性别（男 = 1，女 = 2） −0.617 0.281 0.540（0.311，0.936） 0.028 年龄（≤50 = 0，> 50 = 1） 0.827 0.260 2.285（1.372，3.807） 0.002 体重指数（< 25 = 0，≥25 = 1） 0.708 0.315 2.029（1.093，3.766） 0.025 高血压（无 = 0，是 = 1） 0.848 0.356 2.334（1.161，4.694） 0.017 糖尿病（无 = 0，是 = 1） 0.969 0.394 2.634（1.216，5.706） 0.014 HIV-RNA（< 1×105 = 0，≥1×105 = 1） 0.831 0.273 2.296（1.345，3.918） 0.002
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