Analysis of the Current Status and Influencing Factors of Metabolic Syndrome in Patients Undergoing Antiretroviral Therapy for AIDS
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摘要:
目的 调查艾滋病抗病毒治疗(antiretroviral therapy,ART)患者代谢综合征发生现况,同时分析其影响因素。 方法 收集ART患者相关资料,依据指南的诊断标准了解代谢综合征患病率。t检验、卡方检验及秩和检验比较各相关因素的差异,Logistic回归分析其影响因素。 结果 1 972例患者中符合代谢综合征诊断的有495例(25.05%),男性发生代谢综合征(metabolic syndrome,MS)的风险是女性的2.045倍(P = 0.001);小学及以下文化程度的患者发生MS的风险高于中学(P = 0.001)和大学及以上文化者(P < 0.001);年龄大于40岁者发生MS的风险是小于40岁的8.819倍(P < 0.001);吸烟者发生MS的风险是不吸烟者的1.565倍(P < 0.001);BMI≥25 kg/m2(P < 0.001)、空腹血糖≥6.1 mmol/L(P < 0.001)、TG≥1.7 mmol/L(P < 0.001)、HDL-C<1.04 mmol/L (P < 0.001)、血压≥130/85 mmHg(P < 0.001)的患者发生MS的风险都更高。对于使用不同ART方案的患者两两比较发现使用整合酶的患者MS发生率更高(χ2 = 17.278,P < 0.001)。 结论 ART患者代谢综合征患病率较高,应该给予患者更多的干预措施及建议,积极减少及预防MS的发生。男性、BMI较高、服用整合酶、吸烟、年龄大于40岁都是MS的危险因素,应积极采取相应措施进行个体化治疗及管理,最大限度减少代谢综合征的发生。 Abstract:Objective To investigate the current status of metabolic syndrome (MS) in ART patients and analyze its influencing factors. Methods Data from 1972 ART patients were collected and the prevalence of MS was determined according to the diagnostic guidelines. T-tests, chi-square tests, and rank-sum tests were used to compare the differences in the related factors, and the logistic regression was used to analyze the influencing factors. Results Among these patients, 495 (25.05%) met the diagnostic criteria for MS. The risk of MS in males was 2.045 times higher than that in females (P = 0.001). Patients with elementary or lower education had a higher risk of MS than those with the secondary (P = 0.001) or higher education (P < 0.001). The risk of developing MS for those over 40 years old was 8.819 times higher than those under 40 years old(P < 0.001). Smokers had a 1.565 times higher risk of MS compared to non-smokers (P < 0.001). Patients with BMI≥25 kg/m2 (P < 0.001), fasting glucose≥6.1 mmol/L (P < 0.001), TG≥1.7 mmol/L (P < 0.001), HDL-C<1.04 mmol/L (P < 0.001), and blood pressure≥130/85 mmHg (P < 0.001) were at the higher risk of MS. Pairwise comparisons of the patients using different ART regimens showed that those using integrase inhibitors had a higher incidence of MS (χ2 = 17.278, P < 0.001). Conclusion The prevalence of metabolic syndrome is high among the patients undergoing antiretroviral therapy for AIDS. More interventions and recommendations should be provided to actively reduce and prevent the occurrence of metabolic syndrome. Lifestyle interventions should be a critical part of managing AIDS patients. The focus is on monitoring the blood pressure, blood sugar, and lipid abnormalities, and taking corresponding measures for individualized treatment and management so as to minimize the occurrence of metabolic syndrome. -
Key words:
- HIV AIDS /
- Metabolic syndrome /
- Current status /
- Influencing factors
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表 1 ART患者MS诊断的各项评价指标占比情况
Table 1. The proportion of evaluation indicators of MS diagnosis in ART patients
项目 n 占比 (%) BMI ≥25 kg/m2 395 20.03 空腹血糖≥6.1 mmol/L和(或)已确诊为糖尿病并治疗 421 21.35 血压≥130/85 mmHg和(或)已确诊为高血压并治疗 807 40.92 TG≥1.70 mmol/L 1118 56.69 HDL-C< 1.04 mmol/L 575 29.16 表 2 ART患者中MS与非MS患者人口学资料和临床特征比较[n(%)/($ \bar{x} \pm s $)/M(P25,P75)]
Table 2. Comparison of demographic data and clinical characteristics between MS and non-MS patients with ART[n(%)/($ \bar{x} \pm s $)/M(P25,P75)]
项目 调查人数 (n = 1972) MS (n = 495) 非MS (n = 1477 )F/Z /χ2 P 年龄(岁) 47(39,55) 50(43,59) 46(38,54) −7.038 <0.001* 性别 70.399 <0.001* 男性 1204 (61.05)381(31.64) 823(68.36) 女性 768(38.95) 114(14.84) 654(85.16) 婚姻状况 3.824 0.148 未婚 497(24.89) 109(21.93) 388(78.07) 已婚/有配偶 1160 (64.73)300(25.86) 860(74.14) 离异/丧偶 315(17.58) 86(27.30) 229(72.70) 文化程度 5.834 0.054 小学及以下 443(22.46) 130(29.34) 313(70.66) 中学 1042 (52.84)244(23.42) 798(76.58) 大学及以上 487(24.69) 121(24.85) 366(75.15 传播途径 0.124 0.989 异性性接触 1486 (75.36)374(25.17) 1112 (74.83)同性性接触 239(12.12) 58(24.27) 181(74.33) 静脉注射吸毒 187(9.48) 48 (25.67) 139(9.41) 其它 60(3.04) 15(25.0) 45(75.0) 吸烟 18.230 <0.001* 是 757(38.39) 230(30.38) 527(69.62) 否 1215 (61.61)265(21.81) 950(78.19) ART方案 18.793 <0.001* 核苷+非核苷 1110 (56.29)269(24.23) 841(75.77) 核苷+蛋白酶 384(19.47) 74(19.27) 310(80.73) 核苷+整合酶 478(24.24) 152(31.80) 326(68.20) 血压(mmHg) 457.158 <0.001* ≥130/85 807(40.92) 405(50.18) 402(49.82) <130/85 1165 (59.08)90(7.72) 1075 (92.28)HIVRNA(拷贝/mL) 0.000 0.989 ≥ 1000 32(1.62) 8(25.00) 24(75.00) < 1000 1940(98.38) 487(25.10) 1453 (74.89)BMI(kg/m2) 22.75±2.96 25.17±3.08 21.94±2.43 39.633 <0.001* 空腹血糖(mmol/L) 5.81±1.85 6.66±2.11 5.53±1.66 87.457 <0.001* TG(mmol/L) 2.51±2.20 3.86±2.93 2.06±1.66 129.045 <0.001* TC(mmol/L) 4.85±1.05 5.05±1.14 4.78±1.01 1.799 0.180 HDL-C(mmol/L) 1.17±0.40 1.05±0.26 1.21±0.43 304.428 <0.001* LDL-C(mmol/L) 2.79±0.83 2.71±0.88 2.74±0.81 2.601 0.107 CD4计数 529.5(383,703) 533.5(386.5,731.2) 529.0(382.5,698.0) −0.716 0.474 治疗时间(a) 9(6,12) 9(5,12) 9(6,12) −0.295 0.768 *P < 0.05。 表 3 ART患者发生MS的影响因素分析[n(%)]
Table 3. Analysis of influencing factors of MS in ART patients[n(%)]
项目 调查人数 (n=1972) MS (n=495) aOR(95%CI) P 性别 女性 768(38.95) 114(14.84) 1 男性 1204 (61.05)381(31.64) 2.045(1.352~3.093) 0.001* 年龄(岁) < 40 511(25.91) 77(15.07) 1 ≥40 1461 (74.09)418(28.61) 8.819(5.855~13.283) <0.001* 文化程度 小学及以下 443(22.46) 130(29.34) 1 中学 1042 (52.84)244(23.42) 0.666(0.523~0.847) 0.001* 大学及以上 487(24.69) 121(24.85) 0.495(0.358~0.685) <0.001* BMI( kg/m2) < 25 1577 (79.97)222(14.08) 1 ≥25 395(20.03) 273(69.11) 407.057(143.588~ 1154.203 )<0.001* 空腹血糖( mmol/L) < 6.1 1551 (78.65)237(15.28) 1 ≥6.1 421(21.35) 258(61.28) 305.850(108.723~860.391) <0.001* TG(mmol/L) < 1.7 854(43.31) 41(4.80) 1 ≥1.7 1118 (56.69)454(40.61) 208.042(71.327~606.808) <0.001* HDL-C(mmol/L) ≥1.04 1397 (70.84)191(13.67) 1 < 1.04 575(29.16) 304(52.67) 0.009(0.003~0.026) <0.001* 血压(mmHg) <130/85 1165 (59.08)90(7.72) 1 ≥130/85 807(40.92) 405(50.18) 12.034(9.320~15.537) <0.001* 吸烟 否 1215 (61.61)265(21.81) 1 是 757(38.39) 230(30.38) 1.565(1.273~1.923) <0.001* *P < 0.05。 -
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