上海市抗艾滋病藥物的藥物不良反應(yīng)研究
發(fā)布時(shí)間：2018-10-17 13:36
【摘要】：研究背景 艾滋病又稱獲得性免疫缺陷綜合征(AIDS)，是由艾滋病病毒(HIV)感染引起的以免疫系統(tǒng)損害和感染為主要特征的一組綜合征。所有的抗病毒藥物都會(huì)引起藥物的不良反應(yīng),嚴(yán)重時(shí)會(huì)影響患者服藥依從性,甚至導(dǎo)致抗病毒治療的中斷，部分藥物不良反應(yīng)在治療開始后短時(shí)間內(nèi)即會(huì)發(fā)生,因而要達(dá)到治療效果,必須始終關(guān)注,及時(shí)采取包括更換治療方案等在內(nèi)的應(yīng)對(duì)措施,幫助患者減輕癥狀,提高治療依從性。 研究目的 1、通過對(duì)上海市2009-2013年納入免費(fèi)ART項(xiàng)目的872例艾滋病患者資料進(jìn)行分析，了解該市艾滋病流行現(xiàn)狀，結(jié)合本市實(shí)際情況，預(yù)測(cè)今后流行趨勢(shì)，為科學(xué)制定防控措施提供依據(jù)。 2、分析上海市艾滋病患者抗病毒治療情況，評(píng)價(jià)抗病毒治療效果，為今后開展規(guī)范化抗病毒治療提供科學(xué)依據(jù)。 3、總結(jié)上海市艾滋病患者接受國(guó)家免費(fèi)抗逆轉(zhuǎn)錄病毒治療后藥物不良反應(yīng)的發(fā)生情況，并分析其影響因素，指導(dǎo)臨床合理用藥。研究方法 采用描述性流行病學(xué)的研究方法，對(duì)上海市公共衛(wèi)生臨床中心2009年1月1日至2013年6月30日納入免費(fèi)ART項(xiàng)目的872例艾滋病患者資料進(jìn)行研究，所有患者定期進(jìn)行藥物不良反應(yīng)臨床和實(shí)驗(yàn)室評(píng)估。資料采用SPSS17.0統(tǒng)計(jì)軟件包和EXCEL表格進(jìn)行統(tǒng)計(jì)分析。 研究結(jié)果 1、共收集艾滋病患者報(bào)告872份，其中男性735例，女性137例，男女比例接近5.3:1；年齡集中于30~49歲段人群，低齡和高齡者有增多的趨勢(shì)；職業(yè)以娛樂服務(wù)行業(yè)最多（23.74%），其次為家政待業(yè)（16.97%）；感染途徑以性傳播為主，其中同性傳播占54.93%，提示MSM人群的高危險(xiǎn)性，值得關(guān)注。 2、872例接受免費(fèi)ART的艾滋病患者中，死亡52例，79例合并其他慢性感染，服藥依從性為74.66%，治療方案以AZT+3TC+EFV為主（53.95%），197例更換治療方案，絕大多數(shù)病例CD4+T淋巴細(xì)胞計(jì)數(shù)明顯上升，治療12個(gè)月、18個(gè)月和24個(gè)月后CD4+T淋巴細(xì)胞計(jì)數(shù)水平高于治療前。 3、在872例艾滋病患者中有722例（82.80%）在整個(gè)治療過程中出現(xiàn)藥物相關(guān)不良反應(yīng)，常見的短期不良反應(yīng)有消化系統(tǒng)癥狀（35.67%）、皮疹（15.14%）、骨髓抑制（11.14%）、疲倦（5.05%）和中樞神經(jīng)系統(tǒng)癥狀（7.80%）等，中長(zhǎng)期不良反應(yīng)有脂肪重新分布（5.62%）、外周神經(jīng)炎（6.88%）、肝毒性（5.50%）等。其中含AZT的治療方案以消化系統(tǒng)癥狀、貧血的發(fā)生率較高，含D4T的治療方案主要不良反應(yīng)為體形改變、脂肪重新分布，含EFV和NVP的治療方案與皮疹、肝毒性間有一定的特異關(guān)聯(lián)性。 結(jié)論 1、上海市艾滋病的流行現(xiàn)狀以同性性傳播感染途徑為主，感染例數(shù)逐年迅速上升，應(yīng)引起政府和各參與防治人員的高度重視，對(duì)MSM人群制定有針對(duì)性的防治策略，擴(kuò)大艾滋病咨詢檢測(cè)服務(wù)覆蓋面，，提高M(jìn)SM人群的主動(dòng)檢測(cè)意識(shí)。 2、上海市艾滋病免費(fèi)抗病毒治療的規(guī)模逐年擴(kuò)大，多數(shù)患者的CD4+T淋巴細(xì)胞計(jì)數(shù)上升明顯，抗病毒治療的效果較好，多數(shù)患者具有較好的免疫重建效果，但存在不同程度的藥物不良反應(yīng)，艾滋病的治療工作仍然任重道遠(yuǎn)。提示采取提高抗病毒治療患者的依從性、降低漏服藥物的次數(shù)、減少中途停藥的時(shí)間、及時(shí)開展免疫細(xì)胞的檢測(cè)、適時(shí)更換治療方案等措施，就可能增加治療成功的概率，降低病死率，延長(zhǎng)患者的生存時(shí)間。 3、上海市艾滋病患者接受免費(fèi)抗病毒治療后的相關(guān)藥物不良反應(yīng)發(fā)生率較高，輕微的藥物不良反應(yīng)經(jīng)對(duì)癥處理后能夠好轉(zhuǎn)，大多數(shù)不良反應(yīng)在可耐受范圍內(nèi)；比較嚴(yán)重的不良反應(yīng)，如骨髓抑制、皮疹及肝功能損害等，給患者造成痛苦，甚至危及生命，需即時(shí)更換藥物。提示應(yīng)加強(qiáng)抗病毒治療藥物不良反應(yīng)的監(jiān)測(cè)，及時(shí)處理，保證抗病毒治療順利進(jìn)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
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R512.91
本文編號(hào)：2276825
[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
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R512.91
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