本文選題：艾滋病 + 高效抗逆轉(zhuǎn)錄病毒治療��； 參考：《安徽醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的：描述接受抗逆轉(zhuǎn)錄病毒治療的AIDS患者脂肪營養(yǎng)不良（LD）的現(xiàn)患率及其人群分布特征；分析LD與膳食、體力活動、體成分以及藥物治療的關(guān)系；探討LD的主要影響因素，為預(yù)防LD的發(fā)生提供參考依據(jù)。 方法：本研究為現(xiàn)況研究，從我省艾滋病流行較為嚴重的皖北地區(qū)抽取兩個縣為研究現(xiàn)場。選擇2012年5月25日-5月31日期間，在當?shù)丶膊☆A(yù)防控制中心艾滋病隨訪門診接受定期集中隨訪的艾滋病人作為研究對象。采用面對面問卷調(diào)查方法收集研究對象的社會人口學(xué)特征、行為和飲食習(xí)慣等信息，以國際體力活動問卷（短卷）評價其體力活動水平。采用體格測量方法獲取研究對象的身高、體重、腰圍、臀圍、上臂圍、皮脂厚度（包括腹部、肱三頭肌、肩胛下皮脂厚度）數(shù)據(jù)，并根據(jù)上述指標計算體質(zhì)指數(shù)（BMI）、腰臀比（WHR）、體密度、體脂率和瘦體重等。從安徽省疾病預(yù)防控制中心的艾滋病管理信息系統(tǒng)中提取研究對象的確診感染HIV的時間、開始治療時間、治療方案及其變動情況、疾病目前臨床分期以及最近一次的病毒載量、CD4+細胞計數(shù)水平等臨床資料。用Epidata3.1對數(shù)據(jù)進行雙錄入，運用SPSS16.0進行數(shù)據(jù)處理。 結(jié)果：現(xiàn)場共調(diào)查艾滋病患者264人，獲得完整的問卷和體格檢查資料261份，有效率98.86%，其中男145例（55.6%），女116例（44.4%）。261例患者中共檢出LD患者147例，現(xiàn)患率為56.3%，其中脂肪萎縮95例（36.4%），脂肪堆積17例（6.5%），混合型35例（13.4%）。 按不同特征分組比較發(fā)現(xiàn)，女性較男性LD檢出率高（69.0%vs46.2%，P0.01）；不同年齡組間LD檢出率不同，差異有統(tǒng)計學(xué)意義（P0.05），隨年齡增加LD檢出率增加（趨勢χ~2=5.014，P0.05）；不同經(jīng)濟狀況組LD檢出率差異有統(tǒng)計學(xué)意義（P0.05），且經(jīng)濟狀況越差LD檢出率越高（趨勢χ~2=4.248，P0.05）；吸煙組較不吸煙/戒煙組LD檢出率高（46.2%vs38.2%，P0.01）；而其他方面如上學(xué)年限、婚姻狀況、職業(yè)、飲酒和運動等，組間差異均無統(tǒng)計學(xué)意義（P0.05）。 多數(shù)艾滋病患者膳食結(jié)構(gòu)不合理，，以谷類為主，蔬菜、水果及奶類、肉類等優(yōu)質(zhì)蛋白類食物攝入普遍較低。LD組谷類日均攝入量和肉類的攝入頻率較非LD組（NLD組）低，差異有統(tǒng)計學(xué)意義（P0.01）。兩組間體力活動水平差異無統(tǒng)計學(xué)意義（P0.05）。LD組上臂肌圍和瘦體重均低于NLD組，差異具有統(tǒng)計學(xué)意義（P0.05），BMI、WHR、體脂率等其他指標如組間均無統(tǒng)計學(xué)差異（P0.05）。 LD組的患病時間、治療時間、最近方案使用時間均較NLD組長（P0.01）；HIV臨床分期在兩組分布中也有差異（P0.05），但CD4+細胞計數(shù)和病毒載量組間未見統(tǒng)計學(xué)差異。無論是初始治療方案還是最近治療方案，兩組使用情況均存在差異（P0.01），其中LD組的最近治療方案除3TC+NVP+AZT構(gòu)成比低于NLD組，其余方案均高于NLD。LD組D4T和DDI的暴露率高于NLD組，ZDV暴露率低于NLD組，差異均有統(tǒng)計學(xué)意義（P0.01）。除ZDV外，LD組的NVP、3TC、D4T和DDI的使用時間均較NLD組長（P0.01）。 單因素Logistic回歸分析顯示：年齡、性別、經(jīng)濟狀況、體重、治療時間、患病時間、藥物D4T、ZDV、DDI暴露和D4T、ZDV、DDI、NVP、3TC的使用時間與LD有關(guān)聯(lián)；多因素Logistic回歸分析顯示女性、D4T使用時間長和3TC使用時間長是LD的獨立危險因素。 結(jié)論：LD在接受抗逆轉(zhuǎn)錄病毒治療的AIDS患者中較為常見，且與患者性別、年齡、治療時間及某些藥物特別是D4T的使用等因素有關(guān)。減少使用D4T或者用其他藥物代替D4T有可能降低艾滋病人發(fā)生LD的風(fēng)險。多數(shù)接受抗逆轉(zhuǎn)錄病毒治療的AIDS患者膳食結(jié)構(gòu)不合理，LD患者各類營養(yǎng)素尤其是優(yōu)質(zhì)蛋白攝入不足，其體成分改變主要表現(xiàn)為瘦體重降低和肌肉萎縮，因此應(yīng)增加該人群富含優(yōu)質(zhì)蛋白質(zhì)的食物以及蔬菜水果的攝入。
[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.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R153.9;R512.91

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