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目的了解艾滋病(AIDS)病人接受奈韦拉平(NVP)治疗的相关肝毒性。方法采用回顾性分析的方法,对2005-2011年在布拖县接受抗病毒治疗的AIDS病人,出现3～4级肝毒性的临床资料进行总结和分析。结果接受抗病毒治疗的826例病人中,治疗6个月内出现3～4级肝毒性的22例(2.7%)。基线检查:22例中,丙型肝炎病毒(HCV)抗体阳性16例(72.7%),乙型肝炎病毒表面抗原(HBsAg)阳性12例(54.5%),抗-HCV和HBsAg均阳性者8例(36.4%);抗-HCV和HBsAg均阴性者2例(9.1%),分别与抗-HCV阳性、HBsAg阳性者比较差异均有统计学意义(P<0.05)。丙氨酸氨基转移酶(ALT)平均为(48.71±29.93)U/L,总胆红素(TBIL)平均为(14.34±8.24)μmol/L。全部使用含有NVP的治疗方案,治疗6个月内出现ALT和TBIL升高,与治疗前基线相比分别平均升高(281.67±213.99)U/L和(88.89±189.42)μmol/L,差异有统计学意义(P<0.05)。经保肝及用依非韦伦(EFV)或克力芝(LPV/r)替换NVP后,19例(86.4%)治愈,3例(13.6%)好转出院,其中1例(4.5%)出院3个月后死亡。结论艾滋病毒(HIV)合并HCV或/和HBV感染,是NVP发生严重肝毒性的重要危险因素,尤其是合并HCV感染者危险性大,应避免应用。
Objectives To understand the relative hepatotoxicity of AIDS patients treated with nevirapine (NVP). Methods A retrospective analysis was conducted to summarize and analyze the clinical data of grade 3 to grade 4 hepatotoxicity in AIDS patients receiving antiviral therapy in Putra County from 2005 to 2011. Results Of the 826 patients who received antiviral therapy, 22 (2.7%) had grade 3 to 4 hepatotoxicity within 6 months of treatment. Among the 22 cases, 16 (72.7%) were positive for hepatitis C virus (HCV), 12 (54.5%) were positive for hepatitis B virus surface antigen, 8 were positive for anti-HCV and HBsAg (36.4%). There were 2 cases (9.1%) with anti-HCV and HBsAg negative respectively. There were significant differences between anti-HCV positive and HBsAg positive (P <0.05). The mean alanine aminotransferase (ALT) was (48.71 ± 29.93) U / L and the average total bilirubin (TBIL) was (14.34 ± 8.24) μmol / L. All of the treatment regimens with NVP had elevated ALT and TBIL within 6 months, with an average increase of (281.67 ± 213.99) U / L and (88.89 ± 189.42) μmol / L, respectively, compared with baseline before treatment Statistical significance (P <0.05). Nineteen (86.4%) were cured and 3 (13.6%) were discharged after preservation of the liver and replacement of NVP with EFV or LPV / r, with 1 (4.5%) discharged 3 months after death. Conclusions HIV infection with HCV and / or HBV is an important risk factor for severe hepatotoxicity in NVP. In particular, the risk of HCV infection is high and should be avoided.