昆明地区HIV感染者抗病毒治疗前的肾病及影响因素.

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. [ABSTRACT FROM AUTHOR]