Datta D, Moyle G, Mandalia S, Gazzard B
Kobler Clinic, Chelsea and Westminster Hospital, London, UK.
HIV Med. 2003 Oct;4(4):311-4. doi: 10.1046/j.1468-1293.2003.00164.x.
Lactic acidosis is a life-threatening event during antiretroviral therapy (ART). Hyperlactataemia may be a prelude to acidosis. Our database study suggested that female gender, intercurrent illness and didanosine (ddI)-based regimens may increase risk of lactic acidosis. The aim of this matched case-control study was to identify risk factors for hyperlactataemia requiring screening.
Cases were defined as patients with two consecutive lactate samples > or =3.5 mmol/L taken more than 1 week apart. Cases were matched to two controls on gender, use of ddI and total duration of therapy using a 6-month window on either side. Controls never had raised lactate >2.5 mmol/L. A conditional logistic regression analysis using the PHREG procedure in SAS (SAS Institute Inc, Cary, NC) was performed with a discreet logistic model stratified by matching variables.
Twenty-one cases were matched to 42 controls. In the univariate model, current use of stavudine (d4T), total cholesterol >5.3 mmol/L and glucose levels > or =5.2 mmol/L gave increased likelihood of persistent hyperlactataemia. The multivariate model showed current use of d4T to be a significant independent predictor of persistent hyperlactataemia.
The results of this case-control study indicate that, when controlling for ddI use, d4T use is an additional risk factor for hyperlactataemia.
乳酸酸中毒是抗逆转录病毒治疗（ART）期间的一种危及生命的情况。高乳酸血症可能是酸中毒的前奏。我们的数据库研究表明，女性、并发疾病以及基于去羟肌苷（ddI）的治疗方案可能会增加乳酸酸中毒的风险。这项匹配病例对照研究的目的是确定需要进行筛查的高乳酸血症的危险因素。
病例定义为两次连续的乳酸样本≥3.5 mmol/L且采样间隔超过1周的患者。根据性别、ddI的使用情况以及治疗总时长，以病例为中心前后6个月的范围为窗口，将病例与两名对照进行匹配。对照的乳酸水平从未超过2.5 mmol/L。使用SAS（SAS Institute Inc，北卡罗来纳州卡里）中的PHREG程序进行条件逻辑回归分析，采用按匹配变量分层的离散逻辑模型。
21例病例与42名对照相匹配。在单变量模型中，当前使用司他夫定（d4T）、总胆固醇>5.3 mmol/L以及血糖水平≥5.2 mmol/L会增加持续性高乳酸血症的可能性。多变量模型显示，当前使用d4T是持续性高乳酸血症的一个显著独立预测因素。
这项病例对照研究的结果表明，在控制ddI使用的情况下，使用d4T是高乳酸血症的另一个危险因素。
