McComsey Grace A, Yau Linda
Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
Antivir Ther. 2004 Apr;9(2):205-12.
The significance of asymptomatic hyperlactataemia is unknown.
We measured serial lactate levels in a group of HIV-infected subjects. Objectives were to identify covariates associated with hyperlactataemia, and to explore the natural history of hyperlactataemia.
Overall, 1487 lactate measurements were performed on 396 subjects; 299 subjects had serial lactate testing, with a median of four performed per patient (range: 2-16). At study entry, lactate was >2.4 mmol/l in 6% of subjects and >3.6 mmol/l in 1%. A multiple logistic regression analysis revealed that cholesterol and current stavudine were the only predictors of hyperlactataemia. Lactate levels were highly reproducible both for short-term (within 3 months) and long-term (>1 year) follow-up. During the study period, 16 subjects were identified with sustained hyperlactataemia; 12/16 remained asymptomatic after a median of 210 days (30-585), and four developed symptoms suggestive of lactic acidosis syndrome. In three of the four, asymptomatic hyperlactataemia had preceded the onset of symptoms by 18-122 days. A longitudinal model showed a rapid rise of lactate levels from 0 to 12 months on nucleoside reverse transcriptase inhibitor (NRTI) and then stabilization. Lactate levels did not correlate with baseline or on-study development of lipoatrophy.
Even when optimal methods of collection are used, asymptomatic hyperlactataemia does exist and could be sustained in a subset of NRTI-treated subjects for as long as 585 days. A subset of these subjects became symptomatic, after as long as 122 days of asymptomatic hyperlactataemia. Asymptomatic hyperlactataemia is not predictive of lipoatrophy.
无症状性高乳酸血症的意义尚不清楚。
我们对一组感染HIV的受试者进行了连续乳酸水平测量。目的是确定与高乳酸血症相关的协变量，并探讨高乳酸血症的自然病程。
总体而言，对396名受试者进行了1487次乳酸测量；299名受试者进行了连续乳酸检测，每位患者检测次数的中位数为4次（范围：2 - 16次）。在研究开始时，6%的受试者乳酸水平>2.4 mmol/L，1%的受试者乳酸水平>3.6 mmol/L。多元逻辑回归分析显示，胆固醇和当前使用的司他夫定是高乳酸血症的唯一预测因素。乳酸水平在短期（3个月内）和长期（>1年）随访中都具有高度可重复性。在研究期间，确定有16名受试者存在持续性高乳酸血症；16名中的12名在中位数为210天（30 - 585天）后仍无症状，4名出现了提示乳酸酸中毒综合征的症状。在这4名中的3名中，无症状性高乳酸血症在症状出现前18 - 122天就已存在。纵向模型显示，在核苷类逆转录酶抑制剂（NRTI）治疗的0至12个月期间，乳酸水平迅速上升，然后趋于稳定。乳酸水平与脂肪萎缩的基线情况或研究期间的发展情况无关。
即使采用最佳的采集方法，无症状性高乳酸血症确实存在，并且在接受NRTI治疗的一部分受试者中可持续长达585天。这些受试者中的一部分在无症状性高乳酸血症长达122天后出现症状。无症状性高乳酸血症不能预测脂肪萎缩。
