Malawi-Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine.
Trans R Soc Trop Med Hyg. 2013 Oct;107(10):615-9. doi: 10.1093/trstmh/trt074. Epub 2013 Aug 7.
Stavudine is still widely used in under-resourced settings such as Malawi due to its low price. It frequently causes peripheral neuropathy and lipodystrophy and increases the risk of lactic acidosis and other high lactate syndromes.
We studied the association of longitudinal lactate levels, obtained by routine, 3-monthly point-of-care monitoring, with peripheral neuropathy, lipodystrophy and high lactate syndromes in adult Malawians who were in the second year of stavudine containing antiretroviral therapy (ART).
Point-of-care lactate measurements were feasible in a busy urban ART clinic. Of 1170 lactate levels collected from 253 patients over the course of one year, 487 (41.8%) were elevated (>2.2mg/dl), 58 (5.0%) were highly elevated (>3.5mg/dl). At least one elevated lactate level occurred in 210 (83.0%) of patients and sustained hyperlactatemia in 65 (26.4%). In random effects analyses lipodystrophy and peripheral neuropathy were associated with higher lactate levels. Only five patients developed high lactate syndromes (one lactic acidosis) of whom no preceding lactate measurements were available because events had started before enrolment. Lactate levels significantly decreased over time and no high lactate syndromes were observed after the 15th month on ART.
Lipodystrophy and peripheral neuropathy were associated with higher lactate levels. Lactate levels decreased over time, coinciding with absence of new high lactate syndromes after the 15th month on ART.
由于价格低廉，司他夫定在资源匮乏的环境中（如马拉维）仍被广泛使用。它常导致周围神经病变和脂肪营养不良，并增加乳酸酸中毒和其他高乳酸血症综合征的风险。
我们研究了通过常规、每 3 个月一次的即时检测监测获得的纵向乳酸水平与马拉维成年人在接受含司他夫定的抗逆转录病毒治疗（ART）的第二年中发生周围神经病变、脂肪营养不良和高乳酸血症综合征的关系。
即时检测乳酸的方法在繁忙的城市 ART 诊所是可行的。在一年的时间里，从 253 名患者中收集了 1170 个乳酸水平，其中 487 个（41.8%）升高（>2.2mg/dl），58 个（5.0%）高度升高（>3.5mg/dl）。210 名（83.0%）患者至少有一次升高的乳酸水平，65 名（26.4%）患者持续高乳酸血症。在随机效应分析中，脂肪营养不良和周围神经病变与较高的乳酸水平相关。只有 5 名患者（1 名乳酸酸中毒）发生高乳酸血症综合征，由于事件发生在入组前，因此没有之前的乳酸测量值。乳酸水平随时间显著下降，在开始 ART 治疗后的第 15 个月后未观察到高乳酸血症综合征。
脂肪营养不良和周围神经病变与较高的乳酸水平相关。乳酸水平随时间下降，与开始 ART 治疗后的第 15 个月后不再出现新的高乳酸血症综合征相一致。
