乌干达穆拉戈医院初治抗逆转录病毒治疗的 HIV 感染者中微量白蛋白尿的流行情况及相关因素：一项横断面研究。

Prevalence of microalbuminuria and associated factors among HIV - infected ART naïve patients at Mulago hospital: a cross-sectional study in Uganda.

机构信息

Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.

Department of Internal Medicine, Uganda Martyrs Hospital, Lubaga, P.O. Box 14130, Kampala, Uganda.

出版信息

BMC Nephrol. 2020 Oct 20;21(1):440. doi: 10.1186/s12882-020-02091-2.

DOI:10.1186/s12882-020-02091-2

PMID:33081706

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7574295/

Abstract

BACKGROUND

HIV infection affects multiple organs and the kidney is a common target making renal disease, one of the recognized complications. Microalbuminuria represents an early, important marker of kidney damage in several populations including HIV-infected antiretroviral therapy (ART) naïve patients. Early detection of microalbuminuria is critical to slowing down progression to chronic kidney disease (CKD) in HIV-infected patients, however, the burden of microalbuminuria in HIV-infected antiretroviral therapy (ART) naïve patients in Uganda is unclear.

METHODS

A cross-sectional study was conducted in the Mulago Immune suppression syndrome (ISS) clinic among adult HIV - infected ART naïve outpatients. Data on patient demographics, medical history was collected. Physical examination was performed to assess body mass index (BMI) and hypertension. A single spot morning urine sample from each participant was analysed for microalbuminuria using spectrophotometry and colorimetry. Microalbuminuria was defined by a urine albumin creatinine ratio (UACR) 30-299 mg/g and macroalbuminuria by a UACR > 300 mg/g. To assess the factors associated with microalbuminuria, chi-square, Fisher's exact test, quantile regression and logistic regression were used.

RESULTS

A total of 185 adult participants were consecutively enrolled with median age and CD4+ counts of 33(IQR = 28-40) years and 428 (IQR = 145-689) cells/μL respectively. The prevalence of microalbuminuria was 18.9% (95% CI, 14-25%). None of the participants had macroalbuminuria. CD4+ count <350cells/μL was associated with increased risk of microalbuminuria (OR: 0.27, 95% CI: 0.12-0.59), P value = 0.001). Diabetes mellitus, hypertension, smoking, alcohol intake were not found to be significantly associated with microalbuminuria.

CONCLUSION

Microalbuminuria was highly prevalent in adult HIV - infected ART naive patients especially those with low CD4+ count. There is need to study the effect of ART on microalbuminuria in adult HIV - infected patients.

摘要

背景

HIV 感染会影响多个器官，肾脏是常见的靶器官，因此肾脏疾病是公认的并发症之一。微量白蛋白尿是包括 HIV 未接受抗逆转录病毒治疗（ART）的患者在内的多个人群中肾脏损害的早期重要标志物。早期发现微量白蛋白尿对于减缓 HIV 感染患者慢性肾脏病（CKD）的进展至关重要，然而，乌干达 HIV 未接受 ART 的患者微量白蛋白尿的负担尚不清楚。

方法

在穆拉戈免疫抑制综合征（ISS）诊所对成年 HIV 感染、未接受 ART 的门诊患者进行了横断面研究。收集了患者的人口统计学和病史数据。进行体格检查以评估体重指数（BMI）和高血压。对每个参与者的一份晨尿标本进行分光光度法和比色法分析，以检测微量白蛋白尿。尿白蛋白肌酐比值（UACR）30-299mg/g 定义为微量白蛋白尿，UACR>300mg/g 定义为大量白蛋白尿。为了评估与微量白蛋白尿相关的因素，使用卡方检验、Fisher 确切检验、分位数回归和逻辑回归。

结果

共连续纳入 185 名成年参与者，中位年龄和 CD4+计数分别为 33 岁（IQR=28-40 岁）和 428 个细胞/μL（IQR=145-689 个细胞/μL）。微量白蛋白尿的患病率为 18.9%（95%CI，14-25%）。没有参与者患有大量白蛋白尿。CD4+计数<350 个细胞/μL 与微量白蛋白尿的风险增加相关（OR：0.27，95%CI：0.12-0.59），P 值=0.001）。糖尿病、高血压、吸烟、饮酒与微量白蛋白尿无显著相关性。