Hyperlactataemia syndromes associated with HIV therapy.
Hyperlactataemia syndromes associated with HIV therapy.
复制标题
与 HIV 治疗相关的高乳酸血症综合征。
DOI：
10.1016/s1473-3099(03)00654-6
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
Diehl,AnnaMae
中科院分区：
文献类型：
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作者：
Ogedegbe,AnthonyEmmanuelO;Thomas,DavidL;Diehl,AnnaMae
在服用核苷类似物逆转录酶抑制剂(NRTI)的HIV感染患者中，有8-18.3%出现高乳酸血症。最近的流行病学研究表明，大多数发作是一过性的和亚临床的。然而，也描述了伴随代谢性酸中毒和肝脏脂肪变性(即乳酸中毒综合征)的症状性和偶尔危及生命的病例。虽然尚未完全阐明，但其可能的机制是NRTI诱导的线粒体DNA聚合酶的抑制，最终导致氧化磷酸化和乳酸稳态的紊乱。症状和体征从伴有恶心、腹部不适和体重减轻的轻度高乳酸血症，到伴有昏迷和多器官衰竭的严重、顽固性乳酸酸中毒。最近在研究与NRTI相关的高乳酸血症的自然病史方面取得了重大进展。然而，疾病的其他重要方面，如其发病机制、诱因和治疗，仍然知之甚少。本文回顾了目前发表的关于这些问题的工作，确定了争议的领域，并提出了未来研究的方向。
Hyperlactataemia is seen in 8–18·3% of HIV-infected patients taking nucleoside-analogue reverse transcriptase inhibitors (NRTIs). Recent epidemiological studies suggest that most episodes are transient and subclinical. However, symptomatic and occasionally life-threatening cases accompanied by metabolic acidosis and hepatic steatosis (ie, lactic acidosis syndrome) have also been described. Though yet to be fully elucidated, the proposed mechanism is NRTI-induced inhibition of mitochondrial DNA polymerase culminating in derangements in oxidative phosphorylation and lactate homeostasis. Signs and symptoms range from mild hyperlactataemia accompanied by nausea, abdominal discomfort, and weight loss to severe, intractable lactic acidosis complicated by coma and multi-organ failure. Significant progress has recently been made with regard to the natural history of NRTI-related hyperlactataemia. However, other important aspects of the disorder, such as its pathogenesis, predisposing conditions, and management, remain poorly understood. This article reviews the current published work on these issues, identifies areas of controversy, and addresses directions for future research.