接受抗反转录病毒治疗的HIV感染/AIDS患者骨密度特征及其影响因素分析：基于双能X线吸收法的横断面研究

doi:10.19871/j.cnki.xfcrbzz.2025.06.009

摘要/Abstract

摘要： 目的探讨双能X线骨密度仪（dual energy X-ray absorptiometry,DXA）在HIV感染/艾滋病患者抗反转录病毒治疗（antiretroviral therapy, ART）后骨密度（bone mineral density,BMD）定量评估中的应用价值,并分析影响BMD水平的主要因素,为临床优化HIV感染/AIDS患者ART治疗期间的骨健康管理策略提供参考依据。方法选取2024年1月至12月成都市公共卫生临床医疗中心感染科收治的185例HIV感染/AIDS患者作为研究对象,收集其年龄、体重指数（body mass index,BMI）、ART方案等临床资料。根据DXA检查结果,将患者分为骨量正常组和骨量异常组（包括骨量减少及骨质疏松）,比较两组临床资料及BMD指标差异。使用受试者操作特征曲线（receiver operating characteristic curve,ROC曲线）评估年龄、性别以及是否使用富马酸替诺福韦二吡呋酯（tenofovir disoproxil fumarate,TDF）治疗在判别骨量异常诊断中的效能。结果 185例患者中男性119例（64.32%）,女性66例（35.68%）。患者年龄（59.38±11.92）岁,发生骨量异常共137例（74.05%）。与年龄≤50岁患者、男性患者及未接受TDF治疗的患者相比,年龄>50岁患者、女性患者及接受TDF治疗的患者骨量异常发生率均更高（均P< 0.05）。ROC曲线分析结果显示,以女性、年龄>50岁及接受TDF治疗建立的联合预测模型的ROC曲线下面积为0.781（95%CI：0.700~0.862,P<0.001）,敏感度为0.920,特异度为0.521。结论接受ART的HIV感染/AIDS患者骨量异常发生率为74.05%。女性、年龄>50岁及接受TDF治疗的患者发生骨量异常的风险更大。三者联合建立的多因素预测模型可提高患者骨量异常诊断效能,为HIV感染/AIDS患者骨健康风险分层与临床管理提供参考。

关键词: 双能X线骨密度仪, 人类免疫缺陷病毒, 获得性免疫缺陷综合征, 抗反转录病毒治疗, 骨密度, 替诺福韦

Abstract: Objective To evaluate the application value of dual-energy X-ray absorptiometry (DXA) in the quantitative assessment of bone mineral density (BMD) among patients with HIV infection/AIDS receiving antiretroviral therapy (ART), and to identify key factors associated with BMD alterations, so as to provide evidence for optimizing bone health management during ART. Method A total of 185 HIV-infected/AIDS patients admitted to the Department of Infectious Diseases of Chengdu Public Health Clinical Medical Center between January and December 2024 were retrospectively enrolled. Demographic characteristics, body mass index (BMI), and ART regimens were collected. According to the DXA results, patients were categorized into a normal bone mass group and a bone mass abnormality group (including osteopenia and osteoporosis). Clinical characteristics and BMD indices were compared between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminatory power of age, sex, and the use of tenofovir disoproxil fumarate (TDF) in predicting bone mass abnormality. Result Among the 185 participants, 119 (64.32%) were male and 66 (35.68%) were female, with a mean age of (59.38±11.92) years. Bone mass abnormality was identified in 137 patients (74.05%). Compared with patients aged ≤50 years, male patients, and those not receiving TDF treatment, patients aged >50 years, female patients, and those receiving TDF treatment all had a significantly higher incidence of abnormal bone mass (all P<0.05). ROC analysis showed that the combined model incorporating female sex, age >50 years, and TDF use achieved an area under the curve (AUC) of 0.781 (95%CI: 0.700-0.862, P<0.001), with a sensitivity of 0.920 and a specificity of 0.521. Conclusion The prevalence of bone mass abnormality is 74.05% among HIV-infected/AIDS patients receiving ART. Female sex, age >50 years, and TDF exposure are associated with an increased risk of bone mass abnormality. A multivariate prediction model combining these three factors improves the diagnostic performance for bone mass abnormality and may support risk stratification and clinical management of bone health in HIV-infected/AIDS patients.

Key words: Dual energy X-ray absorptiometry, Human immunodeficiency virus, Acquired immunodeficiency syndrome, Antiretroviral therapy, Bone density, Tenofovir

中图分类号:

R512.91

侯可可, 杨佳, 何江林, 李桃, 张淑颖, 万婷, 熊磊, 高月琴, 傅思琪, 张娜. 接受抗反转录病毒治疗的HIV感染/AIDS患者骨密度特征及其影响因素分析：基于双能X线吸收法的横断面研究[J]. 新发传染病电子杂志, 2025, 10(6): 57-62.

Hou Keke, Yang Jia, He Jianglin, Li Tao, Zhang Shuying, Wan Ting, Xiong Lei, Gao Yueqin, Fu Siqi, Zhang Na. Bone mineral density characteristics and associated factors in HIV-infected/aids patients receiving antiretroviral therapy: a cross-sectional study based on dual-energy X-ray absorptiometry[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(6): 57-62.

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