CAJ | 학술논문

目的调查接受高效抗逆转录病毒治疗(HAART)的AIDS患者糖脂代谢异常的发生率及其在HIV相关脂肪营养不良综合征(HIV related lipodystrophy,HIV-LD)组和非HIV-LD)组中的差异;比较两组的脂联素(adiponectin,APN)、瘦素(leptin,LEP)水平及其与糖脂代谢、脂肪异常分布的关系.方法募集2007年3至5月期间在北京协和医院门诊随诊的成年HIV/AIDS患者52例,根据患者报告和医师评估结果,将上述患者分成HIV-LD组与非HIV-LD组,并对其进行全身双能X射线扫描(DEXA)检查和血浆胆固醇(CHO)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和胰岛索测定,应用ELISA法测定血浆APN和LEP水平,调查血脂异常和高胰岛素血症的发生情况及两组之间差异,并分析APN和LEP水平及其与血脂、胰岛素水平和各部位体脂含量的相关性.结果 ①52例HIV/AIDS患者中,至少一项血脂指标异常者59.6%,合并CHO、TG及HDL-C异常血症者分别为17.3%、50.0%和17.3%,空腹高胰岛素血症发生率25.0%.②LD组的TG水平显著高于非HIV-LD组,LD组的HDL-C水平和APN水平显著低于非HIV-LD组.HIV-LD患者的APN水平降低是HDL-C和胰岛素水平异常的独立预测指标,与四肢/全身脂肪总含量正相关,与躯干/全身脂肪总含量负相关.两组的血浆LEP水平均与全身脂肪总含量、四肢和躯干脂肪含量正相关.结论血脂异常和胰岛素抵抗在接受HAART的AIDS患者中有较高发生率,HIV-LD组比非HIV-LD组更为明显.血浆APN水平下降在HIV-LD组中是HDL-C和胰岛素水平异常的独立预测指标,与脂肪异常分布密切相关;血浆LEP水平则是反映人体内脂肪总最的生物学标志之一.
목적 조사접수고효항역전록병독치료(HAART)적AIDS환자당지대사이상적발생솔급기재HIV상관지방영양불량종합정(HIV related lipodystrophy,HIV-LD)조화비HIV-LD)조중적차이;비교량조적지련소(adiponectin,APN)、수소(leptin,LEP)수평급기여당지대사、지방이상분포적관계.방법 모집2007년3지5월기간재북경협화의원문진수진적성년HIV/AIDS환자52례,근거환자보고화의사평고결과,장상술환자분성HIV-LD조여비HIV-LD조,병대기진행전신쌍능X사선소묘(DEXA)검사화혈장담고순(CHO)、감유삼지(TG)、고밀도지단백담고순(HDL-C)、저밀도지단백담고순(LDL-C)화이도색측정,응용ELISA법측정혈장APN화LEP수평,조사혈지이상화고이도소혈증적발생정황급량조지간차이,병분석APN화LEP수평급기여혈지、이도소수평화각부위체지함량적상관성.결과 ①52례HIV/AIDS환자중,지소일항혈지지표이상자59.6%,합병CHO、TG급HDL-C이상혈증자분별위17.3%、50.0%화17.3%,공복고이도소혈증발생솔25.0%.②LD조적TG수평현저고우비HIV-LD조,LD조적HDL-C수평화APN수평현저저우비HIV-LD조.HIV-LD환자적APN수평강저시HDL-C화이도소수평이상적독립예측지표,여사지/전신지방총함량정상관,여구간/전신지방총함량부상관.량조적혈장LEP수평균여전신지방총함량、사지화구간지방함량정상관.결론 혈지이상화이도소저항재접수HAART적AIDS환자중유교고발생솔,HIV-LD조비비HIV-LD조경위명현.혈장APN수평하강재HIV-LD조중시HDL-C화이도소수평이상적독립예측지표,여지방이상분포밀절상관;혈장LEP수평칙시반영인체내지방총최적생물학표지지일.
Objective To investigate the prevalence of glucose and lipid abnormalities in AIDS patients treated with highly active antiretroviral therapy (HAART) and difference thereof between the HIV-lipedystrophy (LD) and non-HIV-LD groups, and to compare the plasma levels of adiponectin (APN) and leptin (LEP) and their relationship to metabolic disturbance and fat redistribution in these 2 groups Methods Fifty-two HIV-infected patients were divided into HIV-LD group and non-HIV-LD group according to the patients' reports and doctors' evaluation. Body composition was assessed by whole body dual-energy X-ray absorptiometry Plasma samples were analyzed for cholesterol, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), insulin, APN, and LEP. The prevalence of dyslipidemia and hyperinsulinemia, the difference of adipocytokine levels, and the relationship of adiponectin, leptin with lipids, insulin as well as fat mass in different body regions were analyzed between the groups. Results The prevalence rates of hypercholesterolaemia, hypertriglyceridaemia, and low HDL-C level were 17.3%, 50, 0%, and 17.3% respectively. The rate of hyperinsulinemia and any kind of dyslipidemia were 25.0% and 59.6%. Compared with non- HIV-LD patients, HIV-LD patients had higher TG level, and lower HDL-C and APN levels. In the HIV-LD group, the APN level was correlated positively with limb/total body fat, but negatively with trunk/total body fat, and was an independent predictor of HDL-C and insulin level. However, LEP was positively correlated with the levels of total body fat, limb fat, and trunk fat in both groups. Conclusion The prevalence rates of dyslipidemia and insulin resistance are high in Chinese HIV/AIDS patients receiving HAART, especially in the HIV-LD group. The APN concentration in the HIV-LD patients is closely related to fat redistribution and independently predicts the levels of HDL-C and insulin. LEP can serve as a biomarker of total body fat mass.