HIV相关脂肪代谢障碍综合征(HALS)导致HIV感染者(PLHIV)的心血管风险增加。HALS识别,基于临床,敦促客观的工具诊断可能是不准确的。这项研究的目的是寻找DXA衍生的脂肪质量比(FMR)阈值,在那些建议诊断HALS的人中,能够识别高心血管风险的PLHIV。
在对101例HIV感染者(年龄53±11岁,男性55%)和101个年龄和性别匹配的未感染对照,评估了DXA衍生的FMR和人体测量以及心脏代谢参数。与对照组相比,PLHIV显示出更高的FMR(1.15±0.42vs0.95±0.18,p<0.01)以及更大的心脏代谢紊乱,尽管BMI较低(24.3±4.3vs26.9±4.0kg/m2,p<0.01)和脂肪质量指数(FMI,6.6±3.0vs9.2±3.1kg/m2,p<0.01)。特别是,PLHIV伴HALS(n=28),定义为FMR高于1.260和1.329的男性和女性,分别,2型糖尿病的患病率更高(18%vs1%),胰岛素抵抗(68%对27%),高甘油三酯血症(50%对29%),高血压(61%vs30%)和代谢综合征(32%vs10%)比没有HALS(所有比较p<0.05)和对照组。在多变量分析中,PLHIV患者的FMR与空腹血糖(β[95CI]=0.5,[0.1-0.9])显著相关(p<0.05),胰岛素(44.6,[14.9-74.2]),HOMA-IR(1.6,[0.5-2.7]),甘油三酯(1.0,[0.2-1.8])和HDL-胆固醇(-2.1,[-3.9/-0.4])水平。
性别特异性FMR阈值,建议诊断HALS,可以代表PLHIV心脏代谢紊乱的新指标。
HIV-associated lipodystrophy syndrome (HALS) contributes to the increased cardiovascular risk connoting people living with HIV (PLHIV). HALS recognition, based on clinical ground, may be inaccurate urging an objective instrumental diagnosis. The aim of this study is to search for the DXA-derived fat mass ratio (FMR) threshold, among those suggested for the diagnosis of HALS, able to identify PLHIV at high cardiovascular risk.
In a cross-sectional analysis of 101 PLHIV (age 53 ± 11 years, men 55%) and 101 age- and sex-matched uninfected controls, DXA-derived FMR and anthropometric as well as cardio-metabolic parameters were assessed. PLHIV showed a higher FMR (1.15 ± 0.42 vs 0.95 ± 0.18, p < 0.01) together with a greater cardio-metabolic derangement than controls, in spite of lower BMI (24.3 ± 4.3 vs 26.9 ± 4.0 kg/m2, p < 0.01) and fat mass index (FMI, 6.6 ± 3.0 vs 9.2 ± 3.1 kg/m2, p < 0.01). Particularly, PLHIV with HALS (n = 28), defined as those with a FMR above 1.260 and 1.329 for men and women, respectively, had a greater prevalence of type 2 diabetes mellitus (18% vs 1%), insulin resistance (68% vs 27%), hypertriglyceridemia (50% vs 29%), hypertension (61% vs 30%) and metabolic syndrome (32% vs 10%) than those without HALS (p < 0.05 for all comparisons) and controls. At multivariate analyses, FMR in PLHIV was significantly associated (p < 0.05) with fasting glucose (β [95%CI] = 0.5, [0.1-0.9]), insulin (44.6, [14.9-74.2]), HOMA-IR (1.6, [0.5-2.7]), triglycerides (1.0, [ 0.2-1.8]) and HDL-cholesterol (-2.1, [-3.9/-0.4]) levels.
Sex-specific FMR thresholds, proposed for diagnosis of HALS, could represent new indices of cardio-metabolic derangement in PLHIV.