背景:恶病质通常与血清白细胞介素-6(IL.6)升高有关,因为它刺激肌肉蛋白的分解并促进消耗。
目的:一项病例对照研究,以评估体重减轻,面部脂肪流失,和IL-6在抗逆转录病毒和接受治疗的参与者感染艾滋病毒/艾滋病。
方法:IL-6通过高效液相色谱法(HPLC)在97例连续新诊断的初治抗逆转录病毒(ART-Na-ve)HIV/AIDS患者(年龄≥18岁)中进行检测;连续118例,目前正在接受高效抗逆转录病毒治疗(HAART)的年龄匹配参与者,以年龄为标准。在治疗组中,78名(66.7%)受试者服用齐多夫定,拉米夫定与奈韦拉平(Z+L+N);27(23.1%)替诺福韦,拉米夫定与恩曲他滨(T+L+E);5(4.3%)在齐多夫定,拉米夫定与恩曲他滨(ZLE);齐多夫定4(3.4%),拉米夫定与替诺福韦(Z+L+T);2(1.7%)拉米夫定,替诺福韦与奈韦拉平(L+T+N);1(0.9%)替诺福韦,齐多夫定,恩曲他滨(Z+T+E)。
结果:共有215名参与者:97名接受ART治疗,118名接受HAART治疗,年龄匹配的受试者(40.3±9.6对42.7±10.20岁,p=0.08)。初治患者的平均IL-6明显高于治疗组(0.69±0.04对0.66±0.04pg/ml,p=0.002)。总之,73名受试者经历了体重减轻,56(76.7%)天真,17(23.3%)治疗,p<0.0001,在体重减轻的患者中IL-6明显更高(0.69±0.05对0.67±0.05pg/ml,p=0.047)。58名(27.0%)受试者面部脂肪减少,49(84.5%)天真,治疗9人(15.5%),p<0.0001,在面部脂肪减少的患者中IL-6明显更高(0.7±0.05对0.67±0.05pg/ml,p=0.0001)。IL-6与CD4+计数呈负相关(r=-0.141,p=0.041)。在逻辑回归中,体重减轻的独立预测因子包括:IL-6(调整后的赔率,aOR1.3,95CI0·1-2·6,p=0.047);HIV持续时间(aOR11.6,p<0.0001);AIDS定义疾病(aOR3.5,p<0.0001);CD4+计数(aOR3.2,p=0.004);HAART状态(aOR2.7,p<0.0001)。
结论:HIV感染与血清白细胞介素-6的升高有关,这可能导致未治疗参与者的体重和面部脂肪减少;而HAART与IL-6水平抑制有关,从而改善体重和面部脂肪损失。血清IL-6与CD4+计数之间存在负相关关系;血清IL-6可以区分轻度至中度和重度免疫抑制状态。
Cachexia is usually associated with elevated serum interleukin-6 (IL.6) as it stimulates the breakdown of muscle proteins and promotes wasting.
A case-control study to evaluate the relationship between weight loss, facial fat loss, and IL-6 in antiretroviral-naïve and treated participants living with HIV/AIDS.
IL-6 was assayed by High performance liquid chromatography (HPLC) in 97 in consecutive newly diagnosed antiretroviral-naive (ART-naïve) people living with HIV/AIDS (age ≥18 years); and 118 consecutive, age-matched participants currently on Highly Active Antiretroviral Therapy (HAART), using age as a criterion. In the treated group, 78 (66.7%) subjects were on zidovudine, lamivudine with nevirapine (Z+L+N); 27(23.1%) on tenofovir, lamivudine with emtricitabine (T+L+E); 5(4.3%) on zidovudine, lamivudine with emtricitabine (Z+L+E); 4(3.4%) on zidovudine, lamivudine with tenofovir (Z+L+T); 2(1.7%) on lamivudine, tenofovir with nevirapine (L+T+N); 1(0.9%) on tenofovir, zidovudine, emtricitabine (Z+T+E).
A total of 215 participants: 97 ART-naive and 118 HAART-treated, age-matched subjects (40.3±9.6 versus 42.7±10.20years, p=0.08). The mean IL-6 was significantly higher in naïve than treated (0.69±0.04 versus 0.66±0.04 pg/ml, p =0.002). In all, 73 subjects experienced weight loss, 56(76.7%) naive, 17(23.3%) treated, p <0.0001, with significantly higher IL-6 in those with weight loss (0.69±0.05 versus 0.67±0.05pg/ml, p= 0.047). Fifty-eight (27.0%) subjects experienced facial fat loss, 49 (84.5%) naïve, and 9 (15.5%) treated, p <0.0001, with significantly higher IL-6 in those with facial fat loss (0.7 ± 0.05 versus 0.67±0.05pg/ml, p= 0.0001). Negative correlation exists between IL-6 and CD4+ count (r=-0.141, p=0.041). In logistic regression, independent predictors of weight loss include: IL-6 (Adjusted Odds Ratio, aOR 1.3, 95%CI 0·1-2·6, p=0.047); HIV duration (aOR 11.6, p <0.0001); AIDS-defining illness (aOR 3.5, p <0.0001); CD4+ count (aOR 3.2, p=0.004); HAART status (aOR 2.7, p<0.0001).
HIV infection is associated with elevation of serum interleukin-6, which likely contributes to weight and facial fat loss among the treatment-naïve participants; while HAART is associated with suppressed IL-6 levels, thereby ameliorating weight and facial fat loss. Inverse relationship exists between serum IL-6 and CD4+ count; serum IL-6 could differentiate between mild- to moderate and severe immunosuppressive states.