Clinically Indicated Corticosteroids Do Not Affect Bone Turnover During Immune Restoration of Severely Lymphopenic HIV-Infected Patients.
Clinically Indicated Corticosteroids Do Not Affect Bone Turnover During Immune Restoration of Severely Lymphopenic HIV-Infected Patients.
复制标题
临床表明皮质类固醇不会影响严重淋巴细胞减少性 HIV 感染患者的免疫恢复期间的骨转换。
DOI：
10.1089/aid.2015.0028
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发表时间：
2015
影响因子：
1.5
通讯作者：
Sereti,Irini
中科院分区：
文献类型：
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作者：
Grant,PhilipM;Sheikh,Virginia;DerSimonian,Rebecca;Rupert,Adam;Roby,Gregg;Pau,Alice;Sneller,MichaelC;Rico,Sheryl-Vi;Brown,ToddT;Sereti,Irini
淋巴细胞减少症、皮质类固醇、抗逆转录病毒治疗（ART）和炎症对骨转换和骨密度降低有负面影响，但尚未评估其联合作用。我们研究了皮质类固醇激素与开始ART的严重淋巴细胞减少的HIV感染患者骨转换标志物之间的关系。（骨形成标志物）和C末端肽（CTX;骨吸收标志物）在基线、第4，12，在接受（n=28）或未接受皮质类固醇（n=30）的重度淋巴细胞减少症和机会性感染（OI）患者中，在ART的第一年，和在对照组中，CD 4>200（n=15）。使用Wilcoxon检验比较组间变量的中位数。采用斯皮尔曼系数分析血浆白细胞介素（IL）-6和肿瘤坏死因子（TNF）水平与骨转换标志物水平之间的相关性。接受皮质类固醇治疗的个体接受35 mg泼尼松等效日剂量治疗的中位时间为21天。与对照组相比，患有严重淋巴细胞减少症的个体在基线和第4周具有较低的骨钙素水平，并且在ART开始时具有较高的CTX水平。骨转换标志物在严重淋巴细胞减少的患者中根据皮质类固醇的接受情况没有差异。在严重淋巴细胞减少症患者中，仅在ART开始时，较高的IL-6与较高的CTX水平相关。与那些在较高的CD 4水平下开始ART的患者相比，伴有严重淋巴细胞减少和OI的HIV感染患者的骨形成水平较低，骨吸收水平较高。在OI期间使用皮质类固醇与骨转换无关。相反，ART前全身炎症标志物升高与骨吸收增加相关。
Lymphopenia, corticosteroids, antiretroviral therapy (ART), and inflammation negatively impact bone turnover and decrease bone mineral density, but their combined effect has not been evaluated. We examined the association between corticosteroids on bone turnover markers in severely lymphopenic HIV-infected patients initiating ART. Levels of osteocalcin (bone formation marker) and C-terminal telopeptide (CTX; bone resorption marker) were measured at baseline, weeks 4, 12, and 48 of ART in individuals with severe lymphopenia and opportunistic infection (OI) who received (n=28) or did not receive corticosteroids (n=30) during the first year of ART, and in a control group with CD4 >200 (n=15). Wilcoxon tests were used to compare median values of variables between groups. Correlations between plasma interleukin (IL)-6 and tumor necrosis factor (TNF) levels with bone turnover marker levels were performed using Spearman's coefficient. Individuals given corticosteroids received a median of 21 days at a 35 mg prednisone-equivalent daily dose. Individuals with severe lymphopenia had lower osteocalcin levels at baseline and week 4 and higher CTX levels at ART initiation vs. controls. Bone turnover markers did not differ in severely lymphopenic persons according to corticosteroid receipt. In those with severe lymphopenia, higher IL-6 was associated with higher CTX levels at ART initiation only. HIV-infected patients with severe lymphopenia and OI had lower levels of bone formation and higher levels of bone resorption than those initiating ART at higher CD4. Corticosteroid use, as prescribed during OI, was not associated with bone turnover. In contrast, higher markers of systemic inflammation prior to ART were associated with greater bone resorption.