A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors
A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors
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DOI：
10.1097/00002030-199807000-00003
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发表时间：
1998-05-07
期刊：
影响因子：
3.8
通讯作者：
Cooper, DA
中科院分区：
文献类型：
--
作者：
Carr, A;Samaras, K;Cooper, DA
目的：描述外周脂肪营养不良综合征（面部、四肢和上躯干的脂肪消耗）、高脂血症和胰岛素抵抗。设计：横断面研究。设置：一所大学教学医院的门诊。患者：接受至少一种蛋白酶抑制剂（n = 116）或蛋白酶抑制剂初治（n = 32）的HIV感染患者，干预措施和主要观察指标：通过体格检查和问卷调查评估脂肪代谢障碍，通过双能X线吸收法评估身体成分。空腹甘油三酯，胆固醇，游离脂肪酸，葡萄糖，胰岛素，C-肽和果糖胺水平，其他代谢参数，CD 4淋巴细胞计数，和HIV RNA载量也assessed.Results：HIV蛋白酶初治患者有相似的身体组成健康男性。HIV蛋白酶抑制剂治疗与总体脂肪显著降低（蛋白酶抑制剂初治患者为13.2 vs 18.7 kg; P = 0.005），总胆固醇和甘油三酯水平显著升高相关。在平均13.9个月后，在74名（64%）蛋白酶抑制剂接受者和1名（3%）蛋白酶抑制剂初治患者中观察到脂肪代谢障碍（P = 0.0001）。中位10个月后，除腹部外，所有区域均出现脂肪减少。脂肪代谢障碍患者经历了每月0.5公斤的相对体重减轻，并有显着更高的甘油三酯，胆固醇，胰岛素和C-肽水平和胰岛素抵抗比蛋白酶抑制剂受体没有脂肪代谢障碍。与接受茚地那韦的患者相比，接受利托那韦和沙奎那韦联合治疗的患者具有显著更低的体脂、更高的血脂和更短的脂肪代谢障碍时间。3例（2%）患者发展为新发或恶化的糖尿病mellitus.Conclusion：综合征的外周脂肪营养不良，脂血症和胰岛素抵抗是一种常见的并发症的HIV蛋白酶抑制剂。糖尿病是比较少见的。(C)1998 Lippincott-Raven出版社。
Objective: To describe a syndrome of peripheral lipodystrophy (fat wasting of the face, limbs and upper trunk), hyperlipidaemia and insulin resistance in patients receiving potent HIV protease inhibitor therapy.Design: Cross-sectional study.Setting: Outpatient clinic of a university teaching hospital.Patients: HIV-infected patients either receiving at least one protease inhibitor (n = 116) or protease inhibitor-naive (n = 32), and healthy men (n = 47).Interventions and main outcome measures: Lipodystrophy was assessed by physical examination and questionnaire and body composition by dual-energy X-ray absorptiometry. Fasting triglyceride, cholesterol, free fatty acid, glucose, insulin, C-peptide and fructosamine levels, other metabolic parameters, CD4 lymphocyte counts, and HIV RNA load were also assessed.Results: HIV protease inhibitor-naive patients had similar body composition to healthy men. HIV protease inhibitor therapy was associated with substantially lower total body fat (13.2 versus 18.7 kg in protease inhibitor-naive patients; P = 0.005), and significantly higher total cholesterol and triglyceride levels. Lipodystrophy was observed clinically in 74 (64%) protease inhibitor recipients after a mean 13.9 months and 1 (3%) protease inhibitor-naive patient (P = 0.0001). Fat loss occurred in all regions except the abdomen after a median 10 months. Patients with lipodystrophy experienced a relative weight loss of 0.5 kg per month and had significantly higher triglyceride, cholesterol, insulin and C-peptide levels and were more insulin-resistant than protease inhibitor recipients without lipodystrophy. Patients receiving ritonavir and saquinavir in combination had significantly lower body fat, higher lipids and shorter time to lipodystrophy than patients receiving indinavir. Three (2%) patients developed new or worsening diabetes mellitus.Conclusion: A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance is a common complication of HIV protease inhibitors. Diabetes mellitus is relatively uncommon. (C) 1998 Lippincott-Raven Publishers.