Schwenk A, Beisenherz A, Römer K, Kremer G, Salzberger B, Elia M
Klinik I für Innere Medizin der Universität zu Köln, Cologne, Germany.
Am J Clin Nutr. 2000 Aug;72(2):496-501. doi: 10.1093/ajcn/72.2.496.
Highly active antiretroviral treatment (HAART) reduces the risk of wasting in HIV infection and may alter the prognostic weight of wasting. The phase angle from bioelectrical impedance analysis (BIA) can be interpreted as a surrogate marker for the catabolic reaction to chronic HIV infection and opportunistic disease.
Our objective was to assess the prognostic ability of the phase angle in HIV-infected patients in the era of HAART.
Two cross-sectional observation studies were conducted in 1996 and 1997 at a German university outpatient HIV clinic. In the 1996 and 1997 cohorts, HAART was prescribed to 17 of 212 and 168 of 257 patients at baseline and to 179 of 212 and 234 of 257 patients during observation, respectively. Whole-body BIA was assessed at 50 KHz. Time to clinical progression and survival were calculated by using Cox proportional hazard models with time-dependent covariates. Median observation times were 1000 and 515 d for the 1996 and 1997 cohorts, respectively.
Higher phase angle was associated with a lower relative mortality risk, adjusted for viral load and CD4(+) cell count, of 0.49 (95% CI: 0.30, 0.81) per degree in 1996 and of 0.33 (95% CI: 0.18, 0.61) in 1997. The influence of phase angle on time to clinical progression, adjusted for viral load and CD4(+) cell count, was not significant in 1996 but the relative risk was 0.58 (0.36, 0.83) in 1997.
Despite the favorable effects of HAART on the nutritional status of HIV-infected persons, low phase angle remains an independent adverse prognostic marker of clinical progression and survival.
高效抗逆转录病毒治疗（HAART）可降低HIV感染患者体重减轻的风险，并可能改变体重减轻的预后权重。生物电阻抗分析（BIA）得出的相位角可被解释为慢性HIV感染和机会性疾病分解代谢反应的替代标志物。
我们的目的是评估HAART时代HIV感染患者相位角的预后能力。
1996年和1997年在德国一所大学的门诊HIV诊所进行了两项横断面观察研究。在1996年和1997年的队列中，基线时分别有212名患者中的17名和257名患者中的168名接受了HAART治疗，观察期间分别有212名患者中的179名和257名患者中的234名接受了HAART治疗。在50千赫兹下评估全身BIA。使用具有时间依赖性协变量的Cox比例风险模型计算临床进展时间和生存期。1996年和1997年队列的中位观察时间分别为1000天和515天。
校正病毒载量和CD4(+)细胞计数后，较高的相位角与较低的相对死亡风险相关，1996年每度为0.49（95%CI：0.30，0.81），1997年为0.33（95%CI：0.18，0.61）。校正病毒载量和CD4(+)细胞计数后，1996年相位角对临床进展时间的影响不显著，但1997年相对风险为0.58（0.36，0.83）。
尽管HAART对HIV感染者的营养状况有有利影响，但低相位角仍然是临床进展和生存的独立不良预后标志物。
