Hadigan C, Corcoran C, Piecuch S, Rodriguez W, Grinspoon S
Neuroendocrine Unit, Massachusetts General Hospital, Boston 02114, USA.
J Clin Endocrinol Metab. 2000 Oct;85(10):3544-50. doi: 10.1210/jcem.85.10.6923.
A novel lipodystrophy syndrome characterized by insulin resistance, hypertriglyceridemia, and fat redistribution has recently been described in human immunodeficiency virus (HIV)-infected men and women. Women with the HIV lipodystrophy syndrome exhibit a marked increase in waist-to-hip ratio and truncal adiposity; however, it is unknown whether androgen levels are increased in these patients. In this study, we assessed androgen levels in female patients with clinical lipodystrophy based on evidence of significant fat redistribution in the trunk, extremities, neck and/or face (LIPO: n = 9; age, 35.7+/-1.7 yr; BMI, 24.7+/-0.8 kg/m2) in comparison with age- and BMI-matched nonlipodystrophic HIV-infected females (NONLIPO: n = 14; age, 37.6+/-1.1 yr; BMI, 23.4+/-0.6 kg/m2) and healthy non-HIV-infected control subjects (C: n = 16; age, 35.8+/-0.9 yr; BMI, 23.1+/-0.4 kg/m2). Fasting insulin, lipid levels, virologic parameters, and regional body composition using dual energy x-ray absorptiometry were also assessed. Total testosterone [ LIPO, 33+/-6 ng/dL (1.1+/-0.2 nmol/L); NONLIPO, 17+/-2 ng/dL (0.6+/-0.1 nmol/L); C, 23+/-2 ng/dL (0.8+/-0.1 nmol/L); P < 0.05 LIPO vs. C and LIPO vs. NONLIPO] and free testosterone determined by equilibrium dialysis [LIPO, 4.5+/-0.9 pg/mL (16+/-3 pmol/L); NONLIPO, 1.7+/-0.2 pg/mL (6+/-1 pmol/L); C, 2.4+/-0.2 pg/mL (8+/-1 pmol/L); P < 0.05 LIPO vs. C and LIPO vs. NONLIPO] were increased in the lipodystrophic patients. Sex hormone-binding globulin levels were not significantly different between LIPO and C, but were significantly lower in the LIPO vs. NONLIPO patients (LIPO 84+/-7 vs. NONLIPO 149+/-17 nmol/L, P < 0.05). The LH/FSH ratio was significantly increased in the LIPO group compared with the NONLIPO and C subjects (LIPO, 2.0+/-0.6; NONLIPO, 1.1+/-0.1; C, 0.8+/-0.1; P < 0.05 LIPO vs. NONLIPO and LIPO vs. C). Body fat distribution was significantly different between LIPO and C subjects. Trunk to extremity fat ratio (1.46+/-0.17 vs. 0.75+/-0.05, LIPO vs. C, P < 0.05) was increased and extremity to total fat ratio decreased (0.40+/-0.03 vs. 0.55+/-0.01, LIPO vs. C, P < 0.05). In contrast, fat distribution was not different in the NONLIPO group vs. control subjects. Among the HIV-infected patients, free testosterone correlated with percent truncal fat (trunk fat/trunk mass) (r = 0.43, P = 0.04). These data suggest that hyperandrogenemia is another potentially important feature of the HIV-lipodystrophy syndrome in women. Additional studies are necessary to determine the clinical significance of increased androgen levels and the relationship of hyperandrogenism to fat redistribution and insulin resistance in this population of patients.
最近在感染人类免疫缺陷病毒（HIV）的男性和女性中发现了一种以胰岛素抵抗、高甘油三酯血症和脂肪重新分布为特征的新型脂肪营养不良综合征。患有HIV脂肪营养不良综合征的女性腰臀比和躯干肥胖显著增加；然而，这些患者的雄激素水平是否升高尚不清楚。在本研究中，我们评估了临床诊断为脂肪营养不良的女性患者的雄激素水平，这些患者躯干、四肢、颈部和/或面部有明显脂肪重新分布的证据（脂肪营养不良组：n = 9；年龄，35.7±1.7岁；体重指数，24.7±0.8kg/m²），并与年龄和体重指数匹配的未患脂肪营养不良的HIV感染女性（非脂肪营养不良组：n = 14；年龄，37.6±1.1岁；体重指数，23.4±0.6kg/m²）以及健康的未感染HIV的对照受试者（对照组：n = 16；年龄，35.8±0.9岁；体重指数，23.1±0.4kg/m²）进行比较。还评估了空腹胰岛素、血脂水平、病毒学参数以及使用双能X线吸收法测定的局部身体成分。脂肪营养不良患者的总睾酮水平升高[脂肪营养不良组，33±6ng/dL（1.1±0.2nmol/L）；非脂肪营养不良组，17±2ng/dL（0.6±0.1nmol/L）；对照组，23±2ng/dL（0.8±0.1nmol/L）；脂肪营养不良组与对照组比较以及脂肪营养不良组与非脂肪营养不良组比较，P < 0.05]，通过平衡透析法测定的游离睾酮水平也升高[脂肪营养不良组，4.5±0.9pg/mL（16±3pmol/L）；非脂肪营养不良组，1.7±0.2pg/mL（6±1pmol/L）；对照组，2.4±0.2pg/mL（8±1pmol/L）；脂肪营养不良组与对照组比较以及脂肪营养不良组与非脂肪营养不良组比较，P < 0.05]。脂肪营养不良组与对照组的性激素结合球蛋白水平无显著差异，但脂肪营养不良组与非脂肪营养不良组患者相比显著降低（脂肪营养不良组84±7与非脂肪营养不良组149±17nmol/L，P < 0.05）。与非脂肪营养不良组和对照组相比，脂肪营养不良组的促黄体生成素/促卵泡激素比值显著升高（脂肪营养不良组，2.0±0.6；非脂肪营养不良组，1.1±0.1；对照组，0.8±0.1；脂肪营养不良组与非脂肪营养不良组比较以及脂肪营养不良组与对照组比较，P < 0.05）。脂肪营养不良组与对照组的身体脂肪分布有显著差异。躯干与四肢脂肪比增加（脂肪营养不良组1.46±0.17与对照组0.75±0.05，P < 0.05），四肢与总脂肪比降低（脂肪营养不良组0.40±0.03与对照组0.55±0.01，P < 0.05）。相比之下，非脂肪营养不良组与对照受试者的脂肪分布无差异。在感染HIV的患者中，游离睾酮与躯干脂肪百分比（躯干脂肪/躯干质量）相关（r = 0.43，P = 0.04）。这些数据表明，高雄激素血症是女性HIV脂肪营养不良综合征的另一个潜在重要特征。需要进一步研究以确定雄激素水平升高的临床意义以及该患者群体中高雄激素血症与脂肪重新分布和胰岛素抵抗的关系。
