Jaquet D, Lévine M, Ortega-Rodriguez E, Faye A, Polak M, Vilmer E, Lévy-Marchal C
INSERM Unit 457, Hôpital Robert Debré, Paris, France.
AIDS. 2000 Sep 29;14(14):2123-8. doi: 10.1097/00002030-200009290-00008.
To investigate body fat distribution and glucose and lipid metabolism in HIV-infected children with the aim of describing the lipodystrophic syndrome in children.
Cross-sectional study including 39 HIV-infected children aged 3-18 years.
Clinical lipodystrophy was defined as peripheral fat wasting (facial and/or buttock and/or limb atrophy with arm skinfold thickness lower than the third percentile of the reference values for sex and age) and/or truncal adiposity (breast enlargement and/or buffalo neck and/or relative abdominal obesity with trunk : arm skinfold ratio > 2 standard deviations). Fasting serum lipid concentrations were measured and an oral glucose tolerance test was performed.
Of 39 HIV-infected children, lipodystrophy was observed in 13 children (33.3%): eight with truncal lipohypertrophy, three with peripheral lipoatrophy and two with combined lipodystrophy. Combined lipodystrophies were observed only in adolescents with a more severe presentation than in prepubertal children. Lipodystrophic children had higher fasting insulinaemia (7.0+/-8.5 versus 3.0+/-2.3 microU/ml; P = 0.07), suggesting a certain degree of insulin-resistance. Hypercholesterolaemia (23% versus 15%; P = 0.59 ) and hypertriglyceridaemia (15% versus 11%; P = 0.76) were observed with the same proportion in the lipodystrophic as in the non-lipodystrophic groups; 23% of the non-lipodystrophic children had dyslipidaemia.
The lipodystrophic syndrome prevails in HIV-infected children in the three clinical forms initially described in adults but appears less severe before the initiation of puberty. Insulin-resistance occurs in lipodystrophic children only, whereas dyslipidaemia exists in non-lipodystrophic children as well, suggesting that dyslipidaemia could reflect subclinical alteration of the adipose tissue.
调查感染人类免疫缺陷病毒（HIV）儿童的体脂分布及糖脂代谢情况，以描述儿童脂肪代谢障碍综合征。
横断面研究，纳入39名3至18岁的HIV感染儿童。
临床脂肪代谢障碍定义为外周脂肪消耗（面部和/或臀部和/或肢体萎缩，手臂皮褶厚度低于性别和年龄参考值的第三百分位数）和/或躯干肥胖（乳房增大和/或水牛背和/或相对腹部肥胖，躯干：手臂皮褶比>2个标准差）。测量空腹血脂浓度并进行口服葡萄糖耐量试验。
39名HIV感染儿童中，13名（33.3%）出现脂肪代谢障碍：8名有躯干脂肪增多，3名有外周脂肪萎缩，2名有混合型脂肪代谢障碍。混合型脂肪代谢障碍仅见于青少年，表现比青春期前儿童更严重。脂肪代谢障碍儿童的空腹胰岛素血症较高（7.0±8.5对3.0±2.3微单位/毫升；P = 0.07），提示有一定程度的胰岛素抵抗。脂肪代谢障碍组和非脂肪代谢障碍组的高胆固醇血症（23%对15%；P = 0.59）和高甘油三酯血症（15%对11%；P = 0.76）比例相同；23%的非脂肪代谢障碍儿童有血脂异常。
脂肪代谢障碍综合征在HIV感染儿童中以最初在成人中描述的三种临床形式为主，但在青春期开始前似乎不那么严重。胰岛素抵抗仅发生在脂肪代谢障碍儿童中，而非脂肪代谢障碍儿童也存在血脂异常，提示血脂异常可能反映了脂肪组织的亚临床改变。
