Stein J H, Klein M A, Bellehumeur J L, McBride P E, Wiebe D A, Otvos J D, Sosman J M
Department of Medicine, University of Wisconsin Medical School, Madison, Wisconsin, USA.
Circulation. 2001 Jul 17;104(3):257-62. doi: 10.1161/01.cir.104.3.257.
Human immunodeficiency virus protease inhibitors (HIV PIs) are associated with hyperlipidemia, hyperglycemia, and obesity; however, it is not known whether they increase risk of atherosclerotic vascular disease. The purposes of this study were to characterize the lipoprotein abnormalities associated with use of HIV PIs in individuals with HIV infection and to determine the pathophysiological significance of these changes by assessing their effect on endothelial dysfunction.
This was a cross-sectional study of 37 adults with HIV-1 infection who were receiving antiretroviral therapy. Twenty-two were taking HIV PIs (group 1); 15 were not (group 2). Lipids and lipoproteins were measured by enzymatic techniques and nuclear magnetic resonance spectroscopic analysis. Flow-mediated vasodilation (FMD) of the brachial artery was measured by high-resolution ultrasound. Subjects in both groups were similar in regard to age, time since diagnosis of HIV infection, and CD4 cell count. Group 1 subjects had higher total cholesterol (5.68 versus 4.42 mmol/L, P=0.007) and triglyceride (4.43 versus 1.98 mmol/L, P=0.009) levels, characterized by elevated levels of IDL and VLDL. Subjects in group 1 had impaired FMD (2.6+/-4.6%), indicative of significant endothelial dysfunction. Group 2 subjects had normal FMD (8.1+/-6.7%, P=0.005). In group 1, chylomicron, VLDL, IDL, and HDL cholesterol levels predicted FMD.
Use of HIV PIs is associated with atherogenic lipoprotein changes and endothelial dysfunction. Because these metabolic and vascular changes predispose to atherosclerosis, monitoring and treatment of dyslipidemia in patients taking these medications is warranted.
人类免疫缺陷病毒蛋白酶抑制剂（HIV PIs）与高脂血症、高血糖和肥胖有关；然而，尚不清楚它们是否会增加动脉粥样硬化性血管疾病的风险。本研究的目的是描述HIV感染个体使用HIV PIs相关的脂蛋白异常情况，并通过评估其对内皮功能障碍的影响来确定这些变化的病理生理意义。
这是一项对37名接受抗逆转录病毒治疗的HIV-1感染成年人的横断面研究。22人服用HIV PIs（第1组）；15人未服用（第2组）。通过酶促技术和核磁共振光谱分析测量血脂和脂蛋白。通过高分辨率超声测量肱动脉的血流介导的血管舒张（FMD）。两组受试者在年龄、HIV感染诊断后的时间和CD4细胞计数方面相似。第1组受试者的总胆固醇（5.68对4.42 mmol/L，P=0.007）和甘油三酯（4.43对1.98 mmol/L，P=0.009）水平较高，其特征是中间密度脂蛋白（IDL）和极低密度脂蛋白（VLDL）水平升高。第1组受试者的FMD受损（2.6±4.6%），表明存在明显的内皮功能障碍。第2组受试者的FMD正常（8.1±6.7%，P=0.005）。在第1组中，乳糜微粒、VLDL、IDL和高密度脂蛋白胆固醇水平可预测FMD。
使用HIV PIs与致动脉粥样硬化的脂蛋白变化和内皮功能障碍有关。由于这些代谢和血管变化易导致动脉粥样硬化，因此对服用这些药物的患者进行血脂异常的监测和治疗是必要的。
