Treitinger A, Spada C, da Silva L M, Hermes E M, Amaral J A, Abdalla D S
Braz J Infect Dis. 2001 Aug;5(4):192-9. doi: 10.1590/s1413-86702001000400005.
Lipid and acute-phase protein alterations have been described in various infection diseases, and they have been recorded during the early stages of HIV infection. Lipid and acute-phase protein profiles also have been correlated with cellular immunological abnormalities. To document these correlations during HIV infection, we studied 75 HIV-infected patients and 26 HIV-negative controls. Patients were classified according to the criteria proposed by the Walter Reed Army Institute: as WR-1 (CD4 lymphocytes, 1154 +/- 268/mm3), WR-2 (CD4, 793 +/- 348/mm3) and WR3/4 (CD4, 287+/-75 mm3). Triglycerides, total cholesterol and HDL-cholesterol concentrations were measured by enzymatic methods. Immunoglobulins (IgA and IgG) and acute-phase proteins (haptoglobin, alpha1-acid glycoprotein, C-reactive protein and transferrin) were determined by immunonephelometry. Haptoglobin levels were significantly increased in HIV-positive patients and correlated with the progression of HIV-infection (control<WR1<WR2<WR3/4). WR-2 and WR-3/4 patients had lower total cholesterol, HDL-cholesterol, and albumin concentrations, however, alpha1-acid glycoprotein and IgA levels were higher, when compared to HIV-negative controls. Elevated triglyceride levels (1.51+/-0.75 mmol/L) were found only in WR3/4 patients, when compared to the control individuals (1.05+/-0.04 mmol/L). No differences were found in transferrin and C-reactive protein concentrations among the studied groups. CD4+ lymphocyte counts were inversely correlated with triglycerides, IgA, alpha1-acid glycoprotein and haptoglobin, and they were positively correlated with albumin, total cholesterol and HDL-cholesterol. Multiple linear regression analysis showed that increased haptoglobin and IgA levels were the best predictive variables of a decreasing CD4+ lymphocyte count. In conclusion, our data showed that: 1) a decrease in total cholesterol, HDL-cholesterol and albumin levels occurred earlier than hypertriglyceridemia in the course of HIV infection; 2) increased levels of haptoglobin occurred earlier than that of alpha1-acid glycoprotein and IgA; 3) haptoglobin and IgA were the best predictive variables of a decreasing CD4+ lymphocyte count. Decreases in HDL-cholesterol and albumin levels with increases in haptoglobin, alpha1-acid glycoprotein, IgA, and triglycerides levels are indications of disease progression in HIV-infected patients.
脂质和急性期蛋白改变已在多种感染性疾病中有所描述，并且在HIV感染的早期阶段也有记录。脂质和急性期蛋白谱还与细胞免疫异常相关。为了记录HIV感染期间的这些相关性，我们研究了75例HIV感染患者和26例HIV阴性对照。患者根据沃尔特·里德陆军研究所提出的标准进行分类：即WR-1（CD4淋巴细胞，1154±268/mm³）、WR-2（CD4，793±348/mm³）和WR3/4（CD4，287±75/mm³）。甘油三酯、总胆固醇和高密度脂蛋白胆固醇浓度采用酶法测定。免疫球蛋白（IgA和IgG）和急性期蛋白（触珠蛋白、α1-酸性糖蛋白、C反应蛋白和转铁蛋白）通过免疫比浊法测定。HIV阳性患者的触珠蛋白水平显著升高，且与HIV感染的进展相关（对照组<WR1<WR2<WR3/4）。与HIV阴性对照相比，WR-2和WR-3/4患者的总胆固醇、高密度脂蛋白胆固醇和白蛋白浓度较低，然而，α1-酸性糖蛋白和IgA水平较高。与对照个体（1.05±0.04 mmol/L）相比，仅在WR3/4患者中发现甘油三酯水平升高（1.51±0.75 mmol/L）。在所研究的组中，转铁蛋白和C反应蛋白浓度未发现差异。CD4+淋巴细胞计数与甘油三酯、IgA、α1-酸性糖蛋白和触珠蛋白呈负相关，与白蛋白、总胆固醇和高密度脂蛋白胆固醇呈正相关。多元线性回归分析表明，触珠蛋白和IgA水平升高是CD4+淋巴细胞计数下降的最佳预测变量。总之，我们的数据表明：1）在HIV感染过程中，总胆固醇、高密度脂蛋白胆固醇和白蛋白水平的下降早于高甘油三酯血症；2）触珠蛋白水平的升高早于α1-酸性糖蛋白和IgA；3）触珠蛋白和IgA是CD4+淋巴细胞计数下降的最佳预测变量。高密度脂蛋白胆固醇和白蛋白水平的下降以及触珠蛋白、α1-酸性糖蛋白、IgA和甘油三酯水平的升高是HIV感染患者疾病进展的指征。
