鉴别与抗逆转录病毒疗法相关的高脂血症。

Differentiating hyperlipidaemia associated with antiretroviral therapy.

作者信息

Mauss Stefan, Stechel Juergen, Willers Reinhard, Schmutz Guenther, Berger Florian, Richter Werner O

机构信息

Center for HIV and Hepatogastroenterology, Duesseldorf, Germany.

出版信息

AIDS. 2003 Jan 24;17(2):189-94. doi: 10.1097/00002030-200301240-00008.

DOI:10.1097/00002030-200301240-00008

PMID:12545078

Abstract

BACKGROUND

Hyperlipidaemia associated with antiretroviral treatment has led to concerns for an increased cardiovascular risk in HIV-infected patients.

OBJECTIVE

To assess this cardiovascular risk by comparing the lipoprotein pattern of antiretroviral-treated and untreated HIV-positive patients with patients with familial combined hyperlipidaemia (high cardiovascular risk) or familial hypertriglyceridaemia (low cardiovascular risk).

METHODS

Fasting serum samples were drawn from consecutive patients with HIV infection or lipoprotein disorders. Total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, apolipoprotein A1 and B were determined in serum. Very low density lipoprotein (VLDL) was prepared by ultracentrifugation and analysed for cholesterol, triglycerides and apolipoprotein B.

RESULTS

Lipoprotein disorders were found in 114/187 HIV-positive patients (61%). Of these, according to the Fredrickson classification, 10% were type IIa (elevated LDL-cholesterol), 14% type IIb (elevated LDL- and VLDL-cholesterol) and 76% were type IV (elevated VLDL-cholesterol). VLDL composition was analysed in 34 HIV-positive patients with type IV hyperlipidaemia. The ratio of VLDL-triglycerides to VLDL-apolipoprotein B in these patients was 16.2 +/- 6.0. This ratio was not different from 14 patients with famlial hypertriglyceridaemia (16.9 +/- 6.0; = 0.61), but differed substantially from 10 patients with familial combined hyperlipidaemia (6.8 +/- 1.0; < 0.0001).

CONCLUSIONS

In HIV-infected patients with high VLDL, large VLDL particles were found with no increase in number. This pattern resembles familial hypertriglyceridaemia. It is different from familial combined hyperlipidaemia, where an increase in number of small-sized VLDL particles occurs. Further research is needed to assess the contribution of VLDL-associated hypercholesterolaemia in those taking antiretroviral drugs to the cardiovascular risk profile of HIV-positive patients.

摘要

背景

与抗逆转录病毒治疗相关的高脂血症引发了人们对HIV感染患者心血管风险增加的担忧。

目的

通过比较接受抗逆转录病毒治疗和未接受治疗的HIV阳性患者与家族性混合性高脂血症（心血管风险高）或家族性高甘油三酯血症（心血管风险低）患者的脂蛋白模式，评估这种心血管风险。

方法

从连续的HIV感染患者或脂蛋白紊乱患者中采集空腹血清样本。测定血清中的总胆固醇、低密度脂蛋白（LDL）胆固醇、高密度脂蛋白（HDL）胆固醇、甘油三酯、载脂蛋白A1和B。通过超速离心制备极低密度脂蛋白（VLDL），并分析其胆固醇、甘油三酯和载脂蛋白B。

结果

187例HIV阳性患者中有114例（61%）存在脂蛋白紊乱。其中，根据弗雷德里克森分类，10%为IIa型（LDL胆固醇升高），14%为IIb型（LDL和VLDL胆固醇升高），76%为IV型（VLDL胆固醇升高）。对34例IV型高脂血症的HIV阳性患者的VLDL组成进行了分析。这些患者中VLDL甘油三酯与VLDL载脂蛋白B的比值为16.2±6.0。该比值与14例家族性高甘油三酯血症患者（16.9±6.0；P=0.61）无差异，但与10例家族性混合性高脂血症患者（6.8±1.0；P<0.0001）有显著差异。