Limone Paolo, Biglino Alberto, Valle Mauro, Degioanni Maria, Paola Servato Maria, Berardi Clara, Del Rizzo Paola, Pellissetto Cristina, Carlo Isaia Giovanni
Department of Internal Medicine, University of Torino, Torino, Italy.
J Infect. 2003 Jul;47(1):52-8. doi: 10.1016/s0163-4453(03)00055-0.
Abnormalities of insulin sensitivity are increasingly reported in HIV infection. Considering that cytokines (particularly TNF-alpha and IL-1beta) can induce insulin resistance in infections, we investigated the relationship between insulin sensitivity and cytokine release from peripheral blood mononuclear cells (PBMCs) in HIV-infected patients.
Fourteen HIV-positive patients treated with dual-NRTI (nucleosidic reverse transcriptase inhibitors) regimens, and fourteen healthy controls were studied. Insulin resistance was assessed by homeostatic model for insulin resistance (HOMA-IR). Cytokine production by PBMCs ex vivo was measured.
Plasma glucose levels did not differ in HIV patients and in controls. Insulin concentrations and HOMA-IR were significantly higher in HIV-infected patients than in controls (respectively, 11.4+/-4.3 vs. 7.86+/-1.1mIU, P=0.005; 2.27+/-0.91 vs. 1.6+/-0.2, P=0.025). A significant positive linear correlation was observed between HOMA-IR and TNF-alpha concentrations in the supernatants of unstimulated PBMC cultures in HIV patients (r=0.771;P=0.001), but not in controls.
Our results are in accordance with previous findings showing that insulin resistance may indeed be present in PI-naive HIV patients, and suggest that either TNF-alpha, or other mediators released in parallel with this cytokine may induce a state of insulin resistance, unrelated to highly active antiviral treatments, in poorly controlled HIV disease.
越来越多的报告指出，HIV感染患者存在胰岛素敏感性异常。鉴于细胞因子（尤其是肿瘤坏死因子-α和白细胞介素-1β）在感染过程中可诱导胰岛素抵抗，我们研究了HIV感染患者胰岛素敏感性与外周血单核细胞（PBMC）细胞因子释放之间的关系。
研究了14例接受双核苷类逆转录酶抑制剂（NRTI）治疗方案的HIV阳性患者和14例健康对照。采用稳态模型评估胰岛素抵抗（HOMA-IR）。体外检测PBMC产生细胞因子的情况。
HIV患者和对照组的血浆葡萄糖水平无差异。HIV感染患者的胰岛素浓度和HOMA-IR显著高于对照组（分别为11.4±4.3对7.86±1.1mIU，P=0.005；2.27±0.91对1.6±0.2，P=0.025）。在HIV患者未刺激的PBMC培养上清液中，HOMA-IR与肿瘤坏死因子-α浓度之间存在显著的正线性相关（r=0.771；P=0.001），而在对照组中未观察到这种相关性。
我们的结果与先前的研究结果一致，表明初治的HIV患者可能确实存在胰岛素抵抗，并提示在控制不佳的HIV疾病中，肿瘤坏死因子-α或与其同时释放的其他介质可能会诱导一种与高效抗逆转录病毒治疗无关的胰岛素抵抗状态。
