Driscoll Susan D, Meininger Gary E, Lareau Mark T, Dolan Sara E, Killilea Kathleen M, Hadigan Colleen M, Lloyd-Jones Donald M, Klibanski Anne, Frontera Walter R, Grinspoon Steven K
Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts 02144-2696, USA.
AIDS. 2004 Feb 20;18(3):465-73. doi: 10.1097/00002030-200402200-00013.
To determine whether exercise training in combination with metformin improves cardiovascular risk indices and insulin in comparison to metformin alone among HIV-infected patients.
We conducted a prospective, randomized, 3-month study of HIV patients on stable antiretroviral therapy with hyperinsulinemia and fat redistribution. Subjects received metformin alone or metformin and exercise training consisting of 1 h of aerobic and resistance training three times a week. Cardiovascular parameters, including blood pressure and endurance during sub-maximal stress testing, body composition, strength, insulin and other biochemical parameters were determined.
Thirty-seven patients were randomized and 25 subjects completed the study. Subjects receiving exercise training and metformin demonstrated significant decreases in median waist-to-hip ratio [-0.02 (-0.06, -0.01) (median (interquartile range) versus -0.01 (0.03, 0.02), P = 0.026], resting systolic [-12 (-20, -4) versus 0 (-11, 11), P = 0.012] and diastolic blood pressures [-10 (-14, -8) versus 0 (-7, 8), P = 0.001], increased thigh muscle cross-sectional area [3 (-3, 12) versus -7 (-11, 0), P = 0.015], and improved exercise time [3 (0, 4) versus 0 (-1, 1), P = 0.045] compared with subjects receiving metformin alone. Fasting insulin and insulin area under the curve decreased significantly more in the exercise and metformin group (P < 0.05). Lipids and resting lactate did not change significantly between treatment groups.
These data demonstrate that exercise training in combination with metformin significantly improves cardiovascular and biochemical parameters more than metformin alone in HIV-infected patients with fat redistribution and hyperinsulinemia. Combined treatment was safe, well tolerated and may be a useful strategy to decrease cardiovascular risk in this population.
确定在感染HIV的患者中，与单独使用二甲双胍相比，运动训练联合二甲双胍是否能改善心血管风险指标和胰岛素水平。
我们对接受稳定抗逆转录病毒治疗且患有高胰岛素血症和脂肪重新分布的HIV患者进行了一项为期3个月的前瞻性随机研究。受试者单独接受二甲双胍治疗，或接受二甲双胍治疗并进行运动训练，运动训练包括每周三次、每次1小时的有氧训练和抗阻训练。测定心血管参数，包括次极量应激测试期间的血压和耐力、身体成分、力量、胰岛素及其他生化参数。
37名患者被随机分组，25名受试者完成了研究。与单独接受二甲双胍治疗的受试者相比，接受运动训练和二甲双胍治疗的受试者的中位腰臀比显著降低[-0.02（-0.06，-0.01）（中位数（四分位间距））对-0.01（0.03，0.02），P = 0.026]，静息收缩压[-12（-20，-4）对0（-11，11），P = 0.012]和舒张压[-10（-14，-8）对0（-7，8），P = 0.001]降低，大腿肌肉横截面积增加[3（-3，12）对-7（-11，0），P = 0.015]，运动时间改善[3（0，4）对0（-1，1），P = 0.045]。运动和二甲双胍组的空腹胰岛素和胰岛素曲线下面积下降更为显著（P < 0.05）。治疗组之间血脂和静息乳酸水平无显著变化。
这些数据表明，在患有脂肪重新分布和高胰岛素血症的HIV感染患者中，运动训练联合二甲双胍比单独使用二甲双胍能更显著地改善心血管和生化参数。联合治疗安全、耐受性良好，可能是降低该人群心血管风险的有效策略。
