van Lettow Monique, Harries Anthony D, Kumwenda Johnny J, Zijlstra Ed E, Clark Tamara D, Taha Taha E, Semba Richard D
Johns Hopkins University School of Medicine, Baltimore, USA.
BMC Infect Dis. 2004 Dec 21;4(1):61. doi: 10.1186/1471-2334-4-61.
Wasting and micronutrient malnutrition have not been well characterized in adults with pulmonary tuberculosis. We hypothesized that micronutrient malnutrition is associated with wasting and higher plasma human immunodeficiency virus (HIV) load in adults with pulmonary tuberculosis.
In a cross-sectional study involving 579 HIV-positive and 222 HIV-negative adults with pulmonary tuberculosis in Zomba, Malawi, anthropometry, plasma HIV load and plasma micronutrient concentrations (retinol, alpha-tocopherol, carotenoids, zinc, and selenium) were measured. The risk of micronutrient deficiencies was examined at different severity levels of wasting.
Body mass index (BMI), plasma retinol, carotenoid and selenium concentrations significantly decreased by increasing tertile of plasma HIV load. There were no significant differences in plasma micronutrient concentrations between HIV-negative individuals and HIV-positive individuals who were in the lowest tertile of plasma HIV load. Plasma vitamin A concentrations <0.70 micromol/L occurred in 61%, and zinc and selenium deficiency occurred in 85% and 87% respectively. Wasting, defined as BMI<18.5 was present in 59% of study participants and was independently associated with a higher risk of low carotenoids, and vitamin A and selenium deficiency. Severe wasting, defined as BMI<16.0 showed the strongest associations with deficiencies in vitamin A, selenium and plasma carotenoids.
These data demonstrate that wasting and higher HIV load in pulmonary tuberculosis are associated with micronutrient malnutrition.
消瘦和微量营养素营养不良在成年肺结核患者中尚未得到充分描述。我们假设微量营养素营养不良与成年肺结核患者的消瘦及更高的血浆人类免疫缺陷病毒（HIV）载量有关。
在一项横断面研究中，对马拉维宗巴的579名HIV阳性和222名HIV阴性成年肺结核患者进行了人体测量、血浆HIV载量及血浆微量营养素浓度（视黄醇、α-生育酚、类胡萝卜素、锌和硒）的测定。在不同程度的消瘦情况下，研究了微量营养素缺乏的风险。
随着血浆HIV载量三分位数的增加，体重指数（BMI）、血浆视黄醇、类胡萝卜素和硒浓度显著降低。血浆HIV载量处于最低三分位数的HIV阴性个体与HIV阳性个体之间，血浆微量营养素浓度无显著差异。血浆维生素A浓度<0.70微摩尔/升的情况在61%的患者中出现，锌和硒缺乏分别出现在85%和87%的患者中。59%的研究参与者存在消瘦（定义为BMI<18.5），且消瘦与低类胡萝卜素、维生素A和硒缺乏的较高风险独立相关。严重消瘦（定义为BMI<16.0）与维生素A、硒和血浆类胡萝卜素缺乏的关联最为强烈。
这些数据表明，肺结核患者中的消瘦及更高的HIV载量与微量营养素营养不良有关。
