Beregszaszi Marta, Dollfus Catherine, Levine Martine, Faye Albert, Deghmoun Samia, Bellal Nassima, Houang Muriel, Chevenne Didier, Hankard Régis, Bresson Jean-Louis, Blanche Stéphane, Levy-Marchal Claire
INSERM Unit 690, Hôpital Robert Debré, Paris, France.
J Acquir Immune Defic Syndr. 2005 Oct 1;40(2):161-8. doi: 10.1097/01.qai.0000178930.93033.f2.
To assess the rate of progression of lipodystrophy and the associated metabolic disturbances over a 2-year period in children and to assess risk factors associated with lipodystrophy and metabolic disturbances.
Multicenter 2-year prospective study with a standardized evaluation.
One hundred thirty children (median age = 10 years, 64 boys and 66 girls) receiving antiretroviral therapy were recruited in 3 pediatric clinics. Lipodystrophy was defined based on 4 skinfold thickness measurements. Fasting lipids and glucose profile were measured in all children.
The proportion of children presenting with lipodystrophy was 24.6%. Nineteen percent of children had high-density lipoprotein values less than 1 mmol/L. Twenty-two percent and 15% of children had values greater than 2 standard deviations for age and gender for cholesterol and triglycerides, respectively. A total of 13.2% showed insulin resistance. A total of 42.7% showed at least 1 of these biologic disturbances. Prospective follow-up showed no progression at all over 2 years, except for a doubling of the number of children with insulin resistance. In multivariate analyses, ethnicity, previous severe clinical condition, duration of HIV infection, and nucleoside reverse transcriptase inhibitor treatment were significantly associated with lipodystrophy. Tanner stage V of puberty, severe clinical symptoms and protease inhibitor treatment were independently associated with the risk of metabolic disturbances.
Puberty seems to be the time when HIV-infected children taking potent antiretroviral therapy are more likely to develop lipodystrophy and metabolic complications, especially in children with a severe underlying HIV infection. Once developed, lipodystrophy and metabolic changes seem to be extremely stable with time.
评估儿童在2年期间脂肪营养不良的进展率及相关代谢紊乱情况，并评估与脂肪营养不良和代谢紊乱相关的危险因素。
采用标准化评估的多中心2年前瞻性研究。
在3家儿科诊所招募了130名接受抗逆转录病毒治疗的儿童（中位年龄 = 10岁，64名男孩和66名女孩）。基于4次皮褶厚度测量来定义脂肪营养不良。对所有儿童测量空腹血脂和血糖谱。
出现脂肪营养不良的儿童比例为24.6%。19%的儿童高密度脂蛋白值低于1 mmol/L。分别有22%和15%的儿童胆固醇和甘油三酯值高于年龄和性别的2个标准差。共有13.2%表现出胰岛素抵抗。共有42.7%表现出至少1种这些生物学紊乱。前瞻性随访显示，除胰岛素抵抗儿童数量增加一倍外，2年内根本没有进展。在多变量分析中，种族、既往严重临床状况、HIV感染持续时间和核苷类逆转录酶抑制剂治疗与脂肪营养不良显著相关。青春期坦纳五期、严重临床症状和蛋白酶抑制剂治疗与代谢紊乱风险独立相关。
青春期似乎是接受强效抗逆转录病毒治疗的HIV感染儿童更易发生脂肪营养不良和代谢并发症的时期，尤其是在有严重潜在HIV感染 的儿童中。一旦发生，脂肪营养不良和代谢变化似乎随时间极其稳定。
