合并感染HIV-1、社会经济状况及肺结核严重程度与成年肺结核患者消瘦和身体组成的关系

Wasting and body composition of adults with pulmonary tuberculosis in relation to HIV-1 coinfection, socioeconomic status, and severity of tuberculosis.

作者信息

Villamor E, Saathoff E, Mugusi F, Bosch R J, Urassa W, Fawzi W W

机构信息

Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.

出版信息

Eur J Clin Nutr. 2006 Feb;60(2):163-71. doi: 10.1038/sj.ejcn.1602281.

DOI:10.1038/sj.ejcn.1602281

PMID:16234841

Abstract

OBJECTIVE

To examine the impact of HIV coinfection, socioeconomic status (SES) and severity of tuberculosis (TB) on the body composition and anthropometric status of adults with pulmonary TB.

DESIGN

Cross-sectional study.

SETTING

Five TB clinics in Dar es Salaam, Tanzania.

SUBJECTS

A total of 2231 adult men and women diagnosed with pulmonary TB, prior to the initiation of anti-TB therapy.

METHODS

We compared the distribution of anthropometric characteristics including body mass index (BMI), mid-upper arm circumference (MUAC), triceps skin-fold (TSF), and arm muscle circumference (AMC) by HIV status, SES characteristics, and indicators of TB severity (bacillary density in sputum and Karnofsky performance score). Similar comparisons were carried out with body composition variables from bioelectrical impedance analysis and albumin concentrations, in a subsample of 731 subjects.

RESULTS

In multivariate analysis, HIV infection was significantly associated with lower MUAC and AMC in both men and women, but not with BMI or TSF. Compared to HIV-uninfected women, those who were HIV infected had lower body cell mass (BCM) (adjusted difference = -0.85 kg, P = 0.04), intracellular water (-0.68 l, P = 0.04), and phase angle (-0.52, P = 0.02). Albumin concentrations were significantly lower in both men and women infected with HIV. Among HIV-infected men, CD4 cell counts <200/mm(3) were related to lower intracellular water, BCM, fat-free mass and phase angle. Independent of HIV infection, BMI and MUAC were positively related to SES indicators and the Karnofsky performance score; and inversely related to bacillary density.

CONCLUSIONS

HIV infection is associated with indicators of low lean body mass in adults with TB; socioeconomic factors and TB severity are important correlates of wasting, independent of HIV.

SPONSORSHIP

The National Institute of Allergy and Infectious Diseases (UO1 AI 45441-01).

摘要

目的

探讨合并感染艾滋病毒、社会经济地位（SES）和结核病（TB）严重程度对成年肺结核患者身体成分和人体测量状况的影响。

设计

横断面研究。

地点

坦桑尼亚达累斯萨拉姆的五家结核病诊所。

研究对象

共有2231名成年男性和女性，在开始抗结核治疗之前被诊断为肺结核。

方法

我们根据艾滋病毒感染状况、SES特征和结核病严重程度指标（痰菌密度和卡诺夫斯基功能状态评分），比较了人体测量特征的分布情况，包括体重指数（BMI）、上臂中部周长（MUAC）、三头肌皮褶厚度（TSF）和上臂肌肉周长（AMC）。在731名受试者的子样本中，对生物电阻抗分析得出的身体成分变量和白蛋白浓度进行了类似的比较。

结果

在多变量分析中，艾滋病毒感染与男性和女性的较低MUAC和AMC显著相关，但与BMI或TSF无关。与未感染艾滋病毒的女性相比，感染艾滋病毒的女性身体细胞质量（BCM）较低（调整差异=-0.85 kg，P=0.04），细胞内液（-0.68 l，P=0.04）和相位角（-0.52，P=0.02）也较低。感染艾滋病毒的男性和女性的白蛋白浓度均显著较低。在感染艾滋病毒的男性中，CD4细胞计数<200/mm³与较低的细胞内液、BCM、去脂体重和相位角有关。独立于艾滋病毒感染，BMI和MUAC与SES指标和卡诺夫斯基功能状态评分呈正相关；与菌密度呈负相关。