Haugaard Steen B, Andersen Ove, Madsbad Sten, Iversen Johan, Dela Flemming
Department of Infectious Diseases, Hvidovre University Hospital, DK 2650 Hvidovre, Copenhagen, Denmark.
J Infect. 2007 Jan;54(1):89-97. doi: 10.1016/j.jinf.2006.01.003. Epub 2006 Feb 17.
Hyperlactatemia is prevalent in HIV-infected patients on highly active antiretroviral therapy (HAART) and may be associated with depletion of mitochondrial DNA. However, the correlation between fasting lactate and mitochondrial DNA may be weak or absent, implicating that other factors e.g. glucose turnover may contribute to hyperlactatemia.
HIV-infected patients receiving HAART who had lipodystrophy (LIPO, n=18) or were without lipodystrophy (NONLIPO, n=18) were investigated. Insulin sensitivity (M-value), glucose oxidation rate (GOX) and fasting endogenous glucose production (EGP) were determined by hyperinsulinemic euglycemic clamp, indirect calorimetry and glucose tracer technique, respectively.
Fasting p-lactate (median 1.2 mmol/L; range 0.6-4.3, n=36) tended to be increased in LIPO (P=0.12); 6 patients (4 LIPO) had lactate > or =2.0 mmol/L. Fasting lactate correlated inversely with M-value (P<0.001) and positively with fasting EGP (P<0.05) and fasting GOX (P<0.05), together explaining 51% (R2, n=36) of the variation in fasting lactate. Lactate increased in NONLIPO (P<0.05) but not in LIPO (P>0.5) during clamp. Incremental (clamp minus fasting value) GOX (P<0.01) was decreased and incremental insulin (P<0.01) was increased in LIPO.
Fasting EGP, GOX and insulin resistance may be major determinants of fasting lactate levels in HIV-infected patients on HAART. Insulin levels per se may not determine plasma lactate in such patients.
高乳酸血症在接受高效抗逆转录病毒治疗（HAART）的HIV感染患者中普遍存在，可能与线粒体DNA耗竭有关。然而，空腹乳酸与线粒体DNA之间的相关性可能较弱或不存在，这意味着其他因素，如葡萄糖周转率，可能导致高乳酸血症。
对接受HAART治疗且患有脂肪代谢障碍（LIPO组，n = 18）或无脂肪代谢障碍（NONLIPO组，n = 18）的HIV感染患者进行研究。分别通过高胰岛素正常血糖钳夹技术、间接测热法和葡萄糖示踪技术测定胰岛素敏感性（M值）、葡萄糖氧化率（GOX）和空腹内源性葡萄糖生成（EGP）。
LIPO组空腹β-乳酸（中位数1.2 mmol/L；范围0.6 - 4.3，n = 36）有升高趋势（P = 0.12）；6例患者（4例LIPO组）乳酸≥2.0 mmol/L。空腹乳酸与M值呈负相关（P < 0.001），与空腹EGP呈正相关（P < 0.05），与空腹GOX呈正相关（P < 0.05），共同解释了空腹乳酸变化的51%（R²，n = 36）。钳夹期间，NONLIPO组乳酸升高（P < 0.05），而LIPO组未升高（P > 0.5）。LIPO组的增量（钳夹值减去空腹值）GOX降低（P < 0.01），增量胰岛素升高（P < 0.01）。
空腹EGP、GOX和胰岛素抵抗可能是接受HAART治疗的HIV感染患者空腹乳酸水平的主要决定因素。在此类患者中，胰岛素水平本身可能无法决定血浆乳酸水平。
