Hartman Karin, Verweel Gwenda, de Groot Ronald, Hartwig Nico G
Department of Paediatrics, Division of Paediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Pediatr Infect Dis J. 2006 May;25(5):427-31. doi: 10.1097/01.inf.0000215003.32256.aa.
Highly active antiretroviral therapy has been associated with lipodystrophy in adults. Much is unknown about its characteristics, especially in children.
To obtain an objective case definition of the lipodystrophy syndrome.
This was a cross-sectional study. One investigator rated clinical lipodystrophy. Body composition was measured using body mass index, skin fold thickness and circumference of arm, leg, waist and hip. Samples for human immunodeficiency virus (HIV)-1 RNA, CD4 cell count, fasting lipids and glucose variables were drawn. HIV-infected children with lipodystrophy were compared with HIV-infected children without lipodystrophy (controls).
Thirty-four children were included: 28 controls, 2 nonassigned, and 4 with the lipoatrophic phenotype. Lipohypertrophy or mixed syndrome were not observed. All children with lipoatrophy were pubertal; they had used stavudine and didanosine longer. Children with lipoatrophy had significantly smaller arm and leg circumference, and their skin folds were thinner. The torso-to-arm ratio was 3 times higher in lipoatrophic children, but the difference did not reach significance. The waist-to-hip ratio was higher (P = 0.005). None of the laboratory values differed significantly between the two groups, but all children with lipoatrophy had an increased C-peptide level above the upper limit of normal. All children with lipoatrophy could be distinguised from controls by an increased C-peptide level, a waist-to-hip ratio z score of 1 standard deviation or higher and a sum of skin folds z score below -1 standard deviation.
All children with lipoatrophy can be distinguished by using anthropometric measurements and C-peptide measurement in serum. This method is simple, readily available and inexpensive.
高效抗逆转录病毒疗法与成人脂肪代谢障碍有关。关于其特征，尤其是在儿童中的特征，仍有很多未知之处。
获得脂肪代谢障碍综合征的客观病例定义。
这是一项横断面研究。由一名研究人员对临床脂肪代谢障碍进行评估。使用体重指数、皮褶厚度以及手臂、腿部、腰部和臀部的周长来测量身体成分。采集人类免疫缺陷病毒（HIV）-1 RNA、CD4细胞计数、空腹血脂和血糖变量的样本。将感染HIV且患有脂肪代谢障碍的儿童与未患脂肪代谢障碍的感染HIV儿童（对照组）进行比较。
纳入34名儿童：28名对照组儿童、2名未分组儿童和4名脂肪萎缩型儿童。未观察到脂肪增生或混合型综合征。所有脂肪萎缩型儿童均处于青春期；他们使用司他夫定和去羟肌苷的时间更长。脂肪萎缩型儿童的手臂和腿部周长明显更小，皮褶更薄。脂肪萎缩型儿童的躯干与手臂比例高出3倍，但差异未达到显著水平。腰臀比更高（P = 0.005）。两组之间的实验室值均无显著差异，但所有脂肪萎缩型儿童的C肽水平均高于正常上限。所有脂肪萎缩型儿童均可通过C肽水平升高、腰臀比z评分达到或高于1个标准差以及皮褶总和z评分低于-1个标准差与对照组区分开来。
通过人体测量和血清C肽测量可区分所有脂肪萎缩型儿童。该方法简单、易于实施且成本低廉。
