Schindler K, Rieger A, Tura A, Gmeinhardt B, Touzeau-Römer V, Haider D, Pacini G, Ludvik B
Department of Medicine 3, Division of Endocrinology and Metabolism, Medical University of Vienna, Austria.
Horm Metab Res. 2009 Jul;41(7):573-9. doi: 10.1055/s-0029-1202779. Epub 2009 Mar 25.
Highly active antiretroviral therapy (HAART) leads to lipodystrophy and is associated with detrimental changes in glucose and lipid metabolism. This study investigated the impact of rosiglitazone on insulin sensitivity, beta cell function, bone mineral density, and body composition in HIV+ nondiabetic subjects under HAART. In this randomized, double blind, placebo controlled parallel group study, 40 HIV+ subjects were treated with rosiglitazone 4 mg/day (R, n=23) or placebo (P, n=17) for 6 months. Glucose, insulin and C peptide concentrations were analyzed for assessing insulin sensitivity and secretion. Adiponectin and leptin were evaluated. Body fluid compartments were measured with bioelectrical impedance spectroscopy, and bone mineral density and body composition with Dual X Ray absorptiometry. Rosiglitazone improved peripheral insulin sensitivity (+36.7+/-15.7 ml/min/m (2), p=0.03, means+/-SEM), while no change was observed in P (+4.5+/-19.5 ml/min/m (2), p=0.55). Liver insulin resistance, beta cell activity, and hepatic insulin clearance did not change. Plasma adiponectin increased (R: +2.47+/-0.86 microg/ml, p=0.01 vs. P: +0.45+/-0.60, p=0.28). Rosiglitazone had no influence on body composition, fat distribution and bone mineral density but expanded extra-cellular fluid volume in HIV infected persons (R: +0.50+/-0.21 l, p=0.02 vs. P: 0.10+/-0.25 l, p=0.32). Lipid metabolism in P remained unchanged, in R total cholesterol and LDL cholesterol levels increased significantly (p<0.05). Rosiglitazone treatment resulted in improved peripheral insulin sensitivity with increased circulating adiponectin in HIV patients under HAART. No effect was seen on body fat distribution, bone mineral density, and weight. These side effects and their potential for cardiac risk must be weighed against the beneficial effects on glucose metabolism.
高效抗逆转录病毒疗法（HAART）会导致脂肪代谢障碍，并与葡萄糖和脂质代谢的有害变化相关。本研究调查了罗格列酮对接受HAART治疗的HIV阳性非糖尿病患者的胰岛素敏感性、β细胞功能、骨矿物质密度和身体成分的影响。在这项随机、双盲、安慰剂对照平行组研究中，40名HIV阳性受试者接受罗格列酮4毫克/天（R组，n = 23）或安慰剂（P组，n = 17）治疗6个月。分析葡萄糖、胰岛素和C肽浓度以评估胰岛素敏感性和分泌。评估脂联素和瘦素。用生物电阻抗光谱法测量体液成分，用双能X线吸收法测量骨矿物质密度和身体成分。罗格列酮改善了外周胰岛素敏感性（+36.7±15.7毫升/分钟/米²，p = 0.03，均值±标准误），而P组未观察到变化（+4.5±19.5毫升/分钟/米²，p = 0.55）。肝脏胰岛素抵抗、β细胞活性和肝脏胰岛素清除率未改变。血浆脂联素增加（R组：+2.47±0.86微克/毫升，p = 0.01；P组：+0.45±0.60，p = 0.28）。罗格列酮对身体成分、脂肪分布和骨矿物质密度没有影响，但在HIV感染者中增加了细胞外液量（R组：+0.50±0.21升，p = 0.02；P组：0.10±0.25升，p = 0.32）。P组的脂质代谢保持不变，R组的总胆固醇和低密度脂蛋白胆固醇水平显著升高（p < 0.05）。罗格列酮治疗可改善接受HAART治疗的HIV患者的外周胰岛素敏感性，并增加循环脂联素。对身体脂肪分布、骨矿物质密度和体重没有影响。必须权衡这些副作用及其潜在的心脏风险与对葡萄糖代谢的有益作用。
