Podzamczer Daniel, Ferrer Elena, Martínez Esteban, Del Rio Luis, Rosales Joaquín, Curto Jordi, Ribera Esteban, Barrufet Pilar, Llibre Josep M, Aranda Miquel
Infectious Disease Service, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n. L'Hospitalet, Barcelona 08907, Spain.
AIDS Res Hum Retroviruses. 2009 Jun;25(6):563-7. doi: 10.1089/aid.2008.0264.
The objective of this study was to evaluate how much limb fat is needed to be lost for lipoatrophy to become clinically evident. Antiretroviral drug-naive patients from a randomized trial comparing stavudine or abacavir plus lamivudine and efavirenz, who had subjective assessment to detect clinically evident lipoatrophy (standardized questionnaire) and objective measurements of limb fat (dual X-ray absorptiometry) at baseline, 48 weeks, and 96 weeks were included. ROC curves were used to assess the sensitivity and specificity of several cut-off values of absolute and percent limb fat loss for diagnosing lipoatrophy. Of 54 patients included, 13 (24%) had subjective lipoatrophy at 96 weeks. After 96 weeks, median limb fat change was -2.3 kg (interquartile range: -5.2, +0.2) and 0.4 kg (interquartile range: -7.2, +3.4) in patients with and without lipoatrophy, respectively. Median percent limb fat change was -45.5% (interquartile range: -78.0, +3.7) and 5.5% (interquartile range: -62.8, +95.6), respectively. The cut-off values of absolute and percent limb fat loss showing the best sensitivity and specificity values were -1.5 kg (sensitivity, 77%; specificity, 76%) and -30% (sensitivity, 85%; specificity, 73%). At least 30% limb fat is needed to be lost in HIV-infected patients for lipoatrophy to become clinically evident.
本研究的目的是评估需要减少多少肢体脂肪才会使脂肪萎缩在临床上显现出来。纳入了一项随机试验中未接受过抗逆转录病毒药物治疗的患者，该试验比较了司他夫定或阿巴卡韦加拉米夫定与依非韦伦，这些患者在基线、48周和96周时进行了主观评估以检测临床上明显的脂肪萎缩（标准化问卷）和肢体脂肪的客观测量（双能X线吸收法）。采用ROC曲线评估诊断脂肪萎缩时绝对和百分比肢体脂肪减少的几个临界值的敏感性和特异性。在纳入的54例患者中，13例（24%）在96周时出现主观脂肪萎缩。96周后，有和没有脂肪萎缩的患者肢体脂肪变化中位数分别为-2.3 kg（四分位间距：-5.2，+0.2）和0.4 kg（四分位间距：-7.2，+3.4）。肢体脂肪变化百分比中位数分别为-45.5%（四分位间距：-78.0，+3.7）和5.5%（四分位间距：-62.8，+95.6）。显示出最佳敏感性和特异性值的绝对和百分比肢体脂肪减少的临界值分别为-1.5 kg（敏感性77%；特异性76%）和-30%（敏感性85%；特异性73%）。对于HIV感染患者，肢体脂肪至少需要减少30%才会使脂肪萎缩在临床上显现出来。
