Meena L P, Rai M, Singh S K, Chakravarty J, Singh A, Goel R, Pathak A, Sundar Shyam
Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP.
J Assoc Physicians India. 2011 Jun;59:365-6, 371.
To determine the frequency of adrenal, thyroid and gonadal dysfunction in HIV positive male patients and to evaluate the endocrine function at different level of CD4 cell counts.
A total of 150 male HIV positive subjects were included in study. The patients were divided in three groups on the basis of CD4 cell counts. "Group A": HIV positive with CD4 count<200/mm "Group B": HIV positive with CD4 count 200-350/mm3 and "Group C": HIV positive with CD4 count>350/mm3.
In "group A" (n=50) 2 patients had basal cortisol<5 microg/dl while 23 patients had basal cortisol>25 microg/ dl. 15 patients had subclinical hypothyroidism while 11 patients had overt hypothyroidism. 25 patients in this group had gonadal dysfunction: majority of them (24) had primary gonadal dysfunction (elevated LH). None of the patients in "group B" (n=50) had hypocortisolism while 11 patients had elevated cortisol; 18 had subclinical hypothyroidism while 4 had overt hypothyroidism while 17 patients were hypogonad, all having elevated LH. In "group C" (n=50) 2 patients had hypocortisolism and 5 had elevated cortisol; 12 patients had subclinical and one had overt hypothyroidism; 7 patients had primary hypogonadism and one had secondary hypogonadism. Overall 4(2.66%) had hypocortisolism while 39 (26%) had elevated cortisol; 45 (30%) had subclinical hypothyroidism while 16(10.66%) had overt hypothyroidism. Gonadal dysfunction was observed in 50 patients (33%) majority of them (48) had primary hypogonadism. On analysis of Pearson's correlation coefficient CD4 count has strong inverse correlation with basal cortisol (r=-0.301, p<0.0001), TSH (r=-0.257, p=0.002) and LH (r=-0.228, p=0.006), while there was a direct correlation with serum testosterone (r=0.175, p=0.037).
This pilot study has demonstrated a high incidence of endocrine dysfunction in HIV infected patient in this part of country. High incidence of thyroid and gonadal dysfunction may contribute to morbidity of the patients and have a bearing on quality of life of the HIV infected patients. Hypocortisolism was not that common but high level of cortisol may be a marker of stress due to HIV per se or due to associated infection. Many of these dysfunctions might be transient and a large longitudinal study should be undertaken to substantiate the finding of the present study.
确定HIV阳性男性患者肾上腺、甲状腺和性腺功能障碍的发生率，并评估不同CD4细胞计数水平下的内分泌功能。
共纳入150例HIV阳性男性受试者。根据CD4细胞计数将患者分为三组。“A组”：CD4计数<200/mm³的HIV阳性患者；“B组”：CD4计数为200 - 350/mm³的HIV阳性患者；“C组”：CD4计数>350/mm³的HIV阳性患者。
在“A组”（n = 50）中，2例患者基础皮质醇<5μg/dl，而23例患者基础皮质醇>25μg/dl。15例患者有亚临床甲状腺功能减退，11例患者有明显甲状腺功能减退。该组25例患者有性腺功能障碍：其中大多数（24例）有原发性性腺功能障碍（LH升高）。“B组”（n = 50）中无患者有皮质醇减少症，而11例患者皮质醇升高；18例有亚临床甲状腺功能减退，4例有明显甲状腺功能减退，17例性腺功能减退，均有LH升高。在“C组”（n = 50）中，2例患者有皮质醇减少症，5例患者皮质醇升高；12例有亚临床甲状腺功能减退，1例有明显甲状腺功能减退；7例有原发性性腺功能减退，1例有继发性性腺功能减退。总体而言，4例（2.66%）有皮质醇减少症，39例（26%）皮质醇升高；45例（30%）有亚临床甲状腺功能减退，16例（10.66%）有明显甲状腺功能减退。50例患者（33%）观察到性腺功能障碍，其中大多数（48例）有原发性性腺功能减退。经Pearson相关系数分析，CD4计数与基础皮质醇（r = -0.301，p<0.0001）、促甲状腺激素（TSH，r = -0.257，p = 0.002）和LH（r = -0.228，p = 0.006）呈强负相关，而与血清睾酮呈正相关（r = 0.175，p = 0.037）。
这项初步研究表明该国该地区HIV感染患者内分泌功能障碍的发生率较高。甲状腺和性腺功能障碍的高发生率可能导致患者发病，并影响HIV感染患者的生活质量。皮质醇减少症并不常见，但高水平的皮质醇可能是HIV本身或相关感染所致应激的一个指标。这些功能障碍中的许多可能是短暂的，应进行大规模的纵向研究以证实本研究的结果。
