Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India.
Endocr Pract. 2012 Mar-Apr;18(2):158-69. doi: 10.4158/EP11139.OR.
To develop an objective definition of human immunodeficiency virus (HIV)-associated lipodystrophy by using regional fat mass ratios and to assess the utility of anthropometric and skinfold measurements in the initial screening for lipodystrophy.
Male patients between 25 and 50 years old with proven HIV infection (highly active antiretroviral therapy [HAART]-naïve subjects and those receiving successful HAART) were studied and compared with body mass index (BMI)-matched HIV-negative control subjects. Anthropometric variables, body composition, dual-energy x-ray absorptiometry findings, and metabolic variables were compared among the 3 study groups and between those patients with and those without lipodystrophy.
Trunk fat/lower limb fat mass ratio >2.28 identified 54.3% of patients with HIV receiving HAART as having lipodystrophy and had the highest odds ratio for predicting metabolic syndrome. The "clinical diagnosis of lipodystrophy" and the "clinical scoring system" had too many false-positive and false-negative results. Triceps skinfold thickness (SFT)/BMI ratio ≤0.49 and abdominal SFT/triceps SFT ratio >1.385 have good sensitivity but poor specificity in identifying lipodystrophy. In comparison with HAART-naïve patients with HIV, those receiving HAART had significantly higher insulin resistance, and a significantly greater proportion had impaired glucose tolerance and dyslipidemia. Among patients receiving HAART, those with lipodystrophy had a greater degree of insulin resistance, higher triglyceride levels, and lower levels of high-density lipoprotein cholesterol.
The trunk fat/lower limb fat mass ratio in BMI-matched normal subjects can be used to derive cutoff values to define lipodystrophy objectively in HIV-infected patients. Defining lipodystrophy in this way is better than other methods of identifying those patients with increased cardiovascular risk. Triceps SFT/BMI and abdominal SFT/triceps SFT ratios may be useful as screening tools in resource-poor settings.
通过使用区域性脂肪质量比来对人类免疫缺陷病毒（HIV）相关脂肪营养不良进行客观定义，并评估人体测量和皮褶测量在脂肪营养不良初步筛查中的作用。
研究了年龄在 25 至 50 岁之间的、已确诊的 HIV 感染男性患者（初治高效抗逆转录病毒治疗[HAART]患者和接受成功 HAART 治疗的患者），并将他们与体重指数（BMI）匹配的 HIV 阴性对照者进行了比较。比较了 3 个研究组之间以及存在和不存在脂肪营养不良的患者之间的人体测量变量、身体成分、双能 X 射线吸收仪检测结果和代谢变量。
躯干脂肪/下肢脂肪质量比＞2.28 可识别出 54.3%接受 HAART 的 HIV 患者存在脂肪营养不良，且对预测代谢综合征的比值比最高。“脂肪营养不良的临床诊断”和“临床评分系统”存在太多的假阳性和假阴性结果。三头肌皮褶厚度（SFT）/BMI 比≤0.49 和腹部 SFT/三头肌 SFT 比＞1.385 可很好地识别出脂肪营养不良，但特异性较差。与初治 HIV 患者相比，接受 HAART 的患者胰岛素抵抗更明显，糖耐量受损和血脂异常的比例更高。在接受 HAART 的患者中，脂肪营养不良患者的胰岛素抵抗程度更大，甘油三酯水平更高，高密度脂蛋白胆固醇水平更低。
BMI 匹配的正常受试者的躯干脂肪/下肢脂肪质量比可用于推导出界定 HIV 感染者脂肪营养不良的截断值，这种定义方法比其他识别具有更高心血管风险患者的方法更好。三头肌 SFT/BMI 和腹部 SFT/三头肌 SFT 比值可能是资源匮乏环境中有用的筛查工具。
