Chelsea and Westminster Hospital, London, UK.
HIV Med. 2013 Mar;14(3):161-6. doi: 10.1111/j.1468-1293.2012.01047.x. Epub 2012 Sep 21.
The aim of the study was to identify possible causes of pancreatic insufficiency in patients with HIV infection.
A retrospective analysis of 233 HIV-positive patients for whom faecal elastase measurement was available was performed to investigate potential associations with core demographic data, HIV infection characteristics, degree of immunosuppresion, exposure to antiretroviral therapy (ART), alcohol misuse, diabetes, hepatitis C virus (HCV) infection, triglyceride and cholesterol levels and symptomatology. The response to pancreatic enzyme replacement for patients with evidence of insufficiency was also evaluated.
Of 233 patients, 104 (45%) had evidence of pancreatic exocrine insufficiency (faecal elastase < 200 mcg/g). A positive association with exocrine pancreatic insufficiency was found for HCV infection (P = 0.007), previous or current HCV treatment (P = 0.003), alcohol misuse history (P = 0.006) and the presence of steatorrhoea (P = 0.03). There was no demonstrated association between exocrine pancreatic insufficiency and didanosine (ddI) exposure (P = 0.43) or stavudine (d4T) exposure (P = 0.62). Seventy-seven per cent of patients who were treated with pancreatic enzymatic supplementation reported a subjective improvement in symptoms.
Faecal elastase sampling should form part of the routine work-up for HIV-positive patients with chronic diarrhoea even in the absence of 'traditional' risk factors such as ddI exposure. In particular, if the patient has steatorrhoea, a history of alcohol exposure or their HCV serology is positive, they should be considered for investigation. Treatment with pancreatic enzyme supplementation appears to be effective in the treatment of chronic diarrhoea caused by pancreatic insufficiency in the majority of patients.
本研究旨在确定 HIV 感染患者胰腺功能不全的可能原因。
对 233 例 HIV 阳性患者进行回顾性分析，这些患者均进行了粪便弹性蛋白酶检测，以研究与核心人口统计学数据、HIV 感染特征、免疫抑制程度、抗逆转录病毒治疗（ART）暴露、酒精滥用、糖尿病、丙型肝炎病毒（HCV）感染、甘油三酯和胆固醇水平以及症状之间的潜在关联。还评估了胰腺酶替代治疗对有胰腺分泌不足证据的患者的反应。
在 233 例患者中，有 104 例（45%）存在胰腺外分泌功能不全（粪便弹性蛋白酶<200 mcg/g）。HCV 感染（P=0.007）、既往或当前 HCV 治疗（P=0.003）、酒精滥用史（P=0.006）和脂肪泻存在与胰腺外分泌功能不全呈正相关。胰腺外分泌功能不全与地达诺新（ddI）暴露（P=0.43）或司他夫定（d4T）暴露（P=0.62）之间无显著关联。77%接受胰腺酶补充治疗的患者报告症状主观改善。
即使在缺乏 ddI 暴露等“传统”危险因素的情况下，粪便弹性蛋白酶检测也应成为 HIV 阳性慢性腹泻患者常规检查的一部分。特别是如果患者有脂肪泻、酒精暴露史或 HCV 血清学阳性，应考虑进行检查。在大多数患者中，胰腺酶补充治疗似乎对胰腺功能不全引起的慢性腹泻有效。
