Cade W Todd, Reeds Dominic N, Overton E Turner, Herrero Pilar, Waggoner Alan D, Laciny Erin, Bopp Coco, Lassa-Claxton Sherry, Gropler Robert J, Peterson Linda R, Yarasheski Kevin E
Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri.
Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, Missouri.
HIV Clin Trials. 2013 Nov-Dec;14(6):303-12. doi: 10.1310/hct1406-303.
Individuals with HIV infection and peripheral metabolic complications have impaired basal myocardial insulin sensitivity that is related to left ventricular (LV) diastolic dysfunction. It is unknown whether interventions shown to be effective in improving peripheral insulin sensitivity can improve basal myocardial insulin sensitivity and diastolic function in people with HIV and peripheral metabolic complications.
In a pilot study, we evaluated whether the peroxisome proliferator-activated receptor-gamma (PPAR-γ) agonist pioglitazone or combined endurance and resistance exercise training improves basal myocardial insulin sensitivity and diastolic function in HIV+ adults with peripheral metabolic complications.
Twenty-four HIV+ adults with metabolic complications including peripheral insulin resistance were randomly assigned to 4 months of pioglitazone (PIO; 30 mg/d) or supervised, progressive endurance and resistance exercise training (EXS; 90-120 min/d, 3 d/wk). Basal myocardial substrate metabolism was quantified by radioisotope tracer methodology and positron emission tomography (PET) imaging, and LV function was measured by echocardiography.
Twenty participants completed the study. Neither PIO nor EXS resulted in a detectable improvement in basal myocardial insulin sensitivity or diastolic function. Post hoc analyses revealed sample sizes of more than 100 participants are needed to detect significant effects of these interventions on basal myocardial insulin sensitivity and function.
PIO or EXS alone did not significantly increase basal myocardial insulin sensitivity or LV diastolic function in HIV+ individuals with peripheral metabolic complications.
感染人类免疫缺陷病毒（HIV）且伴有外周代谢并发症的个体，其基础心肌胰岛素敏感性受损，这与左心室（LV）舒张功能障碍有关。目前尚不清楚，已证明对改善外周胰岛素敏感性有效的干预措施，是否能改善HIV感染者及外周代谢并发症患者的基础心肌胰岛素敏感性和舒张功能。
在一项初步研究中，我们评估了过氧化物酶体增殖物激活受体γ（PPAR-γ）激动剂吡格列酮，或耐力与抗阻运动联合训练，是否能改善合并外周代谢并发症的HIV阳性成年人的基础心肌胰岛素敏感性和舒张功能。
24名合并包括外周胰岛素抵抗在内的代谢并发症的HIV阳性成年人，被随机分配接受4个月的吡格列酮治疗（PIO；30毫克/天），或接受有监督的渐进性耐力和抗阻运动训练（EXS；90 - 120分钟/天，每周3天）。通过放射性同位素示踪法和正电子发射断层扫描（PET）成像对基础心肌底物代谢进行定量，并通过超声心动图测量左心室功能。
20名参与者完成了研究。PIO和EXS均未使基础心肌胰岛素敏感性或舒张功能得到可检测到的改善。事后分析显示，需要超过100名参与者的样本量，才能检测到这些干预措施对基础心肌胰岛素敏感性和功能的显著影响。
单独使用PIO或EXS，并未显著提高合并外周代谢并发症的HIV感染者的基础心肌胰岛素敏感性或左心室舒张功能。
