感染艾滋病毒的儿童和青少年中的代谢综合征

Metabolic Syndrome in Children and Adolescents Living with HIV.

作者信息

Espiau María, Yeste Diego, Noguera-Julian Antoni, González-Tomé María I, Falcón-Neyra Lola, Gavilán César, Navarro-Gómez María L, Mellado-Peña María J, Gracia-Casanova Mercedes, Colino-Gil María E, Méndez Maria, Ciria Calavia Luis M, Fortuny Clàudia, Carrascosa Antonio, Soler-Palacín Pere

机构信息

From the *Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron-Universitat Autònoma de Barcelona, Barcelona, Spain; †Pediatric Endocrinology Unit, Department of Pediatrics, Hospital Universitari Vall d'Hebron-Universitat Autònoma de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain; ‡Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu-Universitat de Barcelona, Barcelona, Spain; §Pediatric Infectious Diseases and HIV Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; ¶Department of Pediatric Infectious Diseases and Immunology, Hospital Universitario Virgen del Rocío, Sevilla, Spain; ‖Department of Pediatrics, Hospital Universitari Sant Joan d'Alacant, Alicante, Spain; **Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain; ††Infectious and Tropical Diseases Unit, Department of Pediatrics, Hospital Universitario Infantil La Paz-Hospital Carlos III, Madrid, Spain; ‡‡Infectious Diseases Unit, Department of Pediatrics, Hospital Clínico de Zaragoza, Zaragoza, Spain; §§Pediatric Infectious Diseases and HIV Unit, Complejo Hospitalario Insular Materno-Infantil de las Palmas de Gran Canaria, Las Palmas, Spain; ¶¶Infectious Diseases Unit, Department of Pediatrics, Hospital Germans Trias i Pujol, Barcelona, Spain; and ‖‖Infectious Diseases Unit, Department of Pediatrics, Hospital Infantil Universitario Miguel Servet, Zaragoza, Spain.

出版信息

Pediatr Infect Dis J. 2016 Jun;35(6):e171-6. doi: 10.1097/INF.0000000000001118.

DOI:10.1097/INF.0000000000001118

PMID:26910591

Abstract

BACKGROUND

Metabolic syndrome (MetS) is considered an independent risk factor for developing cardiovascular disease. It is well known that the prevalence of metabolic disorders have increased in pediatric HIV-infected children. The objective of this study is to assess the prevalence and characteristics of MetS in HIV-infected children and adolescents in Spain.

METHODS

A cross-sectional multicenter study in 152 patients from the pediatric cohort of the Spanish AIDS Research Network (CoRISpe) was performed. MetS was defined according to the new International Diabetes Federation (IDF) diagnostic criteria and the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Measurements included anthropometry, waist circumference, blood pressure, fasting lipids, glucose and insulin and lipodystrophy assessment. Demographic, clinical, immunological, virological and antiretroviral therapy data were obtained from the Network database.

RESULTS

An abnormally low high-density lipoprotein-cholesterol level was the most prevalent disturbance (21.05%) found. Three patients met IDF criteria for MetS (1.97%), and MetS was significantly associated with lipohypertrophy (P=0.029) in the analysis. When the modified NCEP-ATP III criteria were used, the prevalence of MetS was 5.92% (9 patients), and MetS was significantly associated with Tanner stage ≥2 (P=0.041), lipohypertrophy (P=0.001) and higher Z scores for weight and body mass index (P=0.002 and P<0.001). Insulin resistance was observed in 17 patients (11.18%) and was associated with MetS (as per the modified NCEP-ATP III criteria) (P=0.03) and lower high-density lipoprotein-cholesterol values (P=0.036).

CONCLUSIONS

The prevalence of MetS in our cohort was 1.97% or 5.92%, depending on the diagnostic criteria used. MetS should be actively assessed, particularly in children who show lipohypertrophy.

摘要

背景

代谢综合征（MetS）被认为是心血管疾病发生的独立危险因素。众所周知，儿科感染艾滋病毒的儿童中代谢紊乱的患病率有所增加。本研究的目的是评估西班牙感染艾滋病毒的儿童和青少年中代谢综合征的患病率及特征。

方法

对西班牙艾滋病研究网络（CoRISpe）儿科队列中的152例患者进行了一项横断面多中心研究。代谢综合征根据新的国际糖尿病联盟（IDF）诊断标准和修订后的美国国家胆固醇教育计划成人治疗小组第三次报告（NCEP-ATP III）标准进行定义。测量包括人体测量学、腰围、血压、空腹血脂、血糖、胰岛素及脂肪营养不良评估。人口统计学、临床、免疫学、病毒学及抗逆转录病毒治疗数据均从该网络数据库中获取。

结果

发现异常低的高密度脂蛋白胆固醇水平是最常见的紊乱情况（21.05%）。3例患者符合代谢综合征的IDF标准（1.97%），分析显示代谢综合征与脂肪增生显著相关（P = 0.029）。使用修订后的NCEP-ATP III标准时，代谢综合征的患病率为5.92%（9例患者），且代谢综合征与坦纳分期≥2期（P = 0.041）、脂肪增生（P = 0.001）以及更高的体重和体重指数Z评分显著相关（P = 0.002和P < 0.001）。17例患者（11.18%）存在胰岛素抵抗，且与代谢综合征（根据修订后的NCEP-ATP III标准）相关（P = 0.03）以及更低的高密度脂蛋白胆固醇值相关（P = 0.036）。