Okada Sadanori, Konishi Mitsuru, Ishii Hitoshi
Department of Diabetology, Nara Medical University, Kashihara, Nara, Japan.
Center for Health Control, Nara Medical University, Kashihara, Nara, Japan.
BMJ Case Rep. 2016 Feb 25;2016:bcr2015213637. doi: 10.1136/bcr-2015-213637.
Highly active antiretroviral therapy (HAART) is associated with multiple metabolic disorders, including lipodystrophy, dyslipidaemia and insulin resistance. HIV/HAART-associated lipodystrophy syndrome (HALS) is characterised by subcutaneous fat wasting, central fat accumulation and increased risk of diabetes. Thiazolidinediones are considered a promising treatment for HALS, because they improve insulin sensitivity and increase subcutaneous fat mass. In previous studies, pioglitazone increased overall fat mass in patients with HALS but whether fat distribution changes remains unclear. We describe a HALS patient with diabetes treated with pioglitazone. Prior to pioglitazone therapy, he had hollowed cheeks, loss of fat in the extremities and abdominal obesity. 18 months after starting pioglitazone and switching his HAART regimens, T1-weighted MRI showed obvious increases in the subcutaneous fat mass of the neck and upper trunk, but no changes in the cheeks and extremities. Pioglitazone therapy for HALS could increase subcutaneous fat mass in non-lipoatrophic but not in lipoatrophic regions.
高效抗逆转录病毒疗法（HAART）与多种代谢紊乱有关，包括脂肪代谢障碍、血脂异常和胰岛素抵抗。HIV/HAART相关脂肪代谢障碍综合征（HALS）的特征是皮下脂肪消耗、中心性脂肪堆积以及糖尿病风险增加。噻唑烷二酮类药物被认为是治疗HALS的一种有前景的药物，因为它们能改善胰岛素敏感性并增加皮下脂肪量。在先前的研究中，吡格列酮增加了HALS患者的总体脂肪量，但脂肪分布是否改变仍不清楚。我们描述了一名接受吡格列酮治疗的糖尿病HALS患者。在吡格列酮治疗前，他脸颊凹陷、四肢脂肪减少且腹部肥胖。开始使用吡格列酮并更换其HAART方案18个月后，T1加权磁共振成像显示颈部和上躯干的皮下脂肪量明显增加，但脸颊和四肢没有变化。吡格列酮治疗HALS可增加非脂肪萎缩区域的皮下脂肪量，但对脂肪萎缩区域无效。
