Barton Julia H, Ireland Alex, Fitzpatrick Meghan, Kessinger Cathy, Camp Danielle, Weinman Renee, McMahon Deborah, Leader Joseph K, Holguin Fernando, Wenzel Sally E, Morris Alison, Gingo Matthew R
Department of Medicine, University of Pittsburgh, Pittsburgh, USA.
Department of Pediatrics, University of Pittsburgh, Pittsburgh, USA.
BMC Pulm Med. 2016 Aug 4;16(1):111. doi: 10.1186/s12890-016-0274-5.
Airflow obstruction, which encompasses several phenotypes, is common among HIV-infected individuals. Obesity and adipose-related inflammation are associated with both COPD (fixed airflow obstruction) and asthma (reversible airflow obstruction) in HIV-uninfected persons, but the relationship to airway inflammation and airflow obstruction in HIV-infected persons is unknown. The objective of this study was to determine if adiposity and adipose-associated inflammation are associated with airway obstruction phenotypes in HIV-infected persons.
We performed a cross-sectional analysis of 121 HIV-infected individuals assessed with pulmonary function testing, chest CT scans for measures of airway wall thickness (wall area percent [WA%]) and adipose tissue volumes (mediastinal and subcutaneous), as well as HIV- and adipose-related inflammatory markers. Participants were defined as COPD phenotype (post-bronchodilator FEV1/FVC < lower limit of normal) or asthma phenotype (doctor-diagnosed asthma or bronchodilator response). Pearson correlation coefficients were calculated between adipose measurements, WA%, and pulmonary function. Multivariable logistic and linear regression models were used to determine associations of airflow obstruction and airway remodeling (WA%) with adipose measurements and participant characteristics.
Twenty-three (19 %) participants were classified as the COPD phenotype and 33 (27 %) were classified as the asthma phenotype. Body mass index (BMI) was similar between those with and without COPD, but higher in those with asthma compared to those without (mean [SD] 30.7 kg/m(2) [8.1] vs. 26.5 kg/m(2) [5.3], p = 0.008). WA% correlated with greater BMI (r = 0.55, p < 0.001) and volume of adipose tissue (subcutaneous, r = 0.40; p < 0.001; mediastinal, r = 0.25; p = 0.005). Multivariable regression found the COPD phenotype associated with greater age and pack-years smoking; the asthma phenotype with younger age, female gender, smoking history, and lower adiponectin levels; and greater WA% with greater BMI, younger age, higher soluble CD163, and higher CD4 counts.
Adiposity and adipose-related inflammation are associated with an asthma phenotype, but not a COPD phenotype, of obstructive lung disease in HIV-infected persons. Airway wall thickness is associated with adiposity and inflammation. Adipose-related inflammation may play a role in HIV-associated asthma.
气流阻塞包含多种表型，在HIV感染者中很常见。肥胖和脂肪相关炎症在未感染HIV的人群中与慢性阻塞性肺疾病（固定性气流阻塞）和哮喘（可逆性气流阻塞）均有关联，但在HIV感染者中与气道炎症和气流阻塞的关系尚不清楚。本研究的目的是确定肥胖和脂肪相关炎症是否与HIV感染者的气道阻塞表型有关。
我们对121名HIV感染者进行了横断面分析，这些感染者接受了肺功能测试、胸部CT扫描以测量气道壁厚度（壁面积百分比[WA%]）和脂肪组织体积（纵隔和皮下），以及HIV和脂肪相关炎症标志物检测。参与者被定义为慢性阻塞性肺疾病表型（支气管扩张剂后FEV1/FVC低于正常下限）或哮喘表型（医生诊断的哮喘或支气管扩张剂反应）。计算脂肪测量值、WA%和肺功能之间的Pearson相关系数。使用多变量逻辑回归和线性回归模型来确定气流阻塞和气道重塑（WA%）与脂肪测量值和参与者特征之间的关联。
23名（19%）参与者被归类为慢性阻塞性肺疾病表型，33名（27%）被归类为哮喘表型。慢性阻塞性肺疾病患者和非慢性阻塞性肺疾病患者的体重指数（BMI）相似，但哮喘患者的BMI高于非哮喘患者（平均值[标准差]30.7kg/m²[8.1]对26.5kg/m²[5.3]，p = 0.008）。WA%与更高的BMI（r = 0.55，p < 0.001）和脂肪组织体积相关（皮下，r = 0.40；p < 0.001；纵隔，r = 0.25；p = 0.005）。多变量回归发现慢性阻塞性肺疾病表型与年龄较大和吸烟包年数较多有关；哮喘表型与年龄较小、女性、吸烟史和脂联素水平较低有关；更高的WA%与更高的BMI、年龄较小、更高的可溶性CD163和更高的CD4计数有关。
肥胖和脂肪相关炎症与HIV感染者阻塞性肺疾病的哮喘表型有关，但与慢性阻塞性肺疾病表型无关。气道壁厚度与肥胖和炎症有关。脂肪相关炎症可能在HIV相关哮喘中起作用。
