HIV 感染对 2 型糖尿病患者血糖和肾功能的影响。
The effect of HIV infection on glycaemia and renal function in type 2 diabetic patients.
机构信息
Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa.
Department of Internal Medicine, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
出版信息
PLoS One. 2018 Jun 28;13(6):e0199946. doi: 10.1371/journal.pone.0199946. eCollection 2018.
BACKGROUND
Infection with, and treatment of HIV is associated with effects on glycaemia and renal function. The purpose of this study was therefore to compare glycaemic control and albuminuria in HIV-positive and HIV-negative type 2 diabetic patients.
MATERIALS AND METHODS
Diabetic patients with and without HIV infection were recruited from a diabetic clinic at Chris Hani Baragwanath Hospital in Soweto, South Africa. Data was collected on weight, height, HbA1c, fasting glucose, urine albumin:creatinine ratio, HIV status, CD4 counts, viral load and concomitant therapies. Multivariable regression analysis was used to isolate the determinants of fasting glucose and HbA1c levels and risk factors for albuminuria.
RESULTS
Data were collected from 106 HIV-positive and 214 HIV-negative diabetics. All HIV infected subjects were receiving anti-retroviral therapy. The determinants of fasting glucose levels (log) were HIV infection (β = 0.04, p = 0.01) and use of anti-hypertensive agents (β = 0.07, p = 0.0006), whilst for HbA1c levels (log) they were HIV infection (β = -0.03, p = 0.03), BMI (β = 0.004, p = 0.0005), statin use (β = 0.04, p = 0.002) and glucose levels (β = 0.01, p<0.0005). In HIV-positive subjects, CD4 counts were negatively associated with glucose levels (β = -0.0002, p = 0.03). The risk factors for albuminuria were (odds ratio [95% CIs]) dyslipidaemia (1.94 [1.09, 3.44], p = 0.02) and HbA1c levels (1.24 [1.12, 1.38], p<0.0001).
DISCUSSION
These data suggest that glycaemic control is worse in type 2 diabetic subjects with HIV infection and that HbA1c underestimates glycaemia in these patients. Albuminuria was not associated with HIV-positivity. The negative relationship of CD4 counts with glucose levels may reflect viral removal and easing of the associated inflammatory response. It is possible that the association of statin and anti-hypertensive therapies with high HbA1c and glucose levels, respectively, is due to such therapies being given largely to subjects with poor glycaemic control.
背景
感染 HIV 以及针对 HIV 的治疗会影响血糖和肾功能。因此，本研究旨在比较 HIV 阳性和 HIV 阴性 2 型糖尿病患者的血糖控制和蛋白尿情况。
材料与方法
本研究在南非索韦托的克里斯·哈尼·巴哈加瓦纳医院的糖尿病诊所招募了感染 HIV 和未感染 HIV 的糖尿病患者。收集的资料包括体重、身高、糖化血红蛋白（HbA1c）、空腹血糖、尿白蛋白/肌酐比值、HIV 状态、CD4 计数、病毒载量和伴随治疗。多变量回归分析用于分离空腹血糖和 HbA1c 水平的决定因素以及蛋白尿的危险因素。
结果
共收集了 106 例 HIV 阳性和 214 例 HIV 阴性糖尿病患者的数据。所有 HIV 感染患者均接受抗逆转录病毒治疗。空腹血糖水平（log）的决定因素为 HIV 感染（β = 0.04，p = 0.01）和抗高血压药物的使用（β = 0.07，p = 0.0006），而 HbA1c 水平（log）的决定因素为 HIV 感染（β = -0.03，p = 0.03）、BMI（β = 0.004，p = 0.0005）、他汀类药物的使用（β = 0.04，p = 0.002）和血糖水平（β = 0.01，p<0.0005）。在 HIV 阳性患者中，CD4 计数与血糖水平呈负相关（β = -0.0002，p = 0.03）。蛋白尿的危险因素为血脂异常（1.94 [1.09, 3.44]，p = 0.02）和 HbA1c 水平（1.24 [1.12, 1.38]，p<0.0001）。
讨论
这些数据表明，2 型糖尿病合并 HIV 感染患者的血糖控制更差，且 HbA1c 会低估这些患者的血糖水平。蛋白尿与 HIV 阳性无关。CD4 计数与血糖水平呈负相关可能反映了病毒的清除和相关炎症反应的缓解。他汀类药物和抗高血压治疗与 HbA1c 和血糖水平呈正相关，这可能是由于这些治疗主要用于血糖控制不佳的患者。
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