美国 PHACS SMARTT 研究中肥胖 HIV 未感染者和 NHANES 研究中 HIV 未感染者的代谢结局比较。
A Comparison of Metabolic Outcomes Between Obese HIV-Exposed Uninfected Youth From the PHACS SMARTT Study and HIV-Unexposed Youth From the NHANES Study in the United States.
机构信息
Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA.
出版信息
J Acquir Immune Defic Syndr. 2019 Jul 1;81(3):319-327. doi: 10.1097/QAI.0000000000002018.
BACKGROUND
Metabolic perturbations in HIV-exposed uninfected (HEU) obese youth may differ from those in the general obese pediatric population.
METHODS
Metabolic parameters of obese (body mass index Z-score >95th percentile) HEU youth in the Pediatric HIV/AIDS Cohort Study (PHACS) Surveillance Monitoring of ART Toxicities (SMARTT) study were compared with a matched sample of obese youth from the US National Health and Nutrition Examination Survey (NHANES). We evaluated systolic and diastolic hypertension (blood pressure ≥90th percentile for age, sex, and height), total cholesterol >200 mg/dL, high-density lipoprotein cholesterol <35 mg/dL, low-density lipoprotein cholesterol >130 mg/dL, triglycerides (TGs) >150 mg/dL, and Homeostatic Model Assessment-Insulin Resistance >4.0. Modified Poisson regression models were fit to quantify the prevalence ratio (PR) of each outcome comparing the 2 cohorts, adjusting for confounders.
RESULTS
The blood pressure outcome analytic subgroup included 1096 participants (n = 304 HEU), the total cholesterol and high-density lipoprotein cholesterol subgroup 1301 participants (n = 385 HEU), and the low-density lipoprotein cholesterol, TG, and Homeostatic Model Assessment-Insulin Resistance subgroup 271 (n = 83 HEU). After adjustment, obese HEU youth had a higher prevalence of systolic and diastolic hypertension [PR = 3.34, 95% confidence interval (CI): 2.48 to 4.50; PR = 2.04, 95% CI: 1.18 to 3.52, respectively], but lower prevalence of insulin resistance (PR = 0.67, 95% CI: 0.54 to 0.85) and hypercholesterolemia (PR = 0.67, 95% CI: 0.44 to 1.01) compared with obese NHANES youth.
CONCLUSIONS
In the United States, obese HEU youth seem to have an increased risk of hypertension, but lower risk of insulin resistance and hypercholesterolemia, compared with a general obese pediatric population. Monitoring for cardiovascular morbidity in adulthood may be warranted in HEU children.
背景
HIV 暴露未感染（HEU）肥胖青少年的代谢紊乱可能与一般肥胖儿科人群不同。
方法
对儿科艾滋病毒/艾滋病队列研究（PHACS）监测抗逆转录病毒毒性（SMARTT）研究中肥胖（体重指数 Z 评分>95 百分位）HEU 青少年的代谢参数与来自美国国家健康和营养检查调查（NHANES）的肥胖青少年的匹配样本进行比较。我们评估了收缩压和舒张压高血压（血压≥年龄、性别和身高的 90 百分位）、总胆固醇>200mg/dL、高密度脂蛋白胆固醇<35mg/dL、低密度脂蛋白胆固醇>130mg/dL、甘油三酯（TGs）>150mg/dL 和稳态模型评估-胰岛素抵抗>4.0。使用修正泊松回归模型来量化比较两组的每个结果的患病率比（PR），调整混杂因素。
结果
血压结果分析亚组包括 1096 名参与者（n=304 HEU）、总胆固醇和高密度脂蛋白胆固醇亚组包括 1301 名参与者（n=385 HEU），以及低密度脂蛋白胆固醇、TG 和稳态模型评估-胰岛素抵抗亚组包括 271 名参与者（n=83 HEU）。调整后，肥胖的 HEU 青少年患有收缩压和舒张压高血压的患病率更高[PR=3.34，95%置信区间（CI）：2.48 至 4.50；PR=2.04，95%CI：1.18 至 3.52]，但胰岛素抵抗的患病率较低（PR=0.67，95%CI：0.54 至 0.85）和高胆固醇血症（PR=0.67，95%CI：0.44 至 1.01）与肥胖的 NHANES 青少年相比。
结论
在美国，与一般肥胖儿科人群相比，肥胖的 HEU 青少年似乎患高血压的风险增加，但患胰岛素抵抗和高胆固醇血症的风险较低。在 HEU 儿童中，可能需要监测成年后的心血管发病率。
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