性别特异性脂肪质量比截断值可识别出 HIV 感染者中心血管代谢疾病的高发率。

Sex-specific fat mass ratio cutoff value identifies a high prevalence of cardio-metabolic disorders in people living with HIV.

机构信息

Division of Endocrinology, Diabetology and Metabolic Diseases, Department of General and Specialty Medicine, Molinette Hospital, University of Turin - Cso Dogliotti, 14-10126, Turin, Italy.

出版信息

Nutr Metab Cardiovasc Dis. 2022 Aug;32(8):1936-1943. doi: 10.1016/j.numecd.2022.05.004. Epub 2022 May 17.

DOI:10.1016/j.numecd.2022.05.004

PMID:35680489

Abstract

BACKGROUND AND AIMS

HIV-associated lipodystrophy syndrome (HALS) contributes to the increased cardiovascular risk connoting people living with HIV (PLHIV). HALS recognition, based on clinical ground, may be inaccurate urging an objective instrumental diagnosis. The aim of this study is to search for the DXA-derived fat mass ratio (FMR) threshold, among those suggested for the diagnosis of HALS, able to identify PLHIV at high cardiovascular risk.

METHODS AND RESULTS

In a cross-sectional analysis of 101 PLHIV (age 53 ± 11 years, men 55%) and 101 age- and sex-matched uninfected controls, DXA-derived FMR and anthropometric as well as cardio-metabolic parameters were assessed. PLHIV showed a higher FMR (1.15 ± 0.42 vs 0.95 ± 0.18, p < 0.01) together with a greater cardio-metabolic derangement than controls, in spite of lower BMI (24.3 ± 4.3 vs 26.9 ± 4.0 kg/m, p < 0.01) and fat mass index (FMI, 6.6 ± 3.0 vs 9.2 ± 3.1 kg/m, p < 0.01). Particularly, PLHIV with HALS (n = 28), defined as those with a FMR above 1.260 and 1.329 for men and women, respectively, had a greater prevalence of type 2 diabetes mellitus (18% vs 1%), insulin resistance (68% vs 27%), hypertriglyceridemia (50% vs 29%), hypertension (61% vs 30%) and metabolic syndrome (32% vs 10%) than those without HALS (p < 0.05 for all comparisons) and controls. At multivariate analyses, FMR in PLHIV was significantly associated (p < 0.05) with fasting glucose (β [95%CI] = 0.5, [0.1-0.9]), insulin (44.6, [14.9-74.2]), HOMA-IR (1.6, [0.5-2.7]), triglycerides (1.0, [ 0.2-1.8]) and HDL-cholesterol (-2.1, [-3.9/-0.4]) levels.

CONCLUSION

Sex-specific FMR thresholds, proposed for diagnosis of HALS, could represent new indices of cardio-metabolic derangement in PLHIV.

摘要

背景与目的

HIV 相关脂肪营养不良综合征（HALS）增加了 HIV 感染者（PLHIV）的心血管风险。基于临床的 HALS 识别可能不准确，因此需要客观的仪器诊断。本研究旨在寻找 DXA 衍生的脂肪质量比（FMR）阈值，用于诊断 HALS，以识别具有高心血管风险的 PLHIV。

方法与结果

本横断面分析纳入了 101 名 PLHIV（年龄 53±11 岁，男性占 55%）和 101 名年龄和性别匹配的未感染对照者，评估了 DXA 衍生的 FMR 以及人体测量学和心血管代谢参数。PLHIV 的 FMR 更高（1.15±0.42 比 0.95±0.18，p<0.01），且心血管代谢紊乱比对照组更严重，尽管 BMI（24.3±4.3 比 26.9±4.0 kg/m，p<0.01）和脂肪质量指数（FMI，6.6±3.0 比 9.2±3.1 kg/m，p<0.01）较低。特别是，HALS 组（n=28）定义为 FMR 男性大于 1.260，女性大于 1.329，其 2 型糖尿病患病率（18%比 1%）、胰岛素抵抗（68%比 27%）、高甘油三酯血症（50%比 29%）、高血压（61%比 30%）和代谢综合征（32%比 10%）的发生率均高于无 HALS 组（所有比较均 p<0.05）和对照组。多元分析显示，PLHIV 的 FMR 与空腹血糖（β[95%CI]：0.5，[0.1-0.9]）、胰岛素（44.6，[14.9-74.2]）、HOMA-IR（1.6，[0.5-2.7]）、甘油三酯（1.0，[0.2-1.8]）和高密度脂蛋白胆固醇（-2.1，[-3.9/-0.4]）水平显著相关（p<0.05）。