HIV 感染者中的代谢相关性脂肪性肝病与心血管代谢风险升高相关，这可通过改变的先进脂蛋白谱和靶向代谢组学来证明。
MASLD in persons with HIV is associated with high cardiometabolic risk as evidenced by altered advanced lipoprotein profiles and targeted metabolomics.
机构信息
Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, 702 Rotary Circle, Indianapolis, Indianapolis, IN, 46202, USA.
Division of Gastroenterology, Department of Medicine, Liver Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
Lipids Health Dis. 2024 Oct 17;23(1):339. doi: 10.1186/s12944-024-02317-4.
BACKGROUND
Metabolic dysfunction associated steatotic liver disease (MASLD) is associated with increased cardiovascular disease (CVD) risk in persons with HIV (PWH). The lipidomic and metabolomic alterations contributing to this risk are poorly understood. We aimed to characterize the advanced lipoprotein and targeted metabolomic profiles in PWH and assess if the presence and severity of MASLD influence these profiles.
METHODS
This is a cross-sectional analysis of a prospectively enrolled multicenter cohort. PWH without alcohol abuse or known liver disease underwent vibration-controlled transient elastography for controlled attenuation parameter (CAP) and liver stiffness measurement (LSM). Lipidomic and metabolomic profiling was undertaken with nuclear magnetic resonance (NMR) spectroscopy. Hepatic steatosis was defined as CAP ≥ 263 dB/m and clinically significant fibrosis (CSF) as LSM ≥ 8 kPa. Logistic regression models assessed associations between MASLD, CSF and lipidomic and metabolic parameters.
RESULTS
Of 190 participants (71% cisgender male, 96% on antiretroviral therapy), 58% had MASLD and 12% CSF. Mean (SD) age was 48.9 (12.1) years and body mass index (BMI) 29.9 (6.4) kg/m. Compared to PWH without MASLD (controls), PWH with MASLD had lower HDL-C but higher total triglyceride, VLDL-C, branched-chain amino acids, GlycA, trimethylamine N-oxide levels, Lipoprotein-Insulin Resistance and Diabetes Risk Indices. There were no significant differences in these parameters between participants with MASLD with or without CSF. In a multivariable regression analysis, MASLD was independently associated with changes in most of these parameters after adjustment for age, gender, race/ethnicity, type 2 diabetes mellitus, BMI, and lipid lowering medications use.
CONCLUSIONS
MASLD in PWH is independently associated with altered advanced lipoprotein and targeted metabolic profiles, indicating a higher CVD risk in this population.
背景
代谢功能障碍相关脂肪性肝病（MASLD）与 HIV 感染者（PWH）心血管疾病（CVD）风险增加相关。导致这种风险的脂质组学和代谢组学改变尚不清楚。我们旨在描述 PWH 的先进脂蛋白和靶向代谢组学特征，并评估 MASLD 的存在和严重程度是否会影响这些特征。
方法
这是一项前瞻性纳入多中心队列的横断面分析。无酒精滥用或已知肝病的 PWH 接受振动控制瞬态弹性成像，以测量受控衰减参数（CAP）和肝硬度测量值（LSM）。采用核磁共振（NMR）光谱法进行脂质组学和代谢组学分析。肝脂肪变性定义为 CAP≥263dB/m，临床显著纤维化（CSF）定义为 LSM≥8kPa。Logistic 回归模型评估 MASLD、CSF 与脂质组学和代谢参数之间的关系。
结果
190 名参与者（71%为跨性别男性，96%接受抗逆转录病毒治疗）中，58%有 MASLD，12%有 CSF。平均（标准差）年龄为 48.9（12.1）岁，体重指数（BMI）为 29.9（6.4）kg/m。与无 MASLD（对照组）的 PWH 相比，有 MASLD 的 PWH 的 HDL-C 较低，但总甘油三酯、VLDL-C、支链氨基酸、GlycA、三甲胺 N-氧化物水平、脂蛋白胰岛素抵抗和糖尿病风险指数较高。MASLD 伴或不伴 CSF 的参与者之间，这些参数无显著差异。多变量回归分析显示，在调整年龄、性别、种族/民族、2 型糖尿病、BMI 和降脂药物使用后，MASLD 与这些参数的变化独立相关。
结论
PWH 中的 MASLD 与改变的先进脂蛋白和靶向代谢特征独立相关，表明该人群的 CVD 风险更高。
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