Benhamou Y, Hilmarsdottir I, Desportes-Livage I, Hoang C, Datry A, Danis M, Gentilini M, Opolon P
Département des Maladies Infectieuses, Parasitaires, Tropicales et de Santé Publique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Dig Dis Sci. 1994 Oct;39(10):2163-9. doi: 10.1007/BF02090366.
Lipid accumulation has been described in the duodenal lamina propria of human immunodeficiency virus (HIV)-infected patients with diarrhea and malabsorption. Using light and electron microscopy, we studied duodenal biopsies obtained from 54 consecutive HIV-infected patients by means of upper gastrointestinal endoscopy after an overnight fast. The presence of diarrhea and weight loss were recorded, and all the patients had standard stool study for ova, parasites, and bacteria. Serum levels of albumin, triglycerides, and cholesterol were obtained within one week of the endoscopy. Fecal fat and fecal alpha 1-antitrypsin clearance were measured in 11 patients. Lipid accumulation was observed in nine patients (16.6%). Fat droplets were seen in enterocytes, in their basolateral membrane spaces, and in the lamina propria. The mean serum levels of triglycerides (1.85 +/- 0.20 mmol/liter) and cholesterol (2.81 +/- 0.30 mmol/liter) were significantly lower in the patients with enteric steatosis than in patients without this anomaly (respectively, 3.38 +/- 0.39 and 3.97 +/- 0.18 mmol/liter, P < 0.001 P < 0.01). The mean amount of fecal fat in the three patients with lipid accumulation (16 +/- 1.60 g/24 hr) was significantly larger than in the eight patients without lipid accumulation (4.50 +/- 0.62 g/24 hr, P < 0.01). These findings suggest that fat malabsorption in HIV-infected individuals is due to a blockage of transport through the duodenal mucosa. The frequency of diarrhea, weight loss, or identified enteric pathogens did not differ significantly between patients with and without enteric steatosis. Both the etiology and the pathophysiology of these alterations remain to be documented.
脂质蓄积已在患有腹泻和吸收不良的人类免疫缺陷病毒（HIV）感染患者的十二指肠固有层中被描述。我们使用光学显微镜和电子显微镜，对54例连续的HIV感染患者在禁食过夜后通过上消化道内镜检查获取的十二指肠活检标本进行了研究。记录腹泻和体重减轻的情况，并且所有患者都进行了常规粪便检查以查找虫卵、寄生虫和细菌。在内镜检查后一周内获取血清白蛋白、甘油三酯和胆固醇水平。对11例患者测量了粪便脂肪和粪便α1-抗胰蛋白酶清除率。在9例患者（16.6%）中观察到脂质蓄积。在肠上皮细胞、其基底外侧膜间隙和固有层中可见脂肪滴。有肠道脂肪变性的患者的甘油三酯平均血清水平（1.85±0.20 mmol/升）和胆固醇平均血清水平（2.81±0.30 mmol/升）显著低于无此异常的患者（分别为3.38±0.39和3.97±0.18 mmol/升，P<0.001，P<0.01）。3例有脂质蓄积的患者的粪便脂肪平均量（16±1.60 g/24小时）显著高于8例无脂质蓄积的患者（4.50±0.62 g/24小时，P<0.01）。这些发现提示，HIV感染个体的脂肪吸收不良是由于通过十二指肠黏膜的转运受阻。有和无肠道脂肪变性的患者之间腹泻、体重减轻或已确定的肠道病原体的频率没有显著差异。这些改变的病因和病理生理学仍有待证实。
