中国成人HIV相关脂肪营养不良综合征55例研究

A study of HIV-related lipodystrophy syndrome in 55 HIV-infected Chinese adult patients

目的了解中国部分HIV／AIDS患者在高效抗逆转录病毒治疗（HAART）后HIV相关脂肪营养不良综合征（HIV—LD）的临床特点和危险因素。方法收集2007年3—5月期间在我院门诊随诊的成年HIV／AIDS患者55例，根据患者报告和医师评估结果，将上述患者分成HIV-LD组与非脂肪营养不良综合征（HIV—NLD）组。对两组HIV／AIDS患者进行全身双能X射线扫描（DEXA），并比较两组间临床特点、治疗过程及实验室检查指标的差异，分析发生HIV—LD的可能危险因素。结果55例HIV／AIDS患者中，脂肪异常分布发生率为47．3％。多因素分析结果显示，HAART暴露2年以上、司他夫定（d4T）暴露1年以上与HIV—LD的发生独立相关。DEXA结果显示，HIV／AIDS患者脂肪异常分布主要表现为外周脂肪萎缩。结论脂肪异常分布在接受HAART的AIDS患者中有较高发生率，表现为外周脂肪萎缩。HAART长期治疗及使用d4T方案，尤其后者，是HIV-LD的独立危险因素。

Objective To study the prevalence, clinical characteristics and risk factors of HIV- related lipodystrophy syndrome （HIV-LD） in our cohort of HIV-1 infected Chinese adults. Methods In a cross-sectional study, 55 HIV-infected patients were recruited from the HIV clinic of Peking Union Medical College Hospital; most of them were undergoing the first-class highly active antiretroviral therapy （HAART） of today in China. Lipoatrophy or lipohypertrophy was defined if there was concordance between the report of fat change and clinical examination of the participants. Whole body dual-energy X-ray absorptiometry （DEXA） scanning was performed. Results Prevalence of clinical body fat redistribution in the present study was 47.3%. Comparing with non-LD patients, HIV-LD patients had elder age and longer exposure to HAART （P 〈 0. 05 ）. HAART exposure and stavudine（d4T） usage were two independent risk factors for HIV-LD. Conclusions HIV-related fat redistribution does exist in Chinese HIV population. Peripheral lipoatrophy occurs commonly in HIV-infected adults but is not associated with increased trunk fat. HAART exposure and especially d4T usage are independent risk factors for HIV-LD.