双能X线骨密度测量仪对不同治疗方案的男性HIV相关脂肪营养不良综合征患者体成分测量分析  

To evaluate the changes in body composition in male human immunodeficiency virus-related lipodystrophy after different treatment regimens by dual-energy X-ray absorptiometry

作　　者：周晓红[1] 余卫[1] 李太生[2] 郭伏平[2] 林强[1] 邵红宇 田均平[1] 徐颖[1] 孙朋涛[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院放射科,100730 [2]中国医学科学院北京协和医学院北京协和医院感染科艾滋病诊疗中心,100730

出　　处：《中华内科杂志》2014年第8期622-625,共4页Chinese Journal of Internal Medicine

基　　金：国家“十二五”艾滋病和病毒性肝炎等重大传染病防治科技重大专项资助项目（2012ZX10001003）（2012-2015）

摘　　要：目的 应用双能X线骨密度测量仪（DXA）分析男性HIV相关脂肪营养不良综合征（HIV-LD）患者高效抗逆转录病毒治疗（HAART）由含司他夫定（d4T）方案转换为含齐多夫定（AZT）或替诺福韦（TDF）方案后,其体成分变化情况.方法 选取2007年5月至2013年9月在北京协和医院接受d4T方案HARRT治疗的成年男性HIV-LD患者47例,研究对象均进行两次DXA扫描,两次最小间隔时间为12个月,根据d4T转换为含AZT或TDF方案不同分为AZT组、TDF组,分析两组体成分变化特点.结果 与基线水平比较,AZT组下肢肌量显著增加[（15.5±1.7）kg比（16.0±1.7）kg,=2.781,P＜0.01],下肢脂肪量减少,但差异无统计学意义（P=0.05）;TDF组上肢脂肪量显著增加[（0.6±0.3）kg比（1.0±0.7）kg,t=2.422,P＜0.05],下肢脂肪量显著增加[（1.8±0.8）kg比（2.6±1.7）kg,t=2.369,95％ CI0.08 ～ 1.66,P＜0.05];第2次DXA检查时,AZT组下肢脂肪量较基线水平减少了0.04 kg（4.55％）,TDF组下肢脂肪量较基线水平增加了0.46 kg（27.41％）,两组间下肢脂肪量变化量差异有统计学意义（U=2.954,P＜0.01）.结论 DXA检查显示,男性HIV-LD患者TDF治疗方案可使下肢脂肪量显著增加,TDF治疗方案较AZT治疗方案能明显改善HIV-LD.AZT组HIV-LD未见加重,且肌量增加,所以目前临床上也用于替代d4T治疗.DXA可客观评价男性HIV-LD不同治疗方案的体成分变化,有助于及时调整治疗方案.Objective To evaluate the changes of body composition in male patients with human immunodeficiency （HIV）-related lipodystrophy （LD） syndrome （HIV-LD） switching from stavudine （d4T） to zidovudine （AZT） or tenofovir （TDF） by Dual-energy X-ray absorptiometry （DXA）.Methods A total of 47 men with HIV-LD who had been exposed to stavudine（d4T） were enrolled in our study from May 2007 to September 2013 in Peking Union Medical College Hospital.Twice DXA assessments were administrated with interval of at least 12 months.All patients were divided into two different treatment regimens,either AZT group switching from d4T to zidovudine （AZT） or TDF group switching from d4T to TDF.Parameters of body composition in two groups were evaluated by DXA.Results Compared with baseline level,lower limb lean mass increased significantly after treatment[（15.4 ± 1.7） kg vs （16.0 ± 1.7） kg,t =2.781,P ＜ 0.01] and lower limb fat mass had a small decrease（P =0.05） in AZT group.In TDF group,there were significant increases both in upper limb fat mass [（0.6 ± 0.3） kg vs （1.0 ± 0.7） kg,t =2.422,P ＜ 0.05] and lower limb fat mass [（1.8 ± 0.8） kg vs （2.6 ± 1.7） kg,t =2.369,P ＜ 0.05].In AZT group,change of lower limb fat mass was generally small （median-0.04 kg,-4.55％）.In TDF group,increase of lower limb fat mass and percentage of lower limb fat gain were even greater（median 0.46 kg,27.41％）.In a visual comparison of DXA results between AZT and TDF recipients,more fat gain of leg fat mass was seen in patients who switched from d4T to TDF （U =2.954,P ＜ 0.01）.Conclusions Compared with AZT group,TDF group led to a more increase in leg fat mass.Replacing d4T with TDF translates into an improvement of lipodystrophy.Although fat mass did not show a significant increase in AZT group,lean mass had improved after switching treatment,indicating AZT as a possible alternative agent of d4T.Body composition in men patients with HIV-LD can help to adjust the treatment regim

关 键 词：HIV 脂肪营养不良 双能X线骨密度测量仪 

分 类 号：R512.91[医药卫生—内科学]