NEUROPATHOLOGY OF ACQUIRED-IMMUNODEFICIENCY-SYNDROME (AIDS) - AN AUTOPSY REVIEW
NEUROPATHOLOGY OF ACQUIRED-IMMUNODEFICIENCY-SYNDROME (AIDS) - AN AUTOPSY REVIEW
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DOI：
10.1097/00005072-198611000-00003
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发表时间：
1986-11-01
影响因子：
3.2
通讯作者：
PRICE, RW
中科院分区：
文献类型：
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作者：
PETITO, CK;CHO, ES;PRICE, RW
在纽约和纪念医院的153名死于获得性免疫缺陷综合征(AIDS)的成年患者的大脑和脊髓中，28%的患者出现了亚急性多核细胞脑炎。这种脑炎的特征是主要位于白质的多核细胞，伴有髓鞘苍白和杆状细胞、巨噬细胞、双核星形细胞和淋巴细胞的稀疏浸润。每12个月发病率为0~43%，1983~84年(14%)至1984~85年(43%)明显升高。最近的病毒学和病理学研究表明，这种脑炎可能是由LAV/HTLV-II直接感染中枢神经系统(CNS)引起的。巨细胞病毒性脑脊髓炎和弓形虫病是最常见的机会性感染(分别为26%和10%)。进行性多灶性白质脑病、单纯疱疹病毒性脑炎、水痘-带状疱疹白质脑炎和真菌感染很少见(均低于3%)。伴有小胶质细胞结节和轻度白质改变的非特异性脑炎占17%，空泡性脊髓病占29%，中枢神经系统淋巴瘤占6%。只有不到20%的患者大脑正常或患有终末期代谢性脑病。这项调查显示，艾滋病的神经病理并发症很常见。感染是最常见的并发症，可能由LAV/HTLV-III感染或由机会性生物体引起。
In the brains and spinal cords of 153 adult patients dying with acquired immunodeficiency syndrome (AIDS) at New York and Memorial Hospitals a subacute encephalitis with multinucleated cells was present in 28% of all patients. This encepalitis was characterized by multinucleated cells primarily located in the white matter and associated with myelin pallor and sparse infiltrates of rod cells, macrophages, gemistocytic astrocytes and lymphocytes. The incidence per 12 month period ranged from 0 to 43% and significantly increased between 1983-84 (14%) and 1984-85 (43%). Recent virologic and pathologic studies suggest that this encephalitis may be caused by direct LAV/HTLV-II infection of the central nervous system (CNS). Cytomegalovirus encephalomyelitis and toxoplasmosis were the most common opportunitic infections (26% and 10%, respectively). Progressive multifocal leukoencephalopathy, herpes simplex ventriculitis, varicella-zoster leukoencephalitis and fungal infections were infrequent (less than 3% each). A nonspecific encephalitis with microglial nodules and with mild white matter changes occurred in 17%, vacuolar myelopathy in 29% and CNS lymphoma in 6%. Less than 20% of patients had either normal brains or terminal metabolic encephalopathies. This survey shows that neuropathologic complications of AIDS are frequent. Infections are the most common complication and are caused by probable LAV/HTLV-III infection, or by opportunistic organisms.