Large artery vasculopathy in HIV-positive patients: Another vasculitic enigma
Large artery vasculopathy in HIV-positive patients: Another vasculitic enigma
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DOI：
10.1016/s0046-8177(00)80253-1
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发表时间：
2000-03-01
期刊：
影响因子：
3.3
通讯作者：
Nair, R
中科院分区：
文献类型：
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作者：
Chetty, R;Batitang, S;Nair, R
人类免疫缺陷病毒（HIV）感染会影响身体的所有系统，心血管系统也不例外，最常见的是中小型血管炎。我们介绍了 16 名患有大血管疾病的 HIV 阳性患者，其中包括动脉瘤（通常是多发性）或闭塞性疾病。 9 名男性和 7 名女性年龄在 18 至 38 岁之间，因动脉瘤破裂、短暂性脑缺血发作、高血压、下肢缺血或动脉瘤部位有肿块而就诊。 8例患者有1个动脉瘤，2例有2个病变，其余6例有3至7个动脉瘤。受影响的动脉包括颈总动脉、腹主动脉、髂总动脉、股动脉和腘动脉。 3例患者有并发感染，但均未出现明显的感染性血管病变。只有 1 名患者的梅毒 TPHA 检测结果呈阳性。血液及血栓内容物微生物培养金黄色葡萄球菌阳性1例；没有培养其他生物。关键的组织学特征在外膜内：血管和外膜周围血管的白细胞破碎性血管炎、狭缝状血管通道的增殖、慢性炎症和纤维化。内侧纤维化与肌肉和弹性组织的损失和破碎相关。内膜变化包括内弹力层的重复和碎裂，伴有钙化、粥样硬化和明显的内膜增厚，但不明显。我们认为，这种大血管病变（主要是动脉瘤性）在年轻的 HN 阳性患者中经常出现多处病变，其特征可能是感染或免疫复合物起源，其中血管和外膜周围血管的白细胞破碎性血管炎在许多情况下是关键。版权所有 (C) 2000 W.B.桑德斯公司。
Human immunodeficiency virus (HIV) infection has impacted on all the systems of the body, and the cardiovascular system is no exception, with small to medium-sized vessel vasculitis being most frequently described. We present 16 HIV-positive patients with large vessel disease consisting of either aneurysms (often multiple) or occlusive disease. Nine men and 7 women ranging in age from 18 to 38 years presented with rupture of aneurysm, transient ischemic attacks, hypertension, ischemia to the lower extremity, or a mass at the site of the aneurysm. Eight patients had 1 aneurysm, 2 had 2 lesions, and the remaining 6 cases had from 3 to 7 aneurysms. Arteries affected included the common carotid, abdominal aorta, common iliac, femoral, and popliteal. Three patients had intercurrent infections, but none had any obvious infective vascular lesion. Only 1 patient had a positive TPHA test for syphilis. Microbiologic culture of both blood and thrombus contents was positive for Staphylococcus aureus in 1 case; no other organisms were cultured. The key histological features were within the adventitia: leukocytoclastic vasculitis of the vasa vasora and periadventitial vessels, proliferation of slit-like vascular channels, chronic inflammation, and fibrosis. There was associated medial fibrosis with loss and fragmentation of muscle and elastic tissue. Intimal changes consisted of duplication and fragmentation of the internal elastic lamina with calcification, Atheroma and marked intimal thickening were not evident. We believe that the occurrence of this large vessel vasculopathy (mainly aneurysmal) often with multiple lesions in young HN-positive patients, is characteristic of possible infective or immune complex origin, with leukocytoclastic vasculitis of vasa vasora and periadventitial vessels being pivotal in many cases. Copyright (C) 2000 by W.B. Saunders Company.