HIV neuropathy: Insights in the pathology of HIV peripheral nerve disease
HIV neuropathy: Insights in the pathology of HIV peripheral nerve disease
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DOI：
10.1046/j.1529-8027.2001.006001021.x
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发表时间：
2001-03-01
影响因子：
3.8
通讯作者：
Griffin, JW
中科院分区：
文献类型：
--
作者：
Pardo, CA;McArthur, JC;Griffin, JW
HIV相关性神经病(HIV-N)已成为与HIV感染相关的最常见的神经系统疾病。HIV-N最常见的形式是远端感觉性多发性神经病(DSP)和抗逆转录病毒中毒性神经病(ATN)，这些疾病的主要特征是感觉症状，包括亚急性或慢性病程后的自发或诱发性疼痛。其主要病理特征为远端长轴索“死亡性”变性，无髓纤维消失，周围神经和背根神经节内有不同程度的巨噬细胞浸润。巨噬细胞的显著活化以及促炎细胞因子的作用似乎是DSP的主要免疫致病因素。核苷类抗逆转录病毒药物对DNA合成的干扰和线粒体的异常被认为是ATN的致病因素。皮肤活检已成为评估HIV-N的有用工具。纤维密度降低、纤维静脉曲张频率增加和纤维碎裂是HIV-N患者皮肤活检的显著特征。其他形式的艾滋病毒-N包括急性或慢性炎症性多神经病，在血清转换或艾滋病毒感染的早期阶段可能发生的罕见疾病。机会感染主要与巨细胞病毒或疱疹病毒感染有关，发生在艾滋病的晚期，并产生典型的临床特征，如单神经炎、多发性神经炎或神经根性疾病。
HIV-associatecl neuropathies (HIV-N) have become the most frequent neurological disorder associated with HIV infection. The most common forms of HIV-N are the distal sensory polyneuropathy (DSP) and antiretroviral toxic neuropathies (ATN), disorders characterized mostly by sensory symptoms that include spontaneous or evoked pain that follow a subacute or chronic course. The main pathological features that characterize DSP and ATN include "dying back" axonal degeneration of long axone in distal regions, loss of unmyelinated fibers, and variable degree of macrophage infiltration in peripheral nerves and dorsal root ganglia. Marked activation of macrophages as well as the effect of proinflammatory cytokines appear to be the main immunopathogenic factors in DSP. Interference with DNA synthesis and mitochondrial abnormalities produced by nucleoside anti-retrovirals have been hypothesized as pathogenic factors involved in ATN. The use of skin biopsy has become a useful tool in the evaluation of HIV-N. Reduction in fiber density, increased frequency of fiber varicosities and fiber fragmentation are prominent features of skin biopsies from patients with HIV-N. Other forms of HIV-N include acute or chronic inflammatory polyneuropathies, uncommon disorders that may ocur during seroconversion or early stages of HIV infection. Opportunisitic infections, mostly associated with cytomegalovirus or herpes tester virus infection occur in late stages of AIDS and produce characteristic clinical features such as mononeuritis multiple or radiculopathies.