THE ROLE OF STEREOTAXIC BIOPSY IN THE MANAGEMENT OF HIV-RELATED FOCAL BRAIN-LESIONS
THE ROLE OF STEREOTAXIC BIOPSY IN THE MANAGEMENT OF HIV-RELATED FOCAL BRAIN-LESIONS
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DOI：
10.1227/00006123-199206000-00001
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发表时间：
1992-06-01
期刊：
影响因子：
4.8
通讯作者：
ORENSTEIN, J
中科院分区：
文献类型：
--
作者：
CHAPPELL, ET;GUTHRIE, BL;ORENSTEIN, J
获得性免疫缺陷综合症（艾滋病）患者的脑活检标准仍不清楚，也没有得到普遍接受。为了进一步阐明这个问题，作者回顾了1988年11月至1990年10月期间连续接受立体定向活检的25名患有局灶性脑病变的艾滋病患者的记录。最常见的诊断是淋巴瘤（36%）、进行性多灶性白质脑病（24%）和弓形体病（8%）。中枢神经系统疾病导致初次就诊的患者（约 40%）的中位生存期为 37 周，而之前患有艾滋病相关感染的患者的中位生存期为 6 周。具有诊断意义并有助于患者治疗管理的对比增强病变活检比例为 87.5%。另一方面，只有 67% 的非增强病变活检具有诊断意义，而且这些病变均不可治疗。所有淋巴瘤患者均患有艾滋病一段时间，尽管术前卡诺夫斯基评分合理且术后接受放射治疗，但他们的中位生存期仅为 6 周；然而，活检对于他们的治疗管理至关重要。早期脑活检，而不是经验性抗弓形体病治疗，似乎适合对既往有艾滋病表现的患者进行对比增强病变的积极治疗。对非强化病变进行活检的作用尚不清楚，但它可以提供预后信息。
The criteria for brain biopsy in patients with acquired immunodeficiency syndrome (AIDS) remain unclear and without universal acceptance. In order to shed more light on this issue, the authors reviewed the records of 25 AIDS patients with focal cerebral lesions who consecutively underwent stereotactic biopsy between November 1988 and October 1990. The most frequently occurring diagnoses were lymphoma (36%), progressive multifocal leukoencephalopathy (24%), and toxoplasmosis (8%). Patients whose central nervous system disease resulted in their initial presentation (approximately 40%) survived a median of 37 weeks, as opposed to 6 weeks for those who had previous AIDS-related infections. The proportion of biopsies of contrast-enhancing lesions that were diagnostic and thereby contributed to the patients' therapeutic management was 87.5%. On the other hand, only 67% of the biopsies of nonenhancing lesions were diagnostic, and none of these lesions were treatable. All of the lymphoma patients had had AIDS for some time and, despite a reasonable preoperative Karnofsky score and postoperative radiation therapy, their median survival was only 6 weeks; however, biopsy was critical to their therapeutic management. Early brain biopsy, rather than empiric antitoxoplasmosis therapy, appears indicated for aggressive therapy of contrast-enhancing lesions in patients who have had previous manifestations of AIDS. The role for biopsy of nonenhancing lesions is less clear, but it may provide prognostic information.