Mechanisms of ischemic stroke in HIV-infected patients
Mechanisms of ischemic stroke in HIV-infected patients
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DOI：
10.1212/01.wnl.0000259515.45579.1e
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发表时间：
2007-04-17
期刊：
影响因子：
9.9
通讯作者：
Rabinstein, A. A.
中科院分区：
文献类型：
--
作者：
Ortiz, G.;Koch, S.;Rabinstein, A. A.
目的：探讨艾滋病病毒（HIV）感染人群中脑卒中的类型和发病机制。方法：我们回顾了1996年至2004年期间在一家大城市医院住院的连续的HIV感染急性卒中患者的记录。卒中机制由两位脑血管神经科医生使用吐司分类达成共识。结果：共纳入82例患者，其中缺血性卒中77例，脑出血5例。平均年龄为42岁，89%为非洲裔美国人。有91%的人曾被诊断为艾滋病毒感染，80%的人曾被诊断为艾滋病。平均CD 4计数为113个细胞/mm（3），85%的CD 4计数< 200个细胞/mm（3）。共有61%的患者接受了联合抗逆转录病毒治疗（CART）。缺血性卒中的机制为大动脉粥样硬化12%，心源性栓塞18%，小血管闭塞18%，其他确定病因23%，未确定29%（包括19%评估不完全）。血管炎被认为是10名患者（13%）中风和7名患者（9%）高凝状态的原因。10/22例（45%）患者出现蛋白S缺乏，9/31例（29%）患者出现抗心磷脂抗体。当比较患有大血管或小血管疾病（动脉粥样硬化血栓性卒中）的患者与其他人群时，CART暴露或CD 4计数无差异，但非动脉粥样硬化血栓性卒中患者更年轻（p = 0.04）。近期可卡因暴露在动脉粥样硬化血栓性卒中患者中较不常见（p = 0.02）。35%的病例中中风是致命的或严重致残的。结论：HIV感染患者的卒中机制是可变的，血管炎和高凝状态的发生率相对较高。在我们的严重免疫抑制患者人群中，暴露于联合抗逆转录病毒治疗并没有显着影响中风的机制。
Objective: To evaluate the types and mechanisms of stroke in a large population of HIV-infected patients. Methods: We reviewed records of consecutive HIV-infected patients with acute stroke admitted to a large metropolitan hospital between 1996 and 2004. Stroke mechanism was defined by consensus between two cerebrovascular neurologists using TOAST classification. Results: A total of 82 patients were included, 77 with ischemic stroke and 5 with intracerebral hemorrhage. Mean age was 42 years and 89% were African American. Previous diagnosis of HIV infection was documented in 91% and AIDS diagnosis in 80%. Mean CD4 count was 113 cells/mm(3) and 85% had CD4 count < 200 cells/mm(3). A total of 61% of patients had received combination antiretroviral treatment (CART). The mechanism of ischemic stroke was large artery atherosclerosis in 12%, cardiac embolism in 18%, small vessel occlusion in 18%, other determined etiology in 23%, and undetermined in 29% (including 19% with incomplete evaluation). Vasculitis was deemed responsible for the stroke in 10 patients (13%) and hypercoagulability in 7 (9%). Protein S deficiency was noted in 10/22 (45%) and anticardiolipin antibodies in 9/31 (29%) tested patients. When comparing patients with large or small vessel disease (atherothrombotic strokes) vs the rest of the population, there were no differences in exposure to CART or CD4 count, but patients with non-atherothrombotic strokes were younger (p = 0.04). Recent cocaine exposure was less common among patients with atherothrombotic strokes (p = 0.02). Strokes were fatal or severely disabling in 35% of cases. Conclusions: Stroke mechanisms are variable in HIV-infected patients, with a relatively high incidence of vasculitis and hypercoagulability. In our population of severely immunodepressed patients, exposure to combination antiretroviral treatment did not significantly influence the mechanism of stroke.