Early involvement of the nervous system by human immune deficiency virus (HIV). A study of 79 patients.
Early involvement of the nervous system by human immune deficiency virus (HIV). A study of 79 patients.
复制标题
人类免疫缺陷病毒（HIV）早期累及神经系统。
作者：
N. Diederich;R. Ackermann;R. Jürgens;M. Ortseifen;F. Thun;M. Schneider;I. Vukadinović
我们报告79例人类免疫缺陷病毒（HIV）感染的不同阶段，根据沃尔特-里德分期分类（WR）。比较血清和脑脊液（CSF）中每重量IgG的HIV抗体含量，54例患者（68%）在CSF中的抗体活性高于血清，表明鞘内抗体产生，因此局部挑战病毒。CSF中具有这些抗体的患者百分比从WR 1期（33%）增加到WR 5期（90%）。在WR 6（68%）中再次下降。进一步分析了21例鞘内产生抗体但无机会性或既存神经精神疾病证据的患者。即使在WR 1和2期，这些患者也显示出明显的临床体征。主要表现为冷漠型人格改变（n = 13）、周围神经病变（n = 8）和轻度偏侧综合征（n = 9）。进展为严重痴呆症完全由艾滋病毒脑炎引起的似乎是可能的。更常见的是，精神障碍的加速表明其他病原体的协同作用。我们的研究进一步证明了HIV感染对神经系统的频繁、早期和临床活跃的影响。
We report on 79 patients of different stages of human immune deficiency virus (HIV) infection according to the Walter-Reed staging classification (WR). Comparing the HIV antibody content per weight IgG in serum and cerebrospinal fluid (CSF), 54 patients (68%) showed higher antibody activity in CSF than in serum, indicating intrathecal antibody production and thus a local challenge with the virus. The percentage of patients with these antibodies in CSF increased from stage WR 1 (33%) to WR 5 (90%). It decreased again in WR 6 (68%). Twenty-one patients with intrathecally produced antibodies but without evidence for opportunistic or preexistent neuropsychiatric diseases were further analyzed. Even in stages WR 1 and 2 these patients showed distinct clinical signs. These consisted mostly in apathic personality change (n = 13), peripheral neuropathy (n = 8) or mild hemisyndrome (n = 9). Progression to severe dementia solely caused by HIV encephalitis seems to be possible. More often acceleration of the mental disorder indicates a synergistic action of other pathogens. Our study gives further evidence for very frequent, early and clinically active involvement of the nervous system by the HIV infection.