HIV neuropathy natural history cohort study - Assessment measures and risk factors
HIV neuropathy natural history cohort study - Assessment measures and risk factors
复制标题
DOI：
10.1212/01.wnl.0000218303.48113.5d
复制
发表时间：
2006-06-13
期刊：
影响因子：
9.9
通讯作者：
Clifford, D. B.
中科院分区：
文献类型：
--
作者：
Simpson, D. M.;Kitch, D.;Clifford, D. B.
背景：远端感觉性多发性神经病（DSP）是人类免疫缺陷病毒（HIV）感染最常见的神经系统并发症。在高效抗逆转录病毒治疗时代，DSP 的危险因素尚未得到充分定义。方法：作者在 48 周内对 101 名晚期 HIV 感染受试者进行了评估。评估包括简短的周围神经病变（PN）筛查（BPNS）、神经系统检查、神经传导研究、定量感觉测试（QST）以及定量表皮神经纤维密度的皮肤活检。数据汇总为总神经病评分（TNS）。 DSP 的存在、严重程度和进展与临床和实验室结果相关。结果：平均 TNS（范围 0 至 36）为 8.9，38% 的受试者被归类为无 PN，10% 被归类为有无症状 DSP，52% 被归类为有症状 DSP。 TNS 从基线到第 48 周的进展仅发生在基线时无 PN 组中（平均 TNS 变化 = 1.16 +/- 2.76，p = 0.03）。与 TNS 进展相关的因素包括当前 TNS 较低、远端表皮去神经支配和白种人。与基线时 TNS 诊断 PN 相比，BPNS 的敏感性为 34.9%，特异性为 89.5%。结论：在这组晚期人类免疫缺陷病毒 (HIV) 感染受试者中，远端感觉多发性神经病很常见，并且在 48 周内相对稳定。先前确定的危险因素，包括 CD4 细胞计数、血浆 HIV RNA 和双脱氧核苷抗逆转录病毒药物的使用，并不能预测远端感觉多发性神经病 (DSP) 的进展。远端表皮去神经支配与 DSP 恶化相关。与总神经病变评分相比，简短周围神经病变筛查对于DSP的诊断敏感性相对较低，特异性较高。
Background: Distal sensory polyneuropathy ( DSP) is the most common neurologic complication of human immunodeficiency virus ( HIV) infection. Risk factors for DSP have not been adequately defined in the era of highly active antiretroviral therapy. Methods: The authors evaluated 101 subjects with advanced HIV infection over 48 weeks. Assessments included a brief peripheral neuropathy ( PN) screen ( BPNS), neurologic examination, nerve conduction studies, quantitative sensory testing ( QST), and skin biopsies with quantitation of epidermal nerve fiber density. Data were summed into a Total Neuropathy Score ( TNS). The presence, severity, and progression of DSP were related to clinical and laboratory results. Results: The mean TNS ( range 0 to 36) was 8.9, with 38% of subjects classified as PN-free, 10% classified as having asymptomatic DSP, and 52% classified as having symptomatic DSP. Progression in TNS from baseline to week 48 occurred only in the PN- free group at baseline ( mean TNS change = 1.16 +/- 2.76, p = 0.03). Factors associated with progression in TNS were lower current TNS, distal epidermal denervation, and white race. As compared with the TNS diagnosis of PN at baseline, the BPNS had a sensitivity of 34.9% and a specificity of 89.5%. Conclusions: In this cohort of advanced human immunodeficiency virus ( HIV)-infected subjects, distal sensory polyneuropathy was common and relatively stable over 48 weeks. Previously established risk factors, including CD4 cell count, plasma HIV RNA, and use of dideoxynucleoside antiretrovirals were not predictive of the progression of distal sensory polyneuropathy ( DSP). Distal epidermal denervation was associated with worsening of DSP. As compared with the Total Neuropathy Score, the brief peripheral neuropathy screen had relatively low sensitivity and high specificity for the diagnosis of DSP.