Cross-Sectional Study of Unexplained White Matter Lesions in HIV Positive Individuals Undergoing Brain Magnetic Resonance Imaging
Cross-Sectional Study of Unexplained White Matter Lesions in HIV Positive Individuals Undergoing Brain Magnetic Resonance Imaging
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DOI：
10.1089/apc.2013.0230
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发表时间：
2014-07-01
影响因子：
4.9
通讯作者：
Jaeger, H. Rolf
中科院分区：
文献类型：
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作者：
Haddow, Lewis J.;Dudau, Cristina;Jaeger, H. Rolf
HIV 阳性 (HIV +) 患者的脑部 MRI 中经常会发现白质 (WM) 异常。我们的目的是确定无法解释的 WM 异常的患病率及其与 HIV 疾病和心血管危险因素的关联。我们对 2004 年至 2009 年间在我们中心进行的 HIV + 患者的脑部 MRI 进行了回顾性横断面研究。汇编了临床和实验室数据，并对 WM 病变的图像进行了独立审查。图像取自 254 名患者：70% 为男性，53% 为白人，40% 为黑人，平均年龄 42 岁，当前 CD4 计数中位数为 240 个细胞/mm(3)，41% 未接受抗逆转录病毒治疗 (ART)。 161 例患者 (63.4%) 存在高信号 WM 病变：89 例 (35.0%) 扫描显示弥漫性 WM 信号异常 (DWMSA)，61 例 (24.0%) 符合小血管病变 (SVD，按 Fazekas 量表分级)，37 例 (14.6%) 显示大的不对称局灶性 WM 病变。 SVD 变化与年龄和心血管危险因素相关，虽然脑 SVD 可能与 HIV 感染有关，但 MRI 结果与 HIV 相关因素无关。 DWMSA 的唯一危险因素是黑人种族，并且与心血管危险因素、CD4 计数或临床表现没有相关性。因此，DWMSA 在 HIV + 患者中具有不确定的神经学意义，并且可能代表不止一种临床病理学实体。
White matter (WM) abnormalities are frequently seen on brain MRI of HIV positive (HIV +) patients. We aimed to determine the prevalence of unexplained WM abnormalities and their associations with HIV disease and cardiovascular risk factors. We conducted a retrospective, cross-sectional study of brain MRI of HIV + patients conducted between 2004 and 2009 at our center. Clinical and laboratory data were compiled, and images were independently reviewed for WM lesions. Images were obtained from 254 patients: 70% male, 53% white, 40% black, mean age 42 years, median current CD4 count 240 cells/mm(3), and 41% not taking antiretroviral therapy (ART). Hyperintense WM lesions were present in 161 patients (63.4%): 89 scans (35.0%) showed diffuse WM signal abnormality (DWMSA), 61 (24.0%) were consistent with small vessel disease (SVD, graded by Fazekas' scale), and 37 (14.6%) showed large asymmetrical focal WM lesions. SVD changes were associated with age and cardiovascular risk factors, and while cerebral SVD may be related to HIV infection, the MRI findings were not associated with HIV-related factors. The only risk factor for DWMSA was black race, and no correlation with cardiovascular risk factors, CD4 count, or clinical presentation was identified. DWMSA are therefore of uncertain neurological significance in HIV + patients and could represent more than one clinicopathological entity.