Neurosyphilis in a clinical cohort of HIV-1-infected patients
Neurosyphilis in a clinical cohort of HIV-1-infected patients
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DOI：
10.1097/qad.0b013e32830184df
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发表时间：
2008-06-19
期刊：
影响因子：
3.8
通讯作者：
Gebo, Kelly A.
中科院分区：
文献类型：
--
作者：
Chanem, Khalil G.;Moore, Richard D.;Gebo, Kelly A.
目的：描述的危险因素，临床表现，并长期随访的HIV感染者的诊断和治疗neurosphysis.Methods：前瞻性收集了1990年至2006年之间的所有患者的综合人口统计学，临床和治疗数据的临床队列中招募的患者。如果患者具有阳性梅毒血清学和以下任何一项，则诊断为神经梅毒：（a）腰椎穿刺一个或多个脑脊液异常[白色血细胞> 10/mu l;蛋白质> 50 mg/dl;反应性性病研究实验室]，（B）其他原因不明的神经学发现。在231例新诊断的梅毒病例中，41例神经梅毒病例符合入选标准（中位年龄38.6岁，79.1%为男性）。神经梅毒的危险因素包括梅毒诊断时CD 4细胞计数低于350个/ml（比值比：2.87; 95%可信区间：1.18-7.02）、快速血浆复溶滴度> 1：128（2.83; 1.11-7.26）和男性（2.46; 1.06-5.70）。在梅毒感染前使用高效抗逆转录病毒治疗可使神经梅毒的发病率降低65%（0.35; 0.14-0.91）。63%的病例表现为早期神经梅毒，诊断神经梅毒的中位时间为9个月。有症状患者首次腰椎穿刺脑脊液异常率高于无症状患者（P=0.01）。12个月内的随访腰椎穿刺显示，只有38%的脑脊液异常得到解决。1年时，38%的患者尽管接受了充分的神经梅毒治疗，但其主要症状仍持续存在。41例患者中有12例（29%）因梅毒再次就诊。结论：早期神经梅毒在本队列中较为常见。高活性抗逆转录病毒治疗逆转免疫抑制可能有助于减轻梅毒的神经系统并发症。(c)2008年威科健康垂直酒吧利平科特威廉姆斯&威尔金斯。
Objectives: To describe the risk factors, clinical presentation, and long-term follow up of patients enrolled in a clinical cohort of HIV-infected patients who were diagnosed and treated for neurosyphilis.Methods: Comprehensive demographic, clinical, and therapeutic data were collected prospectively on all patients between 1990 and 2006. Patients were diagnosed with neurosyphilis if they had positive syphilis serologies and any of the following: (a) one or more cerebrospinal fluid abnormalities on lumbar puncture [white blood cells > 10/mu l; protein > 50 mg/dl; reactive venereal diseases research laboratory], (b) an otherwise unexplained neurological finding.Results: Of 231 newly diagnosed syphilis cases, 41 neurosyphilis cases met entry criteria (median age 38.6 years, 79.1 % male). Risk factors for neurosyphilis included a CD4 cell count of less than 350 cells/ml at the time of syphilis diagnosis (odds ratio: 2.87; 95% confidence interval: 1.18-7.02), a rapid plasma regain titer > 1 :128 (2.83; 1.11-7.26), and male sex (2.46; 1.06-5.70). Use of my highly active antiretroviral therapy before syphilis infection reduced the odds of neurosyphilis by 65% (0.35; 0.14-0.91). Sixty-three percent of cases presented with early neurosyphilis and the median time to neurosyphilis diagnosis was 9 months. Symptomatic patients had more cerebrospinal fluid abnormalities on initial lumbar puncture than asymptomatic patients (P=0.01). Follow-up lumbar puncture within 12 months revealed that only 38% had resolution of all cerebrospinal fluid abnormalities. At 1 year, 38% had persistence of their major symptom despite adequate treatment for neurosyphilis. Twelve of 41 (29%) patients were retreated for syphilis.Conclusion: Early neurosyphilis was common in this cohort. Highly active antiretroviral therapy to reverse immunosuppression may help mitigate neurological complications of syphilis. (c) 2008 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.