Cerebrospinal fluid tau concentrations in HIV infected patients with suspected neurological disease
Cerebrospinal fluid tau concentrations in HIV infected patients with suspected neurological disease
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DOI：
10.1136/sti.76.6.443
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发表时间：
2000-12-01
影响因子：
3.6
通讯作者：
Miller, RF
中科院分区：
文献类型：
--
作者：
Green, AJE;Giovannoni, G;Miller, RF
目的：测量患有急性神经系统发作的 HIV 感染患者的脑脊液 (CSF) tau，并将结果与神经系统疾病的类型和严重程度相关联。方法：对伦敦大学学院医院专科病房收治的 76 名连续 HIV 感染患者进行前瞻性测量，以调查急性神经系统发作：将结果与临床诊断进行比较。结果：24 名患者患有 HIV 相关痴呆症(HADC)，淋巴瘤 10 例（其中原发性中枢神经系统淋巴瘤 4 例），脑部感染 20 例（其中巨细胞病毒脑炎 5 例，水痘带状疱疹病毒感染 5 例，隐球菌性脑膜炎 7 例，弓形虫病 2 例，进行性多灶性白质脑病 1 例）； 22 名患者患有其他病症，其中 9 名患有自限性头痛/发烧。 62 名患者 (82%) 脑脊液 tau 浓度正常，14 名患者 (18%) tau 浓度升高。在患有 HADC 的患者中，磁共振成像显示的痴呆或萎缩程度与脑脊液 tau 蛋白之间没有相关性。脑脊液 tau 升高与不良预后相关，因为腰椎穿刺 4 周内死亡的 8 名患者中有 6 名 tau 升高（p = 0.0024，双尾 Fisher 精确检验）。 结论：在大多数出现急性神经系统发作的 HIV 感染患者中，脑脊液 tau 水平并未升高。磁共振成像显示脑脊液 tau 蛋白水平与痴呆/萎缩的严重程度没有相关性。尽管在一些患有导致脑坏死的疾病的患者中观察到脑脊液tau蛋白升高，但这一发现并没有说明潜在的病理学，而是与不良预后相关。
Objectives: To measure cerebrospinal fluid (CSF) tau in HIV infected patients with acute neurological episodes and to correlate the findings with thr type and severity of neurological disease.Methods: CSF tau was prospectively measured in 76 consecutive HIV infected patients admitted to a specialist unit at UCL Hospitals, London, for investigation of acute neurological episodes: the results were compared with the clinical diagnoses.Results: 24 patients had HIV associated dementia complex (HADC), 10 had lymphoma (including four with primary CNS lymphoma), 20 had cerebral infections (including five with CMV encephalitis, five with VZV infection, seven with cryptococcal meningitis, two with toxoplasmosis, and one with progressive multifocal leucoencephalopathy); 22 patients had miscellaneous conditions, including nine with self limiting headache/fever. 62 patients (82%) had normal CSF tau concentration and 14 patients (18%) had elevated tau. In those with HADC, there was no correlation between the degree of dementia or atrophy on magnetic resonance imaging and CSF tau. Elevated CSF tau was associated with poor outcome as six of eight patients who died within 4 weeks of lumbar puncture had elevated tau (p=0.0024, two tailed Fisher's exact test).Conclusions: CSF tau levels are not elevated in the majority of HIV infected patients presenting with acute neurological episodes. CSF tau levels show no correlation with severity of dementia/ atrophy on magnetic resonance imaging. Although elevated CSF tau was observed in some patients with conditions causing cerebral necrosis, the finding did not delineate underlying pathology but was associated with poor outcome.