THE DIAGNOSTIC UTILITY OF ELEVATION IN CEREBROSPINAL-FLUID BETA-2-MICROGLOBULIN IN HIV-1 DEMENTIA
THE DIAGNOSTIC UTILITY OF ELEVATION IN CEREBROSPINAL-FLUID BETA-2-MICROGLOBULIN IN HIV-1 DEMENTIA
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DOI：
10.1212/wnl.42.9.1707
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发表时间：
1992-09-01
期刊：
影响因子：
9.9
通讯作者：
SAAH, A
中科院分区：
文献类型：
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作者：
MCARTHUR, JC;NANCESPROSON, TE;SAAH, A
我们检测了HIV-1血清阳性患者和非痴呆患者的血清和脑脊液β-2-微球蛋白(β-2M)水平，以确定脑脊液β-2M升高的频率和诊断价值。在多中心艾滋病队列研究中，我们将来自27名HIV-1痴呆症患者的34份样本与54名HIV-1血清阳性参与者的110份样本进行了比较，这些人都没有进展性痴呆症。所有受试者均排除神经梅毒和中枢神经系统机会性突起。我们根据HIV血清阳性持续时间和外周血CD4计数对非痴呆受试者进行分层。与非痴呆组相比，痴呆组的脑脊液总蛋白、脑脊液免疫球蛋白%及脑脊液白蛋白/血清白蛋白比值均显著升高。在脑脊液β-2M升高和CD_4计数减少之间发现了高度显著的相关性(p<；0.0001)。痴呆组和非痴呆组在脑脊液白细胞计数或脑脊液HIV-1分离频率方面没有显著差异。非痴呆组脑脊液β-2M平均值为1.9 mg/L，痴呆组为4.2 mg/L(p<；0.0001)。根据脑脊液中β-2m在非痴呆组中的分布，我们得出了脑脊液β-2m的分界值为3.8 mg/L。脑脊液β-2M测定对HIV痴呆诊断的敏感性为44%，特异性为90%，阳性预测值为88%，与非痴呆者的CD_4计数比较，3.8 mg/L是一项有临床应用价值的指标。
We measured serum and CSF beta-2-microglobulin (beta-2M) levels in HIV-1 seropositive individuals with and without dementia to determine the frequency and diagnostic utility of elevation of CSF beta-2M. We compared 34 samples from 27 patients with HIV-1 dementia with 110 samples from 54 HIV-1 seropositive participants in the Multicenter AIDS Cohort Study, none of whom had progressive dementia. Neurosyphilis and CNS opportunistic processes were excluded in all subjects. We stratified the nondemented subjects by duration of HIV seropositivity and peripheral blood CD4 count. Compared with the nondemented group, demented subjects had significantly higher CSF total protein, IgG%, and CSF albumin/serum albumin ratios. A highly significant association was found between elevated CSF beta-2M and reduced CD4 count (p < 0.0001). No significant differences were noted between the demented and nondemented groups in CSF WBC count or in the frequency of CSF HIV-1 isolation. The mean CSF beta-2M was 1.9 mg/l in the nondemented subjects compared with 4.2 mg/l in those with dementia (p < 0.0001). We derived a cutoff of 3.8 mg/l from the distribution of CSF beta-2M in the nondemented group. The determination of CSF beta-2M had a sensitivity of 44%, specificity of 90%, and a positive predictive value of 88% for diagnosis of HIV dementia when compared with nondemented subjects with CD4 counts 3.8 mg/l is a clinically useful marker for HIV dementia.