Tremont-Lukats I W, Teixeira G M, Hernández D E
Department of Neurology, University of Wisconsin Hospital and Clinics, Madison 53792-5132, USA.
J Neurol. 1999 Jul;246(7):540-3. doi: 10.1007/s004150050400.
This study estimated the frequency of nine primitive reflexes (PR) and assessed their possible clinical value in a group of patients with acquired immunodeficiency syndrome. We studied 78 patients with human inmunodeficiency type 1 (HIV-1) infection in WHO clinical stage 3 or 4 and 81 matched seronegative controls. All participants were examined using a standardized neurological examination and the Mini-Mental State Examination. Cognitive impairment and PR was found in 36% of patients but in none of the controls (P<0.0001; logistic regression odds ratio: 14.7). Overall, PR were 2-36 times more frequent in patients with HIV-1 infection. This association was stronger for the glabellar, snout, Rossolimo, and digital signs. At least two PR were observed in 92% of patients vs. 8% of controls (P<0.0001; 95% confidence interval: 68%-100%; logistic regression odds ratio: 10.8). These data support the association of PR with cognitive decline in patients with advanced HIV-1 infection without overt neurological disease. Larger follow-up studies with multivariate techniques are needed to identify which PRs are useful as indicators of HIV-1-associated cognitive/motor complex and minor neurocognitive disorders.
本研究估计了9种原始反射（PR）的出现频率，并评估了它们在一组获得性免疫缺陷综合征患者中的潜在临床价值。我们研究了78例世界卫生组织临床分期为3期或4期的1型人类免疫缺陷病毒（HIV-1）感染患者以及81例匹配的血清阴性对照者。所有参与者均接受标准化神经系统检查和简易精神状态检查。36%的患者存在认知障碍和原始反射，而对照组无一例出现（P<0.0001；逻辑回归优势比：14.7）。总体而言，HIV-1感染患者中原始反射的出现频率是对照组的2至36倍。这种关联在眉间反射、噘嘴反射、罗索利莫反射和指反射中更为明显。92%的患者至少观察到两种原始反射，而对照组为8%（P<0.0001；95%置信区间：68%-100%；逻辑回归优势比：10.8）。这些数据支持了在无明显神经疾病的晚期HIV-1感染患者中原始反射与认知衰退之间的关联。需要进行更大规模的采用多变量技术的随访研究，以确定哪些原始反射可作为HIV-1相关认知/运动复合体及轻度神经认知障碍的指标。
