Ferrarese C, Aliprandi A, Tremolizzo L, Stanzani L, De Micheli A, Dolara A, Frattola L
Department of Neurology, University of Milano-Bicocca, Monza, Italy.
Neurology. 2001 Aug 28;57(4):671-5. doi: 10.1212/wnl.57.4.671.
Experimental evidence suggests that excitotoxicity might play a major role in HIV-induced neurodegeneration. However, few studies have investigated the role of endogenous glutamate in patients with HIV dementia.
To analyze CSF and plasma glutamate levels in 30 patients with AIDS with different dementia severity compared with 10 patients with other neurologic disorders, 11 healthy control subjects, and 10 patients with Alzheimer-type dementia.
CSF and plasma glutamate levels were measured by reverse-phase high-performance liquid chromatography followed by fluorometric analysis.
Glutamate CSF levels were increased fivefold in the patients with HIV vs normal control subjects (p = 0.001), patients with Alzheimer-type dementia (p < 0.0001), and patients with other neurologic disorders (p < 0.01). CSF glutamate levels were also related to the degree of dementia (p < 0.02) and brain atrophy (p < 0.002). Plasma levels were also higher in the patients with HIV (p < 0.0001) but did not correlate with either clinical or imaging features.
Increased CSF glutamate may originate within the CNS and may play a pathogenetic role in HIV dementia, thus supporting the treatment of these patients with glutamate receptor antagonists.
实验证据表明，兴奋性毒性可能在人类免疫缺陷病毒（HIV）诱导的神经退行性变中起主要作用。然而，很少有研究调查内源性谷氨酸在HIV痴呆患者中的作用。
分析30例不同痴呆严重程度的艾滋病患者的脑脊液和血浆谷氨酸水平，并与10例患有其他神经系统疾病的患者、11例健康对照者和10例阿尔茨海默病型痴呆患者进行比较。
采用反相高效液相色谱法结合荧光分析测定脑脊液和血浆谷氨酸水平。
与正常对照者（p = 0.001）、阿尔茨海默病型痴呆患者（p < 0.0001）和其他神经系统疾病患者（p < 0.01）相比，HIV患者的脑脊液谷氨酸水平升高了五倍。脑脊液谷氨酸水平也与痴呆程度（p < 0.02）和脑萎缩（p < 0.002）有关。HIV患者的血浆水平也较高（p < 0.0001），但与临床或影像学特征均无相关性。
脑脊液谷氨酸水平升高可能起源于中枢神经系统，可能在HIV痴呆中起致病作用，因此支持用谷氨酸受体拮抗剂治疗这些患者。
