Goplen A K, Liestøl K, Dunlop O, Bruun J N, Maehlen J
Department of Pathology, Ullevål University Hospital, Oslo, Norway.
Scand J Infect Dis. 2001;33(10):755-8. doi: 10.1080/003655401317074572.
In a well-defined population of adult AIDS patients from Oslo, we studied the correlation between clinical dementia and autopsy results. The study included 91% of all adult AIDS patients from Oslo who died between 1983 and 1996. The autopsy rate was 73% (167/229). Twenty-three percent of patients had definite dementia and 24% possible dementia. In more than half of the patients with definite dementia multinucleated giant cells were present in the brain tissue, suggesting that the dementia was due to HIV encephalitis. Diffuse damage of white matter also showed a significant association with clinical dementia. When found alone it tended to occur in symptomatic patients with a short survival time from onset of dementia until death. This indicates that diffuse damage of white matter may be an early stage of HIV encephalitis. CMV encephalitis was found in 28 cases (17%). Of these, 20 were classified as definitely or possibly demented. In 14 of these 20 cases we detected no multinucleated giant cells, suggesting that CMV caused or contributed to the dementia. Multiple logistic regression supported an association between CMV and conditions clinically classified as HIV dementia. We conclude that HIV encephalitis is the major cause of dementia in AIDS patients, but that CMV encephalitis as a cause of dementia has been underestimated.
在来自奥斯陆的成年艾滋病患者的明确人群中，我们研究了临床痴呆与尸检结果之间的相关性。该研究纳入了1983年至1996年间在奥斯陆死亡的所有成年艾滋病患者中的91%。尸检率为73%（167/229）。23%的患者患有明确的痴呆，24%的患者可能患有痴呆。在超过一半的明确患有痴呆的患者中，脑组织中存在多核巨细胞，这表明痴呆是由HIV脑炎引起的。白质的弥漫性损伤也与临床痴呆有显著关联。单独出现时，它往往发生在从痴呆发作到死亡存活时间较短的有症状患者中。这表明白质的弥漫性损伤可能是HIV脑炎的早期阶段。28例（17%）发现有CMV脑炎。其中，20例被归类为明确或可能患有痴呆。在这20例中的14例中，我们未检测到多核巨细胞，这表明CMV导致或促成了痴呆。多元逻辑回归支持CMV与临床分类为HIV痴呆的病症之间存在关联。我们得出结论，HIV脑炎是艾滋病患者痴呆的主要原因，但CMV脑炎作为痴呆的一个病因一直被低估。
