Rosci M A, Pigorini F, Bernabei A, Pau F M, Volpini V, Merigliano D E, Meligrana M F
L. Spallanzani Hospital for Infectious Diseases, Rome, Italy.
AIDS. 1992 Nov;6(11):1309-16. doi: 10.1097/00002030-199211000-00011.
To determine the optimal diagnostic procedures for identifying early signs of AIDS dementia complex (ADC) in asymptomatic HIV-1-infected individuals, in order to prevent further cognitive function impairment by early treatment.
Study patients had been referred electively and consecutively to hospital; all had been referred for the first time and gave informed consent. Inclusion criteria were (1) lack of history and/or symptoms of psychosis and neurological disorders; (2) lack of active viral, protozoan or fungal pathology; (3) abstinence from heroin and/or cocaine for at least 6 months before baseline evaluation.
Subjects were seen at the L. Spallanzani Hospital for Infectious Diseases, Rome, Italy between March 1989 and March 1991.
Eighty-two asymptomatic HIV-1-infected subjects: 41 drug users, 27 homosexuals and 14 heterosexuals.
All subjects were evaluated using Wechsler-Bellevue I, Benton C form and Bender tests. Thirty-nine subjects underwent single-photon emission computed tomography (SPECT) and 12 magnetic resonance imaging (MRI). The immunological status of each subject was determined.
On psychometric testing, 23 out of the 82 (28%) asymptomatic subjects had a mental decay percentage (MD%) > or = 20%. Cerebral perfusion abnormalities were detected in 31 out of 39 (79.48%) subjects who underwent SPECT; MRI abnormalities were observed in seven out of 12 (58%) subjects. Twelve out of 23 subjects with MD% > or = 20, 15 out of 29 subjects with SPECT abnormalities and four out of seven patients with MRI abnormalities had total CD4+ lymphocyte counts > or = 500 x 10(6)/l.
The high incidence of abnormal SPECT and of MD% > or = 20 in asymptomatic HIV-1-infected patients, and the lack of correlation between immunological status and degree of mental decay, SPECT and MRI abnormalities raise many questions about subclinical HIV-1 neurological disease.
确定在无症状的HIV-1感染者中识别艾滋病痴呆综合征（ADC）早期体征的最佳诊断程序，以便通过早期治疗预防进一步的认知功能损害。
研究患者被选择性地连续转诊至医院；所有患者均为首次转诊并签署知情同意书。纳入标准为：（1）无精神病和神经系统疾病史及/或症状；（2）无活动性病毒、原生动物或真菌病变；（3）在基线评估前至少6个月未使用海洛因和/或可卡因。
1989年3月至1991年3月期间，在意大利罗马的L.斯帕兰扎尼传染病医院对受试者进行观察。
82名无症状的HIV-1感染者：41名吸毒者、27名同性恋者和14名异性恋者。
所有受试者均使用韦克斯勒-贝尔维尤I型、本顿C型和本德尔测试进行评估。39名受试者接受了单光子发射计算机断层扫描（SPECT），12名接受了磁共振成像（MRI）。测定了每位受试者的免疫状态。
在心理测量测试中，82名无症状受试者中有23名（28%）的精神衰退百分比（MD%）≥20%。在接受SPECT检查的39名受试者中，有31名（79.48%）检测到脑灌注异常；在接受MRI检查的12名受试者中，有7名（58%）观察到MRI异常。MD%≥20%的23名受试者中有12名、SPECT异常的29名受试者中有15名以及MRI异常的7名患者中有4名的CD4+淋巴细胞总数≥500×10⁶/l。
无症状的HIV-1感染者中SPECT异常和MD%≥20%的发生率较高，且免疫状态与精神衰退程度、SPECT和MRI异常之间缺乏相关性，这引发了许多关于亚临床HIV-1神经疾病的问题。
