Smego Raymond A, Orlovic Dragana, Wadula Jeanette
Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg, Republic of South Africa.
Int J STD AIDS. 2006 Apr;17(4):271-6. doi: 10.1258/095646206776253390.
We developed a diagnostic and therapeutic algorithm for intracranial mass lesions in patients with HIV/AIDS that obviates the need for neurosurgical intervention. The approach is based upon CD4(+) lymphocyte count, serum toxoplasma immunoglobulin G (IgG) serology, chest X-ray, routine lumbar puncture studies, cerebrospinal fluid (CSF) cytology, CSF adenosine deaminase or Mycobacterium tuberculosis polymerase chain reaction testing, single positron emission-computed tomography (SPECT) scanning for intracranial enhancing lesions, and limited therapeutic trials. Over a 12-month period involving 26 patients, we found that the algorithm correctly identified the aetiology of focal intracranial lesions in all 23 evaluable patients. Costs for SPECT scanning for the entire study cohort were more than offset by the savings achieved by reduced hospital stays for the four patients with lymphoma alone. An algorithmic approach can accurately identify the cause(s) of central nervous system (CNS) mass lesions in HIV-infected patients, and SPECT scanning can replace stereotactic brain biopsy in most cases where opportunistic malignancy is suspected.
我们为感染人类免疫缺陷病毒/获得性免疫缺陷综合征（HIV/AIDS）的患者制定了一种针对颅内占位性病变的诊断和治疗算法，该算法无需进行神经外科干预。该方法基于CD4(+)淋巴细胞计数、血清弓形虫免疫球蛋白G（IgG）血清学、胸部X光、常规腰椎穿刺检查、脑脊液（CSF）细胞学检查、脑脊液腺苷脱氨酶或结核分枝杆菌聚合酶链反应检测、针对颅内强化病变的单光子发射计算机断层扫描（SPECT）以及有限的治疗试验。在涉及26例患者的12个月期间，我们发现该算法在所有23例可评估患者中均正确识别了局灶性颅内病变的病因。仅淋巴瘤患者住院时间的缩短所节省的费用就超过了整个研究队列的SPECT扫描费用。算法方法可以准确识别HIV感染患者中枢神经系统（CNS）占位性病变的病因，并且在大多数怀疑有机会性恶性肿瘤的情况下，SPECT扫描可以替代立体定向脑活检。
