Simpson D M, Kitch D, Evans S R, McArthur J C, Asmuth D M, Cohen B, Goodkin K, Gerschenson M, So Y, Marra C M, Diaz-Arrastia R, Shriver S, Millar L, Clifford D B
Mount Sinai Hospital, New York, NY, USA.
Neurology. 2006 Jun 13;66(11):1679-87. doi: 10.1212/01.wnl.0000218303.48113.5d.
Distal sensory polyneuropathy (DSP) is the most common neurologic complication of human immunodeficiency virus (HIV) infection. Risk factors for DSP have not been adequately defined in the era of highly active antiretroviral therapy.
The authors evaluated 101 subjects with advanced HIV infection over 48 weeks. Assessments included a brief peripheral neuropathy (PN) screen (BPNS), neurologic examination, nerve conduction studies, quantitative sensory testing (QST), and skin biopsies with quantitation of epidermal nerve fiber density. Data were summed into a Total Neuropathy Score (TNS). The presence, severity, and progression of DSP were related to clinical and laboratory results.
The mean TNS (range 0 to 36) was 8.9, with 38% of subjects classified as PN-free, 10% classified as having asymptomatic DSP, and 52% classified as having symptomatic DSP. Progression in TNS from baseline to week 48 occurred only in the PN-free group at baseline (mean TNS change = 1.16 +/- 2.76, p = 0.03). Factors associated with progression in TNS were lower current TNS, distal epidermal denervation, and white race. As compared with the TNS diagnosis of PN at baseline, the BPNS had a sensitivity of 34.9% and a specificity of 89.5%.
In this cohort of advanced human immunodeficiency virus (HIV)-infected subjects, distal sensory polyneuropathy was common and relatively stable over 48 weeks. Previously established risk factors, including CD4 cell count, plasma HIV RNA, and use of dideoxynucleoside antiretrovirals were not predictive of the progression of distal sensory polyneuropathy (DSP). Distal epidermal denervation was associated with worsening of DSP. As compared with the Total Neuropathy Score, the brief peripheral neuropathy screen had relatively low sensitivity and high specificity for the diagnosis of DSP.
远端感觉性多发性神经病（DSP）是人类免疫缺陷病毒（HIV）感染最常见的神经并发症。在高效抗逆转录病毒治疗时代，DSP的危险因素尚未得到充分界定。
作者对101例晚期HIV感染患者进行了48周的评估。评估内容包括简短的周围神经病（PN）筛查（BPNS）、神经系统检查、神经传导研究、定量感觉测试（QST）以及皮肤活检并对表皮神经纤维密度进行定量。数据汇总为总神经病评分（TNS）。DSP的存在、严重程度和进展与临床及实验室结果相关。
TNS平均值（范围0至36）为8.9，38%的受试者被分类为无PN，10%被分类为患有无症状DSP，52%被分类为患有有症状DSP。仅在基线时无PN的组中，TNS从基线到第48周出现了进展（TNS平均变化 = 1.16 +/- 2.76，p = 0.03）。与TNS进展相关的因素包括当前较低的TNS、远端表皮去神经支配和白种人。与基线时TNS对PN的诊断相比，BPNS的敏感性为34.9%，特异性为89.5%。
在这组晚期人类免疫缺陷病毒（HIV）感染受试者中，远端感觉性多发性神经病很常见，且在48周内相对稳定。先前确定的危险因素，包括CD4细胞计数、血浆HIV RNA以及使用双脱氧核苷类抗逆转录病毒药物，均不能预测远端感觉性多发性神经病（DSP）的进展。远端表皮去神经支配与DSP的恶化相关。与总神经病评分相比，简短周围神经病筛查对DSP诊断的敏感性相对较低，特异性较高。
