在资源有限的环境中筛查 HIV 相关周围神经病变。
Screening for HIV-associated peripheral neuropathy in resource-limited settings.
机构信息
Department of Neurology, University of California San Francisco, 1001 Potrero Avenue, 4M62, Box 0870, San Francisco, California, 94110, USA.
出版信息
Muscle Nerve. 2013 Oct;48(4):516-24. doi: 10.1002/mus.23795. Epub 2013 Aug 27.
INTRODUCTION
Peripheral neuropathy is the most common neurological complication of human immunodeficiency virus (HIV) infection but is widely under-diagnosed in resource-limited settings. We investigated the utility of screening tools administered by nonphysician healthcare workers (HCW) and quantitative sensory testing (QST) administered by trained individuals for identification of moderate/severe neuropathy.
METHODS
We enrolled 240 HIV-infected outpatients using 2-stage cluster randomized sampling. HCWs administered the several screening tools. Trained study staff performed QST. Tools were validated against a clinical diagnosis of neuropathy.
RESULTS
Participants were 65% women, mean age 36.4 years, median CD4 324 cells/μL. A total of 65% were taking antiretrovirals, and 18% had moderate/severe neuropathy. The screening tests were 76% sensitive in diagnosing moderate/severe neuropathy with negative predictive values of 84-92%. QST was less sensitive but more specific.
CONCLUSIONS
Screening tests administered by HCW have excellent negative predictive values and are promising tools for scale-up in resource-limited settings. QST shows promise for research use.
简介
周围神经病变是人类免疫缺陷病毒（HIV）感染最常见的神经并发症，但在资源有限的环境中广泛被漏诊。我们研究了非医师医护人员（HCW）管理的筛查工具和经培训人员管理的定量感觉测试（QST）在识别中重度神经病变方面的效用。
方法
我们使用 2 阶段聚类随机抽样法纳入了 240 名 HIV 感染门诊患者。HCW 管理了几种筛查工具。训练有素的研究人员进行了 QST。将这些工具与神经病变的临床诊断进行了验证。
结果
参与者中 65%为女性，平均年龄为 36.4 岁，CD4 细胞中位数为 324 个/μL。共有 65%的人正在服用抗逆转录病毒药物，18%的人患有中重度神经病变。这些筛查测试在诊断中重度神经病变方面的敏感性为 76%，阴性预测值为 84-92%。QST 的敏感性较低，但特异性较高。
结论
由 HCW 管理的筛查测试具有出色的阴性预测值，是在资源有限的环境中推广的有前途的工具。QST 有望用于研究。
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