Tanajura Davi, Castro Néviton, Oliveira Paulo, Neto Abraão, Muniz André, Carvalho Natália B, Orge Glória, Santos Silvane, Glesby Marshall J, Carvalho Edgar M
Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador National Institute of Science and Technology of Tropical Diseases, Salvador Department of Natural Sciences, State University of Bahia Southeast, Vitória da Conquista.
Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador.
Clin Infect Dis. 2015 Jul 1;61(1):49-56. doi: 10.1093/cid/civ229. Epub 2015 Mar 27.
Human T-cell lymphotropic virus type 1 (HTLV-1) is the agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), observed in up to 5% of infected individuals. Despite low prevalence, many HTLV-1-infected patients who do not fulfill criteria for HAM/TSP present with neurological complaints related to sensory, motor, urinary, or autonomic manifestations. The aim of this study was to determine the incidence of neurologic manifestations and risk factors associated with these outcomes.
The incidence of HAM/TSP and new signs and neurologic symptoms were computed in a group of patients enrolled in a cohort study.
Of 414 subjects, 76 had definite HAM/TSP, 87 had possible or probable HAM/TSP, and 251 subjects had no neurologic manifestation and were selected for analysis. Definite HAM/TSP developed in 5 (1.47%) patients. Follow-up of at least 3 years was achieved in 51% of patients. The incidence rate was computed in 1000 person-years (206 for hand numbness, 187 for feet numbness, 130 for nocturia, and 127 for urgency). Average incidence rate in neurological exam was 76 for leg hyperreflexia, 53 for leg weakness, and 37 for Babinski sign. In the applied Expanded Disability Status Scale, the incidence rate of worsening 1 point was 134 per 1000 person-years. Kaplan-Meier curves stratified by sex and proviral load showed that females and patients with proviral load >50,000 copies/10(6) peripheral blood mononuclear cells had a higher risk of progression.
Development of neurological symptoms or signs occurred in up to 30% of asymptomatic subjects during 8 years of follow-up.
人类嗜T淋巴细胞病毒1型（HTLV-1）是HTLV-1相关脊髓病/热带痉挛性截瘫（HAM/TSP）的病原体，在高达5%的感染者中可见。尽管患病率较低，但许多不符合HAM/TSP标准的HTLV-1感染患者存在与感觉、运动、泌尿或自主神经表现相关的神经学主诉。本研究的目的是确定神经学表现的发生率以及与这些结果相关的危险因素。
在一组纳入队列研究的患者中计算HAM/TSP以及新出现的体征和神经症状的发生率。
414名受试者中，76人患有明确的HAM/TSP，87人可能或疑似患有HAM/TSP，251名受试者无神经学表现并被选入分析。5名（1.47%）患者出现明确的HAM/TSP。51%的患者实现了至少3年的随访。按每1000人年计算发病率（手部麻木为206，足部麻木为187，夜尿为130，尿急为127）。神经学检查中腿部反射亢进的平均发病率为76，腿部无力为53，巴宾斯基征为37。在应用的扩展残疾状态量表中，恶化1分的发病率为每1000人年134。按性别和前病毒载量分层的Kaplan-Meier曲线显示，女性和前病毒载量>50,000拷贝/10(6)外周血单个核细胞的患者进展风险更高。
在8年的随访中，高达30%的无症状受试者出现了神经症状或体征。
