Saylor Deanna, Nakigozi Gertrude, Nakasujja Noeline, Robertson Kevin, Gray Ronald H, Wawer Maria J, Sacktor Ned
From the Department of Neurology (D.S., N.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Rakai Health Sciences Program (G.N.), Kalisizo, Uganda; Department of Psychiatry (N.N.), Makerere University, Kampala, Uganda; Department of Neurology (K.R.), University of North Carolina-Chapel Hill; and Department of Epidemiology (R.H.G., M.J.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Neurology. 2017 Aug 1;89(5):485-491. doi: 10.1212/WNL.0000000000004136. Epub 2017 Jul 5.
To determine the prevalence, risk factors, and functional impairment associated with peripheral neuropathy in a prospective cohort of adults in rural Uganda.
Eight hundred participants (400 HIV- and 400 antiretroviral-naive HIV+) in the Rakai Community Cohort Study underwent detailed neurologic evaluations including assessment of neuropathy symptoms, functional measures (Patient Assessment of Own Functioning Inventory and Karnofsky Performance Status scores), and neurologic evaluation by a trained medical officer. Neuropathy was defined as ≥1 subjective symptom and ≥1 sign of neuropathy on examination. Neuropathy risk factors were assessed using log binomial regression.
Fifty-three percent of participants were men, with a mean (SD) age of 35 (8) years. Neuropathy was present in 13% of the cohort and was more common in HIV+ vs HIV- participants (19% vs 7%, < 0.001). Older age (relative risk [RR] 1.04, 95% confidence interval [CI] 1.02-1.06), female sex (RR 1.49, 95% CI 1.04-2.15), HIV infection (RR 2.82, 95% CI 1.86-4.28), tobacco use (RR 1.59, 95% CI 1.02-2.48), and prior neurotoxic medication use (RR 2.08, 95% CI 1.07-4.05) were significant predictors of neuropathy in the overall cohort. Only older age was associated with neuropathy risk in the HIV+ (RR 1.03, 95% CI 1.01-1.05) and HIV- (RR 1.06, 95% CI 1.02-1.10) cohorts. Neuropathy was associated with impaired functional status on multiple measures across all participant groups.
Peripheral neuropathy is relatively common and associated with impaired functional status among adults in rural Uganda. Older age, female sex, and HIV infection significantly increase the risk of neuropathy. Neuropathy may be an underrecognized but important condition in rural Uganda and warrants further study.
确定乌干达农村成年前瞻性队列中周围神经病变的患病率、危险因素及功能损害情况。
在拉凯社区队列研究中，800名参与者（400名未感染HIV者和400名未接受抗逆转录病毒治疗的HIV感染者）接受了详细的神经学评估，包括神经病变症状评估、功能测量（患者自我功能评估量表和卡氏功能状态评分）以及由训练有素的医务人员进行的神经学评估。神经病变定义为检查时有≥1种主观症状和≥1种神经病变体征。使用对数二项回归评估神经病变危险因素。
参与者中53%为男性，平均（标准差）年龄为35（8）岁。队列中13%的人存在神经病变，HIV感染者比未感染HIV者更常见（19%对7%，P<0.001）。年龄较大（相对风险[RR]1.04，95%置信区间[CI]1.02 - 1.06）、女性（RR 1.49，95% CI 1.04 - 2.15）、HIV感染（RR 2.82，95% CI 1.86 - 4.28）、吸烟（RR 1.59，95% CI 1.02 - 2.48）以及既往使用神经毒性药物（RR 2.08，95% CI 1.07 - 4.05）是整个队列中神经病变的显著预测因素。在HIV感染者队列（RR 1.03，95% CI 1.01 - 1.05）和未感染HIV者队列（RR 1.06，95% CI 1.02 - 1.10）中，只有年龄较大与神经病变风险相关。在所有参与者组中，神经病变与多种测量指标的功能状态受损有关。
在乌干达农村成年人中，周围神经病变相对常见且与功能状态受损有关。年龄较大、女性以及HIV感染显著增加神经病变风险。在乌干达农村，神经病变可能是一种未被充分认识但很重要的疾病，值得进一步研究。
