Moolla Salma, Rajkumar Ashmitha, de Vries Elma
School of Public Health and Family Medicine, University of Cape Town, South Africa.
Western Cape Government Department of Health, Mitchells Plain Hospital, South Africa.
South Afr J HIV Med. 2015 Jul 3;16(1):354. doi: 10.4102/sajhivmed.v16i1.354. eCollection 2015.
Current international guidelines recommend that a cranial computed tomography (CT) be performed on all HIV-positive patients presenting with new onset seizures, before a lumbar puncture (LP) is performed. In the South African setting, however, this delay could be life threatening. The present study sought to measure the number of cranial CTs that contraindicate an LP and to predict which clinical signs and symptoms are likely to pose an increased risk from LP.
The study was performed at a district level hospital in Western Cape Province. Data were collected retrospectively from October 2013 to October 2014. Associations between categorical variables were analysed using Pearson's chi-squared test. Generalised linear regression was used to estimate prevalence ratios.
One hundred out of 132 patients were studied. Brain shift contraindicated an LP in 5% of patients. Patients with brain shift presented with decreased level of consciousness, focal signs, headache and neck stiffness. Twenty-five per cent of patients had a space-occupying lesion (SOL) (defined as a discrete lesion that has a measurable volume) or cerebral oedema. Multivariate analysis showed a CD4 count <50 ( = 0.033) to be a statistically significant predictor of patients with SOL and cerebral oedema. Univariate analysis showed focal signs ( = 0.0001), neck stiffness ( = 0.05), vomiting ( = 0.018) and a Glascow Coma Scale (GCS) < 15 ( = 0.002) to be predictors of SOL and cerebral oedema.
HIV-positive patients with seizures have a high prevalence of SOL and cerebral oedema but the majority of them are safe for LP. Doctors can use clinical parameters to determine which patients can undergo immediate LP.
当前国际指南建议，对于所有新发癫痫的HIV阳性患者，在进行腰椎穿刺（LP）之前应先进行头颅计算机断层扫描（CT）。然而，在南非的情况下，这种延迟可能会危及生命。本研究旨在测量禁忌进行LP的头颅CT数量，并预测哪些临床体征和症状可能会增加LP的风险。
该研究在西开普省的一家区级医院进行。回顾性收集了2013年10月至2014年10月的数据。使用Pearson卡方检验分析分类变量之间的关联。采用广义线性回归估计患病率比。
对132例患者中的l00例进行了研究。脑移位在5%的患者中禁忌进行LP。出现脑移位的患者表现为意识水平下降、局灶性体征、头痛和颈部僵硬。25%的患者有占位性病变（SOL）（定义为具有可测量体积的离散病变）或脑水肿。多变量分析显示CD4细胞计数<50（P = 0.033）是SOL和脑水肿患者的统计学显著预测指标。单变量分析显示局灶性体征（P = 0.0001）、颈部僵硬（P = 0.05）、呕吐（P = 0.018）和格拉斯哥昏迷量表（GCS）<15（P = 0.002）是SOL和脑水肿的预测指标。
癫痫发作的HIV阳性患者中SOL和脑水肿的患病率较高，但其中大多数患者进行LP是安全的。医生可以使用临床参数来确定哪些患者可以立即进行LP。
