HIV 感染并不影响 HIV 感染患者的中风结局：一项前瞻性研究。

HIV infection does not influence stroke outcomes in HIV-infected patients: A prospective study.

机构信息

Department of Clinical Sciences, University of Douala, 25019 Douala, Cameroon; Douala General Hospital, Douala, Cameroon.

Department of Clinical Sciences, University of Douala, 25019 Douala, Cameroon.

出版信息

Rev Neurol (Paris). 2019 May;175(5):313-318. doi: 10.1016/j.neurol.2018.09.020. Epub 2019 Apr 1.

DOI:10.1016/j.neurol.2018.09.020

PMID:30948261

Abstract

BACKGROUND

Human immunodeficiency virus (HIV) infection, opportunistic infections and antiretroviral therapy contribute to the pathogenesis of stroke, yet, little is known about the influence of HIV infection on outcome in stroke patients. The aim of this study was to compare the outcome of stroke in HIV-infected patients with that of HIV-negative patients at the Douala General Hospital (DGH).

PATIENTS AND METHODS

A prospective cohort study was carried out at the Neurology unit and the Intensive Care Unit of the DGH from January 2010 to December 2015. All patients aged 15 years and above, admitted for stroke confirmed by brain imaging were included. HIV testing was systematically prescribed for all stroke patients. HIV-infected patients were then compared with HIV-uninfected patients. Quantitative variables were expressed as means while qualitative variables were expressed as frequencies, and were compared with the Chi test or the Fisher test and the Student test respectively. Stroke outcome was evaluated by the mortality, in-hospital stay and functional outcome at 6 months post-stroke. Kaplan-Meyer method was used to determine survival.

RESULTS

Forty of the 608 patients with stroke were HIV-positive, giving an in-hospital HIV prevalence of 6.6%. Mean age of the HIV-infected stroke patients was 51.3±10.4 years as against 59.6±13.53 in the HIV-uninfected group (P=0.001). The proportion of dyslipidemia in HIV-infected stroke patients with was greater than that in HIV-uninfected stroke patients (57.5% vs 8.9%, P<0.001). The most common type of stroke was ischemic in two-thirds of the patients in both groups. HIV-infected stroke patients had a mean hospital stay longer than that of HIV-uninfected patients (10.3±8.1 days vs 8.1±6.3 days, P=0.042). Post-stroke infections were more frequent in HIV-infected patients (17.5% vs 6.9%, P=0.014). The cumulative mortality rates at 6 months were 37.5% and 34.5% for the HIV-infected and the HIV-uninfected groups respectively (P=0.471). The functional outcome was similar in both groups at the 6 month post-stroke (Rankin score>2: 38.5%vs 38.8%, P=0.973). There was no difference in survival between the two groups.

CONCLUSION

HIV infection does not affect in-hospital mortality and functional outcome in stroke patients a part the length of hospital stay.

摘要

背景

人类免疫缺陷病毒（HIV）感染、机会性感染和抗逆转录病毒治疗是导致中风发病机制的原因，但HIV 感染对中风患者预后的影响知之甚少。本研究旨在比较喀麦隆杜阿拉总医院（DGH）HIV 感染患者与 HIV 阴性患者中风的结局。

方法

这是一项在 2010 年 1 月至 2015 年 12 月期间在 DGH 的神经科病房和重症监护病房进行的前瞻性队列研究。所有年龄在 15 岁及以上、经脑部影像学检查确诊为中风的患者均纳入研究。所有中风患者均常规进行 HIV 检测。然后，将 HIV 感染患者与 HIV 未感染患者进行比较。定量变量用平均值表示，定性变量用频率表示，并分别用卡方检验或 Fisher 检验和 Student 检验进行比较。中风结局通过死亡率、住院时间和中风后 6 个月的功能结局进行评估。Kaplan-Meier 法用于确定生存情况。

结果

608 例中风患者中，有 40 例 HIV 阳性，院内 HIV 感染率为 6.6%。HIV 感染的中风患者平均年龄为 51.3±10.4 岁，而 HIV 未感染的中风患者为 59.6±13.53 岁（P=0.001）。HIV 感染的中风患者中血脂异常的比例大于 HIV 未感染的中风患者（57.5%比 8.9%，P<0.001）。两组中超过三分之二的患者最常见的中风类型是缺血性中风。与 HIV 未感染的中风患者相比，HIV 感染的中风患者的平均住院时间更长（10.3±8.1 天比 8.1±6.3 天，P=0.042）。HIV 感染的中风患者中风后感染更为常见（17.5%比 6.9%，P=0.014）。两组患者 6 个月的累积死亡率分别为 37.5%和 34.5%（HIV 感染组和 HIV 未感染组分别为 37.5%和 34.5%，P=0.471）。两组患者在中风后 6 个月的功能结局相似（Rankin 评分>2：38.5%比 38.8%，P=0.973）。两组患者的生存率无差异。