Diederich N, Ackermann R, Jürgens R, Ortseifen M, Thun F, Schneider M, Vukadinovic I
Universitäts-Nervenklinik Köln, Schwerpunkt Neurologie, FRG.
Eur Neurol. 1988;28(2):93-103. doi: 10.1159/000116238.
We report on 79 patients of different stages of human immune deficiency virus (HIV) infection according to the Walter-Reed staging classification (WR). Comparing the HIV antibody content per weight IgG in serum and cerebrospinal fluid (CSF), 54 patients (68%) showed higher antibody activity in CSF than in serum, indicating intrathecal antibody production and thus a local challenge with the virus. The percentage of patients with these antibodies in CSF increased from stage WR 1 (33%) to WR 5 (90%). It decreased again in WR 6 (68%). Twenty-one patients with intrathecally produced antibodies but without evidence for opportunistic or preexistent neuropsychiatric diseases were further analyzed. Even in stages WR 1 and 2 these patients showed distinct clinical signs. These consisted mostly in apathic personality change (n = 13), peripheral neuropathy (n = 8) or mild hemisyndrome (n = 9). Progression to severe dementia solely caused by HIV encephalitis seems to be possible. More often acceleration of the mental disorder indicates a synergistic action of other pathogens. Our study gives further evidence for very frequent, early and clinically active involvement of the nervous system by the HIV infection.
我们报告了79例根据沃尔特 - 里德分期分类（WR）处于不同阶段的人类免疫缺陷病毒（HIV）感染患者。比较血清和脑脊液（CSF）中每重量IgG的HIV抗体含量，54例患者（68%）脑脊液中的抗体活性高于血清，表明存在鞘内抗体产生，从而提示病毒的局部侵袭。脑脊液中存在这些抗体的患者百分比从WR 1期（33%）增加到WR 5期（90%）。在WR 6期又降至68%。对21例有鞘内产生抗体但无机会性或既往神经精神疾病证据的患者进行了进一步分析。即使在WR 1期和2期，这些患者也表现出明显的临床症状。这些症状主要包括情感淡漠性人格改变（n = 13）、周围神经病变（n = 8）或轻度偏瘫综合征（n = 9）。仅由HIV脑炎导致进展为严重痴呆似乎是可能的。更常见的是精神障碍加速表明其他病原体的协同作用。我们的研究进一步证明HIV感染非常频繁、早期且临床上积极累及神经系统。
