HIV 与退行性脊柱疾病手术：系统评价。
HIV and Surgery for Degenerative Spine Disease: A Systematic Review.
机构信息
University of Caxias do Sul, Caxias do Sul, Brazil.
Health Sciences Postgraduate Program, University of Caxias do Sul, Caxias do Sul, RS, Brazil.
出版信息
J Neurol Surg A Cent Eur Neurosurg. 2021 Sep;82(5):468-474. doi: 10.1055/s-0041-1724111. Epub 2021 Apr 12.
BACKGROUND AND STUDY AIMS
The objective of this review is to evaluate the incidence of operative treatment, outcomes, and complications of surgery for degenerative spine disease (DSD) on human immunodeficiency virus (HIV) positive patients. Combined antiretroviral treatment led HIV patients to live long enough to develop many chronic conditions common in the uninfected population. Surgery for DSD is one of the most commonly performed neurosurgical procedures. However, the incidence of spine surgery for DSD in HIV-positive patients seems to be lower than that in uninfected individuals, although this has not been clearly determined.
METHODS
A systematic search of the Medline, Web of Science, Embase, and SciElo databases was conducted. Only primary studies addressing DSD surgery on HIV-positive patients were included. Evaluated variables were rates of surgical treatment, surgical outcomes and complications, year of publication, country where study was conducted, type of study, and level of evidence.
RESULTS
Six articles were included in the review from 1,108 records. Significantly lower rates of DSD surgery were identified in HIV-infected patients (0.86 per 1,000 patient-years) when compared with uninfected patients (1.41 per 1,000 patient-years). There was a significant increase in spinal surgery in HIV-positive patients over time, with a 0.094 incidence per 100,000 in the year 2000 and 0.303 in 2009. HIV-positive patients had very similar outcomes when compared with controls, with 66.6% presenting pain relief at a 3-month follow-up. Higher incidences of hospital mortality (1.6 vs. 0.3%; < 0.001) and complications (12.2 vs. 9.5%, < 0.001) were observed in HIV carriers.
CONCLUSIONS
HIV-positive individuals appear to undergo less surgery for DSD than HIV-negative individuals. Improvement rates appear to be similar in both groups, even though some complications appear to be more prevalent in HIV carriers. Larger studies are needed for decisive evidence on the subject.
背景和研究目的
本综述的目的是评估人类免疫缺陷病毒（HIV）阳性患者退行性脊柱疾病（DSD）手术的治疗率、结果和并发症。联合抗逆转录病毒治疗使 HIV 患者的寿命延长到足以患上许多在未感染者中常见的慢性疾病。DSD 的手术治疗是最常见的神经外科手术之一。然而，HIV 阳性患者脊柱手术治疗 DSD 的发生率似乎低于未感染者，尽管这一点尚未明确确定。
方法
对 Medline、Web of Science、Embase 和 SciElo 数据库进行了系统检索。仅纳入了针对 HIV 阳性患者 DSD 手术的原始研究。评估的变量包括手术治疗率、手术结果和并发症、发表年份、研究所在国家、研究类型和证据水平。
结果
从 1108 条记录中纳入了 6 篇文章进行综述。与未感染者（每 1000 名患者年 1.41 例）相比，HIV 感染者（每 1000 名患者年 0.86 例）接受 DSD 手术的比例明显较低。随着时间的推移，HIV 阳性患者的脊柱手术显著增加，2000 年每 10 万人中有 0.094 例，2009 年有 0.303 例。与对照组相比，HIV 阳性患者的结果非常相似，3 个月随访时 66.6%的患者疼痛缓解。HIV 携带者的住院死亡率（1.6%比 0.3%； < 0.001）和并发症发生率（12.2%比 9.5%； < 0.001）更高。
结论
HIV 阳性个体接受 DSD 手术的比例似乎低于 HIV 阴性个体。尽管 HIV 携带者的一些并发症似乎更为普遍，但两组的改善率似乎相似。需要更大的研究来提供关于该主题的决定性证据。
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