HIV 感染者的癫痫发作：埃塞俄比亚的回顾性研究——临床表现、病因和治疗结局。

Seizure in HIV-infected patients: clinical presentation, cause and treatment outcome in Ethiopia-a retrospective study.

机构信息

Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia.

出版信息

BMC Infect Dis. 2021 Aug 10;21(1):790. doi: 10.1186/s12879-021-06497-7.

DOI:10.1186/s12879-021-06497-7

PMID:34376185

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8353860/

Abstract

BACKGROUND

The estimated number of adult patients living with HIV infection in Ethiopia in 2012 was approximately 800,000. Seizure occurs in 2 to 3% and 6.1% to 34.3% in patients with HIV infection and patients with neurological complications of HIV infection, respectively. Studies on HIV infection and seizure are rare in Ethiopia. The purpose of this study was to assess clinical presentation, cause and treatment outcome of patients with HIV infection presented with seizure.

METHODS

In this retrospective study, patients aged ≥ 13 years with HIV infection presented with seizure were included. Medical records were reviewed and demographic and clinical data were collected.

RESULTS

Records of 146 patients were analysed. Males were 55.5% and the mean age was 34 years. The diagnosis of HIV infection was made after current hospital admission in 69% of patients. Almost all patients (98.6%) had stage 4 HIV infection with very low CD4 count (mean = 77/mm). In almost all patients seizure was a recent onset at current admission; either it started after admission (42.5%) or within 3 months prior to admission (52.5%). The types of seizures were: generalized tonic-clonic seizure [GTCS] (69.2%), focal motor with secondarily generalization [FMWSG] (19.9%) and simple focal motor (11%). The common causes of seizure were: cerebral toxoplasmosis (46%), tuberculous meningitis (35.6%) and cryptococcal meningitis (13.7%). Case-fatality was 53% and predictors of mortality were: seizure started after admission, change in mentation and comatose at initial evaluation.

CONCLUSIONS

Most patients had stage 4 HIV infection with very low CD4 count and a recent onset seizure which started within 3 months at initial evaluation. GTCS was the commonest seizure type and most causes of seizure were central nervous system opportunistic infections. The case-fatality was high and change in sensorium was an independent predictor of mortality. To prevent the high mortality and morbidity prevention of HIV infection, early diagnosis and treatment, improving diagnostic facilities and access to non-enzyme inducing antiepileptic drugs are recommended.

摘要

背景

2012 年，埃塞俄比亚估计有 80 万成年艾滋病毒感染者。在艾滋病毒感染者和艾滋病毒感染引起的神经并发症患者中，分别有 2%至 3%和 6.1%至 34.3%出现癫痫发作。在埃塞俄比亚，关于艾滋病毒感染和癫痫发作的研究很少。本研究旨在评估以癫痫发作为表现的艾滋病毒感染患者的临床表现、病因和治疗结果。

方法

在这项回顾性研究中，纳入了年龄≥13 岁且以癫痫发作为首发表现的艾滋病毒感染患者。对病历进行了回顾，并收集了人口统计学和临床数据。

结果

分析了 146 例患者的记录。男性占 55.5%，平均年龄为 34 岁。69%的患者是在当前住院期间确诊为艾滋病毒感染的。几乎所有患者（98.6%）均处于 HIV 感染 4 期，CD4 计数极低（平均为 77/mm）。几乎所有患者的癫痫发作均为当前入院时的近期发作；要么是入院后开始发作（42.5%），要么是入院前 3 个月内开始发作（52.5%）。发作类型为：全面强直阵挛发作[GTCS]（69.2%）、局灶性运动伴继发全面性发作[FMWSG]（19.9%）和单纯局灶性运动（11%）。癫痫发作的常见病因是：脑弓形虫病（46%）、结核性脑膜炎（35.6%）和隐球菌性脑膜炎（13.7%）。病死率为 53%，死亡的预测因素为：入院后开始发作、意识状态改变和初始评估时昏迷。

结论

大多数患者 HIV 感染处于 4 期，CD4 计数极低，且近期发作的癫痫发作在初始评估 3 个月内开始。GTCS 是最常见的癫痫发作类型，大多数癫痫发作的病因是中枢神经系统机会性感染。病死率高，意识状态改变是死亡的独立预测因素。为了预防高死亡率和发病率，建议预防艾滋病毒感染、早期诊断和治疗、改善诊断设施和获得非酶诱导抗癫痫药物。