Martínez A J, Sell M, Mitrovics T, Stoltenburg-Didinger G, Iglesias-Rozas J R, Giraldo-Velásquez M A, Gosztonyi G, Schneider V, Cervós-Navarro J
Freie Universität Berlin, Universitätsklinikum Benjamin Franklin, Germany.
Pathol Res Pract. 1995 Jun;191(5):427-43. doi: 10.1016/S0344-0338(11)80730-2.
The brains of 200 patients who died with Acquired Immunodeficiency Syndrome (AIDS) from Berlin were examined retrospectively. This study was specifically intended to evaluate and document the prevalence of neuropathologic abnormalities, establishing the frequency of the various types of structural lesions, their combinations, their relative incidence, and the risk factors involved in different age groups. The data were compared and contrasted with the findings reported from other parts of the world and other German cities. It was found that the mean age of this group of patients was 41.4 years old, 75% were homosexual/bisexuals (H/B) and 18.5% were drug abusers (DA). Only 5.5% were women. Brain parenchymal changes, called in this report, HIV-related encephalopathy (HIVRE), characterized by vacuolization or spongy changes and astrocytosis in the subcortical white matter, and occasionally in gray matter, were found in 67 patients (33.5%). Drug abusers had a higher incidence of HIVRE (59.5%) compared with homosexual/bisexuals (28%). This is statistically significant (p < 0.0005). CMV encephalitis was found in 26 patients (13%) (8% of the drug abusers in contrast to 13% in the homosexual/bisexuals group). Primary central nervous system lymphoma (PCNSL) was seen in 28 patients (14%) regardless of the risk factor involved. 20 (13%) of the 150 H/B and 3 (8%) of the 37 DA had CMV encephalitis. Of the 150 H/B, 24 (16%) had PCNSL compared with only 4 of 37 (11%) of the DA. A significant incidence of opportunistic infections, both protozoal and viral was found in all groups. Cerebral toxoplasmosis occurred in 68 patients (34%). Microglial (phagocytic) nodules, probably related to CMV or cerebral Toxoplasmosis, were observed in 40 cases (20%). Diffuse microglial proliferation was noted in 104 patients (52%). Cerebral cryptococcosis was found in three patients. Progressive multifocal leukoencephalopathy was seen in 16 patients (8%). Various combinations of CNS pathological processes were found in 44 of the patients (22%). These include concomitant infections with Toxoplasma gondii and HIVRE in 13 patients; Toxoplasmosis and PCNSL in 8 patients; Toxoplasmosis with CMV and HIVRE in 4 patients; Toxoplasmosis with CMV in 2 patients; Toxoplasmosis with PCNSL and CMV in 2 patients; Toxoplasmosis with PCNSL and HIVRE in 2 patients and Toxoplasmosis with PML and HIVRE in 2 patients; Cerebral CMV with PCNSL and HIVRE in 4 patients; Cerebral CMV with HIVRE in 2 patients; PML with PCNSL in one patient; PML with HIVRE in 2 patients; and PML with PCNSL and HIVRE in one patient. Cerebrovascular lesions were found in 34 patients (17%).(ABSTRACT TRUNCATED AT 400 WORDS)
对200例死于获得性免疫缺陷综合征（艾滋病）的柏林患者的大脑进行了回顾性检查。本研究旨在评估和记录神经病理学异常的患病率，确定各种类型结构病变的频率、它们的组合、相对发病率以及不同年龄组的相关危险因素。将这些数据与世界其他地区和德国其他城市报告的研究结果进行了比较和对比。结果发现，该组患者的平均年龄为41.4岁，75%为同性恋/双性恋者（H/B），18.5%为药物滥用者（DA）。女性仅占5.5%。在67例患者（3,5%）中发现了脑实质变化，本报告中称为与HIV相关的脑病（HIVRE），其特征为皮质下白质出现空泡化或海绵状变化以及星形细胞增多，偶尔在灰质中也有出现。与同性恋/双性恋者（28%）相比，药物滥用者中HIVRE的发病率更高（59.5%）。这具有统计学意义（p<0.0005）。26例患者（13%）发现有巨细胞病毒（CMV）脑炎（药物滥用者中有8%，而同性恋/双性恋者组中有13%）。无论涉及何种危险因素，28例患者（14%）出现原发性中枢神经系统淋巴瘤（PCNSL）。150例H/B中有20例（13%）、37例DA中有3例（8%）患有CMV脑炎。150例H/B中有24例（16%）患有PCNSL，而37例DA中只有4例（11%）患有PCNSL。在所有组中均发现了大量机会性感染，包括原生动物和病毒感染。68例患者（34%）发生脑弓形虫病。在40例患者（20%）中观察到可能与CMV或脑弓形虫病相关的小胶质细胞（吞噬性）结节。104例患者（52%）出现弥漫性小胶质细胞增生。3例患者发现脑隐球菌病。16例患者（8%）出现进行性多灶性白质脑病。44例患者（22%）发现中枢神经系统病理过程的各种组合。这些包括13例患者同时感染弓形虫和HIVRE；8例患者同时患有弓形虫病和PCNSL；4例患者同时患有弓形虫病、CMV和HIVRE；2例患者同时患有弓形虫病和CMV；2例患者同时患有弓形虫病、PCNSL和CMV；2例患者同时患有弓形虫病、PCNSL和HIVRE；2例患者同时患有弓形虫病、PML和HIVRE；4例患者同时患有脑CMV、PCNSL和HIVRE；2例患者同时患有脑CMV和HIVRE；1例患者同时患有PML和PCNSL；2例患者同时患有PML和HIVRE；1例患者同时患有PML、PCNSL和HIVRE。34例患者（17%）发现脑血管病变。（摘要截选至400字）
