McArthur J C, Hoover D R, Bacellar H, Miller E N, Cohen B A, Becker J T, Graham N M, McArthur J H, Selnes O A, Jacobson L P
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
Neurology. 1993 Nov;43(11):2245-52. doi: 10.1212/wnl.43.11.2245.
We determined incidence and future projections of dementia after AIDS onset in 492 homosexual men with AIDS in the Baltimore/Los Angeles sites of the Multicenter AIDS Cohort Study, 64 of whom developed dementia. We studied various risk factors for dementia, including demographic and clinical features, medical history, markers of immune status before AIDS, and zidovudine use. During the first 2 years after AIDS, HIV dementia developed at an annual rate of 7%. Overall, 15% of the cohort followed through death developed dementia. The median survival after dementia was 6.0 months. Using a proportional hazards model, risk factors for more rapid development of dementia were lower hemoglobin (relative hazard, 0.59 per additional 2 g/dl; p = 0.0005) and body mass index (relative hazard, 0.64 per additional 5 kg/m2; p = 0.05) 1 to 6 months before AIDS, more constitutional symptoms 7 to 12 months before AIDS (relative hazard, 1.68 per additional symptom, p = 0.005), and older age at AIDS onset (relative hazard, 1.60 per decade older; p = 0.009). In a multivariate model, pre-AIDS hemoglobin remained the most significant predictor of dementia. There were no significant risks defined from demographic characteristics, specific AIDS-defining illnesses, zidovudine use before AIDS, or CD4+ lymphocyte count before AIDS. We project that 12 months after the first AIDS diagnosis, 7.1% of survivors will have dementia. The observed association between anemia, low weight, constitutional symptoms, and dementia suggests a role for cytokines inducing both systemic and neurologic disease.
我们在多中心艾滋病队列研究的巴尔的摩/洛杉矶站点，对492名患有艾滋病的同性恋男性进行了研究，以确定艾滋病发病后痴呆症的发病率及未来预测情况，其中64人患上了痴呆症。我们研究了痴呆症的各种风险因素，包括人口统计学和临床特征、病史、艾滋病发病前的免疫状态标志物以及齐多夫定的使用情况。在艾滋病发病后的头两年，HIV痴呆症的年发病率为7%。总体而言，随访至死亡的队列中有15%患上了痴呆症。痴呆症后的中位生存期为6.0个月。使用比例风险模型，痴呆症更快发展的风险因素包括艾滋病发病前1至6个月时较低的血红蛋白水平（相对风险，每增加2 g/dl为0.59；p = 0.0005）和体重指数（相对风险，每增加5 kg/m2为0.64；p = （此处原文有误，推测为0.05）），艾滋病发病前7至12个月更多的全身症状（相对风险，每增加一个症状为1.68；p = 0.005），以及艾滋病发病时年龄较大（相对风险，每大十岁为1.60；p = 0.009）。在多变量模型中，艾滋病发病前的血红蛋白仍然是痴呆症最显著的预测指标。从人口统计学特征、特定的艾滋病界定疾病、艾滋病发病前齐多夫定的使用情况或艾滋病发病前CD4 +淋巴细胞计数中未发现显著风险。我们预计在首次诊断艾滋病12个月后，7.1%的幸存者将患有痴呆症。贫血、低体重、全身症状与痴呆症之间观察到的关联表明细胞因子在引发全身和神经系统疾病中发挥了作用。
