Portegies P, Enting R H, de Gans J, Algra P R, Derix M M, Lange J M, Goudsmit J
Department of Neurology, University of Amsterdam, The Netherlands.
AIDS. 1993 May;7(5):669-75.
To assess the clinical presentation and course of the AIDS dementia complex (ADC).
Retrospective study of a consecutive series of symptomatic HIV-1-infected patients [Centers for Disease Control and Prevention (CDC) stages IVA, B, C and D] evaluated for neurological symptoms between 1982 and 1992.
An academic referral centre for AIDS.
A total of 536 symptomatic HIV-1-infected patients evaluated for neurological symptoms between 1982 and 1992.
Zidovudine treatment, which was introduced in The Netherlands on 1 May 1987 for patients with severe symptoms of HIV infection (CDC stages IVA, B, C and D).
Diagnosis of ADC and CD4 cell count, clinical features, neuropsychological abnormalities, computed tomography (CT) and magnetic resonance imaging (MRI) abnormalities, cerebrospinal fluid (CSF) findings and course in patients with ADC.
ADC was diagnosed in 40 out of 536 (7.5%) immunosuppressed, neurologically symptomatic HIV-1-infected patients in CDC stage IV, and was the AIDS-defining illness in six. The mean CD4 cell count of the 40 patients with ADC was 109 x 10(6)/l. Neuropsychological abnormalities in 15 out of 17 patients tested were in accordance with subcortical dementia. On CT scan of the brain, 70% showed no or only mild cortical atrophy. MRI was more sensitive than CT scan for detecting white matter abnormalities (73 versus 35%; P = 0.02). CSF examination showed mononuclear pleocytosis in 25%, protein level increase in 55%, and HIV-1 p24 core protein in 38% (13 out of 34). The mean survival was 6.7 months in the 40 ADC patients, but 4 months in 20 patients who had never used zidovudine, compared with 14.8 months in 10 patients who started zidovudine after they were classified as having ADC (P < 0.001). Three of these 10 patients improved remarkably, and two slightly, after starting zidovudine. ADC developed after discontinuation of zidovudine in nine patients. Only one patient developed ADC while receiving 600 mg zidovudine.
MRI is more sensitive than CT for detecting white matter abnormalities. To date, there is no specific or sensitive CSF marker for ADC. Zidovudine may improve symptoms and prolong survival in patients with ADC, which rarely developed with continued zidovudine use in our study.
评估艾滋病痴呆综合征（ADC）的临床表现及病程。
对1982年至1992年间因神经系统症状接受评估的一系列连续的有症状HIV-1感染患者（美国疾病控制与预防中心[CDC] IVA、B、C和D期）进行回顾性研究。
一家艾滋病学术转诊中心。
1982年至1992年间共有536名有症状的HIV-1感染患者因神经系统症状接受评估。
齐多夫定治疗，1987年5月1日在荷兰开始用于有严重HIV感染症状的患者（CDC IVA、B、C和D期）。
ADC的诊断及CD4细胞计数、临床特征、神经心理学异常、计算机断层扫描（CT）和磁共振成像（MRI）异常、脑脊液（CSF）检查结果以及ADC患者的病程。
在536名处于CDC IV期、免疫抑制且有神经系统症状的HIV-1感染患者中，40例（7.5%）被诊断为ADC，其中6例为定义艾滋病的疾病。40例ADC患者的平均CD4细胞计数为109×10⁶/L。17例接受测试的患者中有15例神经心理学异常符合皮质下痴呆。脑部CT扫描显示，70%无或仅有轻度皮质萎缩。MRI在检测白质异常方面比CT扫描更敏感（73%对35%；P = 0.02）。脑脊液检查显示，25%有单核细胞增多，55%蛋白水平升高，38%（34例中的13例）检测到HIV-1 p24核心蛋白。40例ADC患者的平均生存期为6.7个月，但20例从未使用过齐多夫定的患者生存期为4个月，而10例在被诊断为ADC后开始使用齐多夫定的患者生存期为14.8个月（P < 0.001）。这10例患者中有3例在开始使用齐多夫定后显著改善，2例略有改善。9例患者在停用齐多夫定后发生ADC。仅1例患者在接受600 mg齐多夫定治疗时发生ADC。
MRI在检测白质异常方面比CT更敏感。迄今为止，尚无针对ADC的特异性或敏感性脑脊液标志物。齐多夫定可能改善ADC患者的症状并延长生存期，在我们的研究中，持续使用齐多夫定很少发生ADC。
