Norton G R, Sweeney J, Marriott D, Law M G, Brew B J
Department of Neurology, St Vincent's Hospital, Sydney, New South Wales, Australia.
J Neurol Neurosurg Psychiatry. 1996 Dec;61(6):606-9. doi: 10.1136/jnnp.61.6.606.
Pronounced infiltration of activated macrophages occurs in the peripheral nerves of patients with HIV distal symmetric polyneuropathy (DSPN). Mycobacterium avium complex (MAC) is a common facultative intracellular parasite of the macrophage in advanced HIV disease and may induce macrophage activation. Whether MAC disease is associated with DSPN was examined prospectively.
One hundred and fifty consecutive patients with HIV infection were assessed for the probability of DSPN. Blood cultures for MAC were performed, independently of neurological assessment, as part of the investigation of unexplained fever, anaemia, weight loss, or, less commonly, diarrhoea.
There were 20 patients with possible, 14 with probable, and 22 with definite HIV DSPN. Blood cultures for MAC were performed on 80 patients, of whom 39 were positive and 41 negative. The test for trend, when corrected for CD4 count, disclosed a significant association (P = 0.01). There was no statistically significant association between DSPN and cytomegalovirus (CMV) disease.
Coinfection of the macrophage by MAC may further activate the HIV infected macrophage thereby accelerating the elaboration of neural toxins or MAC infection of the macrophage itself may lead to the production of neural toxins.
在人类免疫缺陷病毒（HIV）相关远端对称性多发性神经病变（DSPN）患者的周围神经中，活化巨噬细胞有明显浸润。鸟分枝杆菌复合体（MAC）是晚期HIV疾病中巨噬细胞常见的兼性细胞内寄生虫，可能诱导巨噬细胞活化。本研究前瞻性地探讨MAC疾病与DSPN是否相关。
对150例连续的HIV感染患者进行DSPN可能性评估。作为不明原因发热、贫血、体重减轻或较少见的腹泻调查的一部分，独立于神经学评估进行MAC血培养。
有20例可能患有、14例很可能患有以及22例确诊患有HIV相关DSPN。80例患者进行了MAC血培养，其中39例阳性，41例阴性。校正CD4计数后，趋势检验显示存在显著相关性（P = 0.01）。DSPN与巨细胞病毒（CMV）疾病之间无统计学显著相关性。
MAC与巨噬细胞的合并感染可能进一步激活被HIV感染的巨噬细胞，从而加速神经毒素的产生，或者MAC对巨噬细胞本身的感染可能导致神经毒素的产生。
