Bouwman F H, Skolasky R L, Hes D, Selnes O A, Glass J D, Nance-Sproson T E, Royal W, Dal Pan G J, McArthur J C
Johns Hopkins University, Department of Neurology, Baltimore, MD, USA.
Neurology. 1998 Jun;50(6):1814-20. doi: 10.1212/wnl.50.6.1814.
A consecutive series of 71 patients diagnosed with HIV-associated dementia (HAD) (1984-1994) were studied to characterize the clinical course of HAD, and to identify predictive markers of rapid neurologic progression. Neurologic progression rate was determined from the change in the Memorial Sloan Kettering (MSK) dementia severity score from diagnosis to death. Those with the most rapid progression in neurologic disability were compared with those with slow or no progression. Autopsy material was immunostained for macrophage activation markers and gp41 in 30 individuals. Median survival was 3.3 months and 6.1 months for rapid-progression and no-progression patients, respectively. Rapid progression was associated with injection drug use but not with race, gender, or age. CD4+ cell counts were lower at diagnosis among rapid-progression than no-progression patients but no differences in AIDS-defining illnesses or patterns of antiretroviral therapy were found. At presentation, rapid-progression patients had more prominent symptoms of mental slowing than those with no progression; however, no other clinical features, CSF, or imaging features distinguished the groups. Less abundant macrophage activation in both basal ganglia and midfrontal gyrus regions, as judged by HAM56 immunostaining, was noted in 9 no-progression patients, compared with 12 rapid-progression patients. Neurologic progression and survival with HAD is highly variable. A significant proportion of individuals with dementia have prolonged survival of more than 12 months and remain cognitively stable. A history of injection drug use and presentation with prominent psychomotor slowing is associated with more rapid neurologic progression, and these patients tend to show more abundant macrophage activation within the CNS.
对1984年至1994年间连续确诊的71例HIV相关痴呆（HAD）患者进行了研究，以描述HAD的临床病程，并确定神经功能快速进展的预测标志物。神经功能进展率通过从诊断到死亡时纪念斯隆凯特琳（MSK）痴呆严重程度评分的变化来确定。将神经功能残疾进展最快的患者与进展缓慢或无进展的患者进行比较。对30例个体的尸检材料进行巨噬细胞激活标志物和gp41的免疫染色。快速进展组和无进展组患者的中位生存期分别为3.3个月和6.1个月。快速进展与注射吸毒有关，与种族、性别或年龄无关。快速进展组患者诊断时的CD4 +细胞计数低于无进展组，但在定义艾滋病的疾病或抗逆转录病毒治疗模式方面未发现差异。就诊时，快速进展组患者的精神迟缓症状比无进展组更明显；然而，没有其他临床特征、脑脊液或影像学特征能够区分这两组。通过HAM56免疫染色判断，9例无进展患者的基底神经节和额中回区域的巨噬细胞激活程度低于12例快速进展患者。HAD的神经功能进展和生存期差异很大。相当一部分痴呆患者生存期延长超过12个月，且认知保持稳定。注射吸毒史和出现明显的精神运动迟缓与神经功能进展更快有关，这些患者往往在中枢神经系统内表现出更丰富的巨噬细胞激活。
