hiv感染者进行性多灶性脑白质病的临床和实验室特征及预后因素

A. Pokrovskaya, E. A. Samotolkina, S. Matosova, D. Kireev, E. Domonova, S. Voznesenskiy, T. Ermak, E. S. Samotolkina, Y. Parkhomenko, O. A. Tishkevich
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引用次数: 0

摘要

目的:分析hiv感染者进行性多灶性脑白质病(PML)的临床和实验室特征,以预测其预后。材料与方法:回顾性分析2015-2017年感染艾滋病毒的中枢神经系统病变患者的病史,并对2018-2019年在莫斯科市卫生厅第二感染临床医院重症监护病房(ICU)就诊的中枢神经系统病变患者进行动态监测。结果与讨论:196例脑炎/脑膜脑炎患者:脑脊液(CSF) -研究组(JCPyV+)检测到JCPyV的患者124例(63%),脑脊液(CSF) -对照组(JCPyV -)未检测到JCPyV的患者72例。住院时间较晚,主要在JCPyV+组(平均- 58±6天)。大多数患者存在严重免疫缺陷,在JCPyV+组中CD40.05的患者数量。病情恶化后14天以内入院的患者的生存机会高出2.5倍(OR=2.468 [95% CI: 1.244-4.898])。CD4<200 cells/μL患者的死亡几率是CD4≥200 cells/μL患者的5.5倍(OR=5.449 [95% CI: 2.388 ~ 12.431])。脑脊液中JCPyV DNA和HIV RNA的浓度与它们对疾病结局的影响之间没有关系。结论:PML出现症状后14天住院且CD4<200细胞/μL的患者在ICU治疗期间生存预后较差。所有艾滋病毒阳性个体早期开始抗逆转录病毒治疗可显著减少机会感染的数量并提高预期寿命。
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Clinical and laboratory features and prognostic factors for outcome of progressive multifocal leukoencephalopathy in HIV-infected patients
Objective: To analyze clinical and laboratory features to predict the outcome of progressive multifocal leukoencephalopathy (PML) in HIV-infected patients.Materials and methods: Retrospective analysis of medical histories of HIV-infected patients with CNS lesions in 2015–2017, and dynamic monitoring of HIV patients with CNS lesions in 2018–2019, who were intensive care unit (ICU) in Infectious Clinical Hospital No. 2 of the Department of Health of Moscow.Results and discussion: A total 196 patients with encephalitis/meningoencephalitis: 124 (63%) patients with detected JCPyV in the cerebrospinal fluid (CSF) — study group (JCPyV+), 72 patients with undetectable JCPyV in CSF — comparison group (JCPyV–). Late terms of hospitalization were noted, mainly in the JCPyV+ group (mean — 58±6 days). The majority of patients had severe immunodeficiency, in the JCPyV+ group the number of patients with CD4<200 cells/μl was significantly higher than in the JCPyV– group (87.8% and 75.8%, p<0.05). Only 22% of patients received antiretroviral therapy (ART) prior to hospitalization. The main clinical manifestations of PML in the study were: paralysis and paresis of the limbs, speech impairment, cognitive disorders in combination with cerebral symptoms in the absence of meningeal signs. In 87.8% patients with positive JCPyV DNA no other pathogens were detected in the CSF; in the patients without PML the detection of infectious agents in the CSF was also rare (14.3%). The disease led to the death for 78% patients in the JCPyV+ group and 72% JCPyV– group, p>0.05. The chance of survival was 2.5 times higher for patients admitted to hospital less than 14 days after deterioration (OR=2.468 [95% CI: 1.244–4.898]). Patients with CD4<200 cells/μL were 5.5 times more chance to die than patients with higher CD4 rates (OR=5.449 [95% CI: 2.388–12.431]). There was no relationship between the concentration of JCPyV DNA and HIV RNA in the CSF and their impact for the disease outcome.Conclusion: Survival prognosis for PML during treatment in ICU was worser for patients hospitalized after 14 days from the onset of symptoms and with CD4<200 cells/μL. Early ART initiation for all HIV-positive individuals significantly reduces the number of opportunistic infections and improve life expectancy.
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来源期刊
HIV Infection and Immunosuppressive Disorders
HIV Infection and Immunosuppressive Disorders Medicine-Infectious Diseases
CiteScore
0.70
自引率
0.00%
发文量
37
期刊介绍: In the scientific-practical journal "HIV Infection and Immunosuppressive Disorders", published various issues of HIV medicine (epidemiology, molecular mechanisms of pathogenesis to the development of educational programs) leading scientists of Russia and countries of CIS, USA, as well as practical healthcare professionals working in research centers, research institutes, universities, clinics where done basic medical work. A special place on the pages of the publication is given to basic and clinical research, analytical reviews of contemporary and foreign reports, the provision of medical care for various diseases.
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