摘要
目的 对比分析HIV合并梅毒性脑动脉炎性脑梗死和HIV合并动脉粥样硬化性脑梗死的临床特征,为提高诊断水平提供依据。方法 收集2017年1月—2021年12月期间在武汉大学中南医院住院,出院诊断同时为神经梅毒、HIV感染和脑梗死的患者(梅毒组),随机选择同期住院且出院诊断为脑梗死和HIV感染的患者作为对照组(动脉硬化组),分析其临床特征和预后。结果 梅毒组10例,动脉硬化组21例,梅毒组中位年龄[26(24,32)岁]<动脉硬化组[51(45,59)岁],差异有统计学意义(P<0.001)。住院时间上,梅毒组患者中位住院日22(16,26)d,长于动脉硬化组9(7,13)d,差异有统计学意义(P=0.001)。梅毒组CD4计数(103±112)个/mm^(3)低于动脉硬化组(319±221)个/mm^(3),差异有统计学意义(P=0.003)。在凝血功能检查上,梅毒组的凝血酶原活动度(PTA)(86.5±11.2)%低于动脉硬化组(101.6±17.5)%,差异有统计学意义(P=0.020),而凝血酶原时间(PT)、国际标准化比值(INR)、D-二聚体在两组间差异均无统计学意义。梅毒组病变部位以基底节区为最常见,而动脉硬化组病变部位以脑叶最常见。累及的血管,梅毒组以多支病变为主,其中5例出现血管闭塞,4例出现狭窄,大脑前动脉闭塞/狭窄最常见,而动脉硬化组以单支病变为主,其中血管闭塞14例,血管狭窄5例,大脑中动脉闭塞/狭窄最常见。随访期内,梅毒组和动脉硬化组各死亡1例,其余均存活。结论 HIV感染合并脑梗死患者应警惕神经梅毒的发生,及时诊断和治疗可有效降低致残率和死亡率。
Objective To compare and analyze the clinical features of HIV combined with cerebral infarction caused by syphilitic cerebral arteritis and HIV combined with atherosclerotic cerebral infarction,providing a basis for improving diagnosis.Methods Patients admitted to our hospital from January 2017 to December 2021 with discharge diagnosis of neurosyphilis,HIV infection and cerebral infarction(syphilis group)were collected,and patients hospitalized during the same period with discharge diagnosis of cerebral infarction and HIV infection were randomly selected as the control group(arteriosclerosis group).Their clinical characteristics and prognosis were analyzed.Results There were 10 patients in the syphilis group and 21 patients in arteriosclerosis group.The median age of syphilis group was 26(24,32)years,which was younger than that of arteriosclerosis group[51(45,59)years],suggesting significant differences(P<0.001).The median duration of hospital stay in the syphilis group was 22(16,26)d,which was longer than that in the arteriosclerosis group[9(7,13)d],and the difference was statistically significant(P=0.001).CD4 count in syphilis group[(103±112)/mm^(3)]was lower than that in arteriosclerosis group[(319±221)/mm^(3)],and the difference was statistically significant(P=0.003).In terms of coagulation function test,PTA in the syphilis group[(86.5±11.2)%]was lower than that in arteriosclerosis group[(101.6±17.5)%],and the difference was statistically significant(P=0.020),while PT,INR and DD were not statistically significant between the two groups.The most common lesion site was the basal ganglia in the syphilis group,and the cerebral lobe in the arteriosclerosis group.Among the accumulated vessels,multi-vessel lesions were the most common in the syphilis group,among which 5 cases had vascular occlusion,4 cases had stenosis,and anterior cerebral artery occlusion/stenosis was the most common,while single-vessel lesions were the most common in the arteriosclerosis group,among which there were 14 cases of vascular occlusion and 5 cases of vascular stenosis,with middle cerebral artery occlusion/stenosis being the most common.During the follow-up period,one patient died in the syphilis group and one in the arteriosclerosis group,while the others survived.Conclusion For patients with HIV infection combined with cerebral infarction,clinicians should be alert to neurosyphilis,and timely diagnosis and treatment can effectively reduce disability and mortality.
作者
郭凯
张永喜
杨蓉蓉
柯亨宁
GUO Kai;ZHANG Yongxi;YANG Rongrong;KE Hengning(Department of Infectious Diseases,Zhongnan Hospital of Wuhan University,Hubei AIDS Clinical Training Center,Wuhan 430071,China)
出处
《中国皮肤性病学杂志》
CAS
CSCD
北大核心
2024年第1期74-80,共7页
The Chinese Journal of Dermatovenereology
基金
国家自然科学基金面上项目(31760263)。
关键词
HIV
梅毒
动脉硬化
脑梗死
HIV
Syphilis
Arteriosclerosis
Cerebral infarction
