摘要
目的探讨艾滋病相关进行性多灶性白质脑病(progressive multifocal leukoencephalopathy,PML)的临床特点。方法回顾性分析2021年5月—2022年5月贵阳市公共卫生救治中心感染科收治的15例通过宏基因组二代测序(metagenomic next-generation sequencing,mNGS)诊断为艾滋病相关PML患者临床资料,分析其临床特点。结果15例艾滋病相关PML患者中,男性12例,女性3例;年龄为(40.8±11.45)岁。CD4^(+)T淋巴细胞计数中位数为59(36.5,131.0)个/μl,CD4^(+)T/CD8^(+)T中位数为0.14(0.06,0.29)。HIV RNA最低小于监测值下限,最高为1.21×10^(6)拷贝/ml。脑脊液JCV DNA序列数为1—12950,中位数为94;格拉斯评分:9~15分。15例患者从HIV感染确诊到PML确诊中位时间为30(29.5,65.0)d;总体中位生存时间为195(59.5,330.0)d;死亡患者中位生存时间为21(19.0,46.0)d。使用基于多替拉韦的患者中位生存时间为237.5(39.75,309.75)d,使用其他抗反转录病毒治疗方案治疗的患者中位生存时间为189.0(120.0,387.0)d。表现为对侧肢体无力、运动障碍6例,共济失调3例,言语含混3例,视物模糊2例,记忆减退1例。磁共振表现:任何部位均可出现异常信号影。15例患者中1例失访,5例死亡,其余9例均存活,存活的患者其中4例症状好转,4例进展恶化,1例未见好转。结论艾滋病相关PML较为少见,在临床表现、脑脊液常规检测结果和影像学表现的基础上,应用脑脊液mNGS技术有助于诊断PML,且强效、早期、规律抗病毒治疗能改善患者预后。
Objective The aim of the study is to investigate the clinical characteristics of AIDS-related progressive multifocal leukoencephalopathy.Methods We enrolled 15 patients in the Infection Department of Guiyang Public Health Treatment Center from May 2021 to May 2022.The patients were diagnosed as AIDS-related progressive multifocal leukoencephalopathy by metagenomic next-generation sequencing.Furthermore,PCR and flow cytometry were used to detect HIV RNA level and CD4^(+)T lymphocyte cell counts in peripheral blood,respectively.Meanwhile,metagenomic next-generation sequencing was used to detect JCV DNA in cerebrospinal fluid.Moreover,we also retrospectively analyzed the clinical symptom,magnetic resonance imaging findings,treatment,and clinical outcomes of 15 individuals.Results Among the 15 AIDS-related PML patients,there were 12 males and 3 females.The age was(40.8±11.45)years.The median CD4^(+)T lymphocyte count was 59(36.5,131.0)/μl,and the median CD4^(+)T/CD8^(+)T ratio was 0.14(0.06,0.29).The minimum HIV RNA is less than the lower limit of the monitoring value,and the maximum is 1.21×10^(6)copies/ml.The number of JCV DNA sequences in cerebrospinal fluid ranged from 1 to 12950,with a median of 94.The range of glasgow coma scale:9-15;The median time from diagnosis of HIV infection to diagnosis of PML was 30(29.5,65.0)days.Overall median survival time was 195(59.5,330.0)days.The median survival time of patients who died was 21(19.0,46.0)days.The median survival time was 237.5(39.75,309.75)days for patients using DTG-based and 189.0(120.0,387.0)days for patients using other antiretroviral therapy regimens.The clinical manifestations were contralateral limb weakness and dyskinesia in 6 cases,ataxia in 3 cases,speech ambiguity in 3 cases,blurred vision in 2 cases,and memory loss in 1 case.Nuclear magnetic resonance manifestation:Abnormal signal shadow can be found anywhere.Among the 15 patients,1 patient was lost to follow-up,5 patients died,and the remaining 9 patients survived.Among surviving patients,4 patien
作者
何香溪
甘霖
符燕华
谢小馨
龙海
何金洪
刘霜
陈圆圆
朱宇珍
黎玲屹
张凯凯
罗星星
彭银霜
马淑静
HE Xiangxi;GAN Lin;FU Yanhua;XIE Xiaoxin;LONG Hai;HE Jinhong;LIU Shuang;CHEN Yuanyuan;ZHU Yuzhen;LI linyi;ZHANG Kaikai;LUO Xingxing;PENG Yinshuang;MA Shujing(Infectious disease Department,Guiyang Public Health Treatment Center,550000,China)
出处
《传染病信息》
2023年第2期114-118,共5页
Infectious Disease Information
关键词
AIDS
HIV
进行性多灶性白质脑病
JC病毒
脑脊液
宏基因组二代测序
抗反转录病毒治疗
磁共振成像
临床特点
AIDS
HIV
progressive multifocal leukoencephalopathy
John Cunningham Virus
metagenomic next-generation sequencing
antiretroviral therapy
magnetic resonance imaging
clinical characteristics
