HIV相关性中枢神经系统感染的诊断思路  

The diagnosis of HIV-associated central nervous system opportunistic infections

作　　者：龚启明[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院感染科,200025

出　　处：《中国现代神经疾病杂志》2013年第1期24-30,共7页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：人类免疫缺陷病毒(HIV)感染患者若出现中枢神经系统机会性感染,即符合美国疾病控制与预防中心1993年修订的真性获得性免疫缺陷综合征(艾滋病)期的诊断标准,临床上属于危重患者。病原微生物涉及病毒、细菌、分枝杆菌、真菌、寄生虫等,临床症状与体征、实验室检查等亦与非免疫缺陷患者有所不同,尤其是经抗HIV治疗后,仍可出现病情加重或新的感染发生,对临床医师极具挑战意义。及时明确诊断是临床治疗转归的基础。Opportunistic infections of the central nervous system（CNS） are very common and severe complications of advanced immunodeficiency in patients with human immunodeficiency virus type 1（HIV-1） infection,which are included in the diagnostic criteria for acquired immunodeficiency syndrome（AIDS） defining conditions according to 1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS among Adolescents and Adults published by USA Centers for Disease Control and Prevention（CDC）.The etiologic microorganisms of CNS opportunistic infections include virus,bacteria,fungus,mycobacterium and parasite.The clinical symptoms,signs and laboratory examinations of these diseases are different from that of patients with non immunodeficiency.Even in the era of highly active antiretroviral therapy（HAART）,worsening conditions or new infections may occur.Therefore,prompt diagnosis and treatment of such disorders are critical.The immune reconstitution inflammatory syndrome（IRIS） in HIV-1 infected patients in the initiating antiretroviral therapy results from restored immunity to specific infectious or non infectious antigens.This study reviews the epidemiology,pathogenesis,clinical features,diagnosis of some common CNS disorders in HIV-1 infected patients.Physicians caring for such patients must be aware of the new diagnostic modalities and therapeutic options of these diseases.

关 键 词：获得性免疫缺陷综合征 HIV感染 中枢神经系统 综述 

分 类 号：R512.91[医药卫生—内科学]