Neurology：HIV感染早期即出现脑部结构改变

　　HIV感染早期即出现脑部结构改变

　　HIV感染早期的脑部改变特征尚不清楚。为此，美国芝加哥东北大学Feinberg医学院影像学系的Ann B. Ragin博士等人进行了一项研究，研究结果在线发表在2012年11月28日的Neurology杂志上。研究结果显示：HIV感染早期即存在脑部结构改变，挑战了HIV感染早期无脑部损伤的假说。

　　该研究为芝加哥HIV早期感染研究。研究人员纳入了43位HIV感染者和21位对照。根据检查结果，平均感染时间估计小于1年。获取高分辨神经解剖影像。使用自动图像分析获得全脑、脑室容积、组织分级（总的、皮质灰质、白质和脑脊液）的情况。使用分离图像分析公式计算各脑区值。认知功能用神经精神评价进行评估。

　　研究结果显示：HIV组出现了量化的总体（p=0.0547）和皮质（p=0.0109）中灰质的减少。用分离图像分析公式对各脑区进行分析后发现持续存在脑皮质减少（p=0.042）和第三脑室扩大（p=0.046）。早期HIV感染组在不少神经精神测试方面的表现也较差，最大的差异在精神运动速度（p=0.001）。

　　该研究显示：HIV感染早期即出现结构改变。这个结果挑战了HIV感染早期脑部无受损的假说。脑对病毒-宿主最初相互作用过程中存在易感性，早期HIV感染就存在神经损伤，应进一步研究新的神经保护策略。　

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Structural brain alterations can be detected early in HIV infection

Objective

Brain changes occurring early in HIV infection are not well characterized. The Chicago Early HIV Infection Study aimed to evaluate the presence and extent of structural brain alterations using quantitative MRI.

Methods

Forty-three HIV and 21 control subjects were enrolled. Mean length of infection was estimated as less than 1 year based on assay results. High-resolution neuroanatomical images were acquired. Automated image analysis was used to derive measurements for total brain, ventricular volume, and for tissue classes (total and cortical gray matter, white matter, and CSF). A separate image analysis algorithm was used to calculate measurements for individual brain regions. Cognitive function was assessed by neuropsychological evaluation.

Results

Reductions were quantified in total (p = 0.0547) and cortical (p = 0.0109) gray matter in the HIV group. Analysis of individual brain regions with a separate image analysis algorithm revealed consistent findings of reductions in cerebral cortex (p = 0.042) and expansion of third ventricle (p = 0.046). The early HIV group also demonstrated weaker performance on several neuropsychological tests, with the most pronounced difference in psychomotor speed (p = 0.001).

Conclusions

This cross-sectional brain volumetric study indicates structural alterations early in HIV infection. The findings challenge the prevailing assumption that the brain is spared in this period. Revisiting the question of the brain's vulnerability to processes unfolding in the initial virus-host interaction and the early natural history may yield new insights into neurologic injury in HIV infection and inform neuroprotection strategies.