HIV患者脑活检的安全性及诊断价值:一组1209例的分析及meta分析

Safety and diagnostic value of brain biopsy in HIV patients: A case series and meta-analysis of 1209 patients
2016-09-28 12:03发表评论
作者:Lee, A.M., Bai, H.X., Zou, Y., Qiu, D., Zhou, J., Alvarez, M.M-L., Zhang, P., Tao, Y., Tang, X., Xiao, B. , Yang, L.
机构: 中南大学湘雅二医院神经内科
期刊: J NEUROL NEUROSUR PS2016年7月7期87卷

Early brain biopsy may be indicated in HIV patients with focal brain lesion. This study aimed to evaluate and compare the safety and diagnostic value of brain biopsy in HIV patients in the pre-highly active antiretroviral therapy (HAART) versus post-HAART era via metaanalysis. Appropriate studies were identified per search criteria. The local database was retrospectively reviewed to select a similar patient cohort. Patient demographics, brain biopsy technique, histopathology and patient outcomes were extracted from each study. Study-specific outcomes were combined per random-effects model. Outcomes were compared between the pre-HAART and post-HAART era. Correlations between outcomes and baseline characteristics were assessed via metaregression analysis. The proportions of histopathological diagnosis were tabulated and compared between the pre- and post-HAART era. Survival analysis was performed for patients in the post-HAART era. A total of 26 studies (including the local database) with 1209 patients were included in this meta-analysis. The most common indications for brain biopsy were diagnosis unlikely to be toxoplasmosis (n=8, 42.1%), focal brain lesion (n=5, 26.3%) or both (n=3, 15.8%). The weighted proportions for diagnostic success were 92% (95% CI 90.0% to 93.8%), change in management 57.7% (45.9% to 69.1%) and clinical improvement 36.6% (26.3% to 47.5%). Morbidity and mortality were 5.7% (3.6% to 8.3%) and 0.9% (0.3% to 1.9%), respectively. Diagnostic success rate was significantly higher in the post-HAART than the pre-HAART era (97.5% vs 91.9%, p=0.047). The odds ratio (OR) for diagnostic success in patients with contrast-enhanced lesions was 2.54 ((1.25 to 5.15), p<0.01). The median survival for HIV patients who underwent biopsy in the post-HAART era was 225 days (90-2446). Brain biopsy in HIV patients is safe with high diagnostic yield. Early brain biopsy should be considered in patients without classic presentation of toxoplasmosis encephalitis.

通讯机构: Department of Neurology, The Second Xiangya Hospital, Central South University, No 139 Middle Renmin Road, Changsha, Hunan, China
学科代码:神经外科学 睡眠医学   关键词:HIV患者 脑活检 ,中国作者重要发表 爱思唯尔医学网, Elseviermed
来源: Scopus
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