覃海明，农影星



AIDS合并巨细胞病毒性视网膜炎60例临床观察

覃海明1，农影星2

1Department of ENT;2Infection Department, the Fourth People’s hospital in Nanning, AIDS Treatment Center in Guangxi Zhuang Autonomous Region, Nanning 530023, Guangxi Zhuang Autonomous Region, China

Correspondence to:Hai-Ming Qin.Department of ENT, the Fourth People’s hospital in Nanning, AIDS Treatment Center in Guangxi Zhuang Autonomous Region, Nanning 530023, Guangxi Zhuang Autonomous Region, China. qhjsj0316@163.com

Abstract

•AIM: To investigate the clinical characteristics of acquired immunodeficiency syndrome (AIDS) complicated with cytomegalovirus (CMV) retinopathy (CMVR), and the clinical manifestations of immune reconstruction inflammatory syndrome (IRIS) in eye.

•METHODS: Patients who accepted treatments diagnosed with AIDS in our hospital of Department of Infectious Disease from Jan. 2010 to Dec. 2015 were retrospective analyzed. Sixty cases (103 eyes) with cytomegalovirus retinitis were identified. The clinical symptoms, the fundus manifestation, CD4+T cell count and the prognosis were examined.

•RESULTS: Visual acuity of 65 eyes (63.1%), 26 eyes (25.2%), and 12 eyes (11.7%) were ≤0.1, 0.1-0.3 and ≥0.3 respectively. The fundus manifestations had yellow-white lesions along vascular distribution and hemorrhage of retina. The vitreous body was rarely involved. The retinal necroses in 37 eyes (35.9%) involved the posterior pole, 45 eyes (43.7%) involved peripheral region, and 21 eyes (20.4%) with mixed type. In 60 patients, CD4+T cells counts was 38.6±12.3 cells/μL on average, 43 cases (71.7%) of CD4+T cells is ≤50 cells/μL, 8 cases (13.3%) of CD4+T cells >50-100 cells/μL, and 9 cases (15.0%) >100 cells/μL. Visual acuity of 89 eyes improved with highly active antiretroviral therapy (HARRT) and anti-CMV treatment, 19 eyes unchanged, 18 eyes decreased, and CD4+T cells counts was significantly higher (P<0.05). Five patients (9 eyes) with IRIS were responded well to treatment.

•CONCLUSION: CMVR is a common intraocular complication of AIDS. Routine fundus examination should be performed when the CD4+T cells counts is less than ≤50 cells/μL. Immune reconstitution inflammatory syndrome CMV retinopathy has worse in the prognosis.

目的：探讨获得性免疫缺陷综合征(AIDS)合并巨细胞病毒性视网膜炎(CMVR)的临床特征，及CMVR相关眼部免疫重建综合征(IRIS)的临床特点。

方法：回顾性分析我院感染科2010-01/2015-12收治确诊为AIDS合并CMVR患者60例103眼，对其临床表现、眼底病变、CD4+T淋巴细胞计数及预后等进行观察。

结果：初诊视力≤0.1者65眼(63.1%)，>0.1～<0.3者26眼(25.2%)，≥0.3者12眼(11.7%)，眼底改变表现为沿血管分布的黄白色病灶，伴片状出血，较少累及玻璃体。患者60例103眼，其中37眼(35.9%)视网膜病变主要累及后极部，45眼(43.7%)主要累及周边部，21眼(20.4%)为混合型。60例患者中CD4+T淋巴细胞计数平均38.6±12.3个/μL，其中≤50个/μL 43例(71.7%)，>50～<100个/μL 8例(13.3%)，≥100个/μL 9例(15.0%)。经高效抗逆转录病毒治疗(HARRT)及抗巨细胞病毒(CMV)治疗后，66眼视力提高，19眼视力不变，18眼视力下降。54例患者CD4+T淋巴细胞计数升高，治疗前后CD4+T细胞变化有统计学差异(P<0.05)。5例9眼为HARRT后IRIS的CMVR，经抗病毒治疗，病情得到控制。

结论：CMVR为AIDS常见眼部并发症，当CD4+T淋巴细胞计数≤50个/μL时应常规进行眼科检查。IRIS的CMVR预后较差。

获得性免疫缺陷综合征；巨细胞病毒性视网膜炎；CD4+T淋巴细胞

引用：覃海明，农影星.AIDS合并巨细胞病毒性视网膜炎60例临床观察.国际眼科杂志2016;16(9):1702-1704

0引言

巨细胞病毒性视网膜炎(cytomegalovirus retinopathy, CMVR)是获得性免疫缺陷综合征(acquired immune deficiency syndrome，AIDS)患者最常见、最严重的眼部并发症，是视力下降和致盲的常见原因[1]。随着高效抗逆转录病毒治疗(highly active antiretroviral therapy，HARRT)的应用，AIDS患者生存时间延长，出现CMVR的患者数量越来越多，以眼部症状为首发表现者亦不罕见。本研究回顾性分析2010-01/2015-12我院眼科收治的AIDS患者经眼科会诊确诊为CMVR 60例103眼的临床特点，以期提高眼科医师对AIDS合并CMVR的认识，为正确诊疗提供帮助。

1对象和方法

1.1对象选择2010-01/2015-12由我院眼科收治的AIDS患者经眼科会诊确诊为CMVR患者60例103眼，其中男47例81眼，女13例22眼，年龄21～65(平均42.56±10.61)岁。其中双眼患病43例，右眼患病9例，左眼患病8例，共103眼。AIDS诊断按照2011年中国艾滋病诊疗指南[2]的诊断标准：流行病学史，实验室检查HIV抗体阳性，加上机会性感染或肿瘤等，或HIV抗体阳性，同时CD4+T淋巴细胞计数<200个/μL。CMVR由同一经验丰富眼科医师诊断，诊断标准为典型的进行性、坏死性视网膜炎，沿血管分布的黄白色病灶伴片状出血，合并视网膜血管炎，眼底表现可描述为“奶酪加番茄酱样视网膜炎”[3]。玻璃体透明或轻微混浊。

1.2方法所有患者均行视力、眼压、裂隙灯、间接检眼镜、彩色眼底照相、眼部B超检查，同时行CD4+T淋巴细胞计数。所有患……