AIDS合并巨细胞病毒性视网膜炎的临床研究

A Clinical Study on Cytomegaloviral Retinitis as a Complication of AIDS

目的探讨获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者巨细胞病毒性视网膜炎预防、临床特点和治疗方法。方法对获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎11例(13眼)进行临床分析。结果 11例(13眼)均有特征性视网膜病变及视力下降或眼前黑影;10例患者 CD_4^+ T 细胞计数<50个/μl,均处于 AIDS 晚期,且合并有其他机会感染;5例 CMV-PCR 检测为阳性;8例 CMV IgM 检测中1例(+),7例(-)。6例经更昔洛韦治疗后视力提高,但需要较长的疗程;3例死于多重机会感染。结论巨细胞病毒性视网膜炎是获得性免疫缺陷综合征患者的常见机会感染,早发现和及时治疗对其治愈有重要意义,获得性免疫缺陷综合征患者应常规眼科检查和随访,尤其 CD_4^+ T 细胞计数<50个/μl的患者。病原学检测在诊断中具有重要价值。

Purpose To investigate the characteristics, systemic features, preventive and therapeutic methods of cytomegalovirus retinitis（CMVR） associated with acquired immunodeficiency syndrome （AIDS）. Methods The data of 13 eyes with CMV retinitis of 11 AIDS patients were analyzed retrospectively. Results All the 13 eyes of 11 AIDS patients with CMVR had typical features, blurred vision and/or floating. CD4^＋ T lymphocyte counts of the 10 patients were less than 50 cell/μl. These patients were at later stage of AIDS, and were co-infected with other opportunistic infections（OIs）. Positive reaction was found in CMV -PCR test in 5 cases. One positive and seven negative results were obtained in CMV-lg M antibody test. The vision acuity of six patients was improved after they were treated with gancyclovir for relatively long time. The rest of the three patients died of multiple OIs. Conclusion CMVR is a common opportunistic infection in AIDS. The patients with CMVR may loss their vision if no proper therapy is administrated. Early diagnosis and treatment is necessary for protecting vision with CMVR. CMV-PCR test is useful for the diagnosis for CMVR