278例人类免疫缺陷病毒感染患者的眼部表现

Characteristics of ophthalmic symptoms in the 278 patients with human immunodeficiency virus

目的探讨人类免疫缺陷病毒（HIV）感染患者眼部表现的特点，为早期诊断、及时治疗提供依据。方法回顾性分析2002年9月至2004年7月中非共和国278例HIV感染患者的临床资料，对眼部病变病程、症状、体征、全身情况及首诊病因进行分析。结果102例（36．7％）HIV感染患者眼部有病变表现，同时伴慢性全身消耗性症状和体征，CD4细胞值降低。其中20例（7．2％）患者将眼部病变作为首诊的病因。眼部病变表现为机会性感染和肉瘤形成，依次为HIV视网膜病变、葡萄膜炎、眼外肌麻痹、眼部带状疱疹及眼睑卡波济肉瘤等。HIV视网膜病变不具特异性，表现为视网膜出血、棉絮状斑、血管闭塞、视网膜坏死、视网膜脱离及视神经萎缩等。结论HIV感染后可出现多种眼部病变，严重视网膜、葡萄膜病变是造成患者失明的重要因素。我国HIV感染患者日益增多，其早期症状和体征应引起眼科医师的高度关注。

Objective To investigate the characteristics of ophthalmic symptoms of patients with human immunodeficiency virus （HIV） and to provide reference for early diagnosis and treatment of HIV. Methods The clinical data of 278 patients with HIV, including ophthalmic symptoms and general condition collected from September 2002 to July 2004, were analyzed retrospectively. These patients were from the Central African Republic. Results Among the 278 patients with HIV, 102 had pathologic changes in the eyes and were accompanied with chronic dissipative symptoms and decreased CIM cell counts. The pathogen of 278 patients with HIV at the initial reception were airway infection（n = 87, 31.3% ）, digestive tract infection（n =65, 23.4% ）, skin symptoms（n =55, 19.8% ）, multiple organ failure（n =51, 18.4% ） and ophthalmic symptoms（ n = 20, 7. 2% ）. Ophthalmic symptoms manifested as opportunistic infection and sarcoma formation, such as HIV retinopathy, chronic uveitis, external ophthalmoplegia, ocular herpes, and Kaposi＇s sarcoma in the eyelid. HIV-related retinopathy was not specific, which manifested as retinal hemorrhage, cotton wool spots, vascular occlusion, retinal necrosis, retinal detachment and ocular nerve atrophy. Conclusions Many kinds of ophthalmic symptoms might appear in patients with HIV. Severe retinopathy and uveitis are the main causes of ablepsia. Because of neglecting the ophthalmic symptoms in the early stage, many HIV patients suffer from decreased visual acuity, which may severely affect the quality of their lives. Consequently, ophthalmologists should pay more attention to patients in the early stage of HIV.