获得性免疫缺陷综合征患者合并巨细胞病毒性视网膜炎的诊治

Diagnosis and treatment on cytomegalovirus retinitis associated with acquired immunodeficiency syndrome

目的探讨AIDS患者巨细胞病毒性视网膜炎的临床特征及转归。方法观察21例(31眼)AIDS合并巨细胞病毒性视网膜炎的临床表现,随访2～18个月,对其临床特征和实验室资料进行分析。结果9眼视网膜病变为早期后极部血管旁白色棉絮斑伴出血;22眼为沿血管分布的视网膜大片黄白色病损及颗粒伴出血,晚期血管狭窄、闭塞。7眼并发视神经乳头水肿。本组患者CD4^+T细胞计数平均为(27.05±28.15)/μL,经实时定量PCR检测发现,19例CMV阳性。更昔洛韦治疗有效,6例(8眼)治愈,8例(12眼)好转,31眼的治愈、好转率为64.5%(20/31),7例(11眼)无好转,其中6例患者随访期间死于各种机会感染。结论巨细胞病毒性视网膜炎眼部病变特征为早期后极部血管旁白色棉絮斑伴出血,进展期为沿血管分布的视网膜大片黄白色病损和灰白颗粒伴出血。CD4^+T细胞计数<50/μL是巨细胞病毒性视网膜炎发病的危险因素。

Objective To investigate the clinical characteristics and therapeutic outcomes of cytomegalovirus retinitis （CMVR） related to acquired immunodeficiency syndrome （AIDS）. Methods Clinical and laboratory data of 31 eyes in 21 AIDS patients with CMVR in our hospital were observed and analyzed. The patients were followed up 2 18 months. Results Earlier stage of the retinopathy was demonstrated in 9 eyes characterized as white cotton-wool spots in the posterior pole area. Dense, full-thickness, yellow-white retinal vascular lesions distributed with haemorrahage and granualar border were identified in 22 eyes. Angiostegnosis and vessel obstruction occurred at later stage. Optic nerve papillary edema appeared in 7 eyes. The mean of CD4^＋ T lymphocyte was （27.05±28.15） /μL in 21 cases. CMV viral loads of 21 samples were quantified by real-time polymerase chain reaction（PCR）. CMV real-time PCR was positive in 19 cases（90. 5 % ）. The eyesights of 14 patients（20 eyes） were improved after gancyclovir therapy. Six patients died of multiple opportunistic infections during highly active antiretroviral therapy（HAART）. Conclusions The characteristics of CMVR include white cotton-wool spot in posterior pole aera at the early stage, yellow-white retinal leision with haemorrahage and grey granula in progressive cases. CD4^＋ T lymphocyte lower than 50 /μL is the risk factor of cytomegalovirus retinitis.