艾滋病合并巨细胞病毒性视网膜炎11例临床分析

Clinical analysis of 11 cases with cytomegalovirus retinitis associated with acquired immunodeficiency syndrome

目的探讨获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)并发巨细胞病毒(cytomegalovirus,CMV)性视网膜炎的发病特点及临床经过,为早期诊断及治疗提供依据。方法总结2007年6月至2008年5月期间的11例AIDS并发CMV性视网膜炎住院病例(中位年龄为34岁,男8例,女3例)的临床表现,分析其眼部病变、症状、CD4+T淋巴细胞及血常规检测结果。结果11例AIDS并发CMV性视网膜炎均伴有不同程度的视力模糊、视力下降等症状。入院后立即进行高效抗逆转录酶病毒治疗(highly active antiretroviral therapy,HAART)和抗CMV治疗。结果9例眼部症状明显好转,CD4+T淋巴细胞计数上升。AIDS晚期并发多发感染的2例患者未见明显好转。结论巨细胞病毒性视网膜炎是艾滋病最严重的眼部并发症。对人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者应常规进行眼底检查,还有原因不明的视网膜出血及视网膜血管炎患者有必要检测血清HIV抗体,以免耽误治疗。

Objective To investigate the incidence characteristics and clinical course of the acquired immunodeficiency syndrome （AIDS） complicated with cytomegalovirus（CMV） retinitis. Methods The clinical manifestations,CD4^＋ T lymphocytes counts and complete blood counts of 11 cases（median age 34 years old,8 males and 3 females） who were treated from June 2007 to May 2008 were analyzed. Results Eleven cases of AIDS complicated with CMV retinitis patients all showed main clinical features of varying degrees of blurred or declined vision. Admitted to hospital, the patients received immediately highly active antiretroviral therapy（HAART） outside the anti-CMV treatment. The ocular symptoms improved significantly,CD4^＋ T lymphocyte counts increased after HAART. No obvious improvement was found in two advanced cases. Conclusion CMV retinitis is the most common intraocular complication in patients with AIDS. Routine eye examination should be performed if the test of HIV is positive. And also for the patients with yellow-white retinal lesions,hemorrhage and retinal vasculitis of unkown cause,anti-HIV antibody should be tested.