HIV感染伴发葡萄膜炎患者的诊治分析

Diagnosis and treatment analysis of HIV with uveitis

目的探讨HIV感染伴发葡萄膜炎的临床特征、治疗效果、视力预后及诊治中存在的问题。方法回顾性分析2005年1月—2010年11月期间在郑州市第六人民医院眼科就诊的HIV感染者318例,其中伴发葡萄膜炎者37例(45眼)。通过详细的临床检查、实验室检查及治疗观察,对其临床特征、治疗效果、并发症及视力预后进行分析。结果葡萄膜炎发病率为11.6%。CD4+T淋巴细胞数大于200个/mm3者6例(16.2%),CD4+T淋巴细胞数小于200个/mm3者31例(83.8%)。急性葡萄膜炎16例(43.2%),其中急性视网膜坏死1例,带状疱疹感染性葡萄膜炎3例;慢性葡萄膜炎21例(56.8%)。前葡萄膜炎14例(37.8%),后葡萄膜炎16例(43.2%),全葡萄膜炎7例(18.9%)。就诊时最佳矫正视力高于0.5者16眼(35.6%),0.5～0.12者17眼(37.8%),低于0.1者12眼(26.7%)。33眼出现色素性或尘状角膜后沉着物(KP)。各种并发症发生率42.2%(19眼)。结论 HIV感染伴发葡萄膜炎发病率高,视力损害严重,临床诊治过程中应高度重视。

Objective To explore the clinical characters,effects of the treatment,the prognosis of visual acuity and the problems in the treatment of the HIV with uveitis.Methods The retrospective case series study was used to observe the clinical characters,treatment effects,the complications and the prognosis of 318 cases of HIV with uveitis,including 37cases（45eyes） HIV with uveitis,from January,2005 to November,2010 in the sixth people’s hospital of Zhengzhou City.Results The disease incidence of the uveitis was 11.6%.There were 6 cases（16.2%） whose CD＋ 4T lymphocytes was more than 200/mm3.There were 31 cases（83.8%） whose lymphocytes was less than 200/mm3.There were 16 cases（43.2%） of acute uveitis including 1 case acute retinal necrosis and 3 cases herpes zoster infection in uveitis.There were 21 cases（56.8%） of chronic uveitis.There were 14 cases（37.8%） of anterior uveitis,16 cases（43.2%） of posterior uveitis and 7 cases（18.9%） panuveitis.There were 14 cases whose best corrected visual acuity was better than 0.5,17 cases（37.8） that between 0.5 and 0.12,and 12 cases（26.7%） that worse than 0.1.There were 33 eyes that had pigmented and KP.The percentage of the complications was 42.2%（19 eyes）.Conclusions The disease incidence of the HIV with uveitis is high and do harm to the vision and should be taken seriously in the clinical treatment