HIV感染者和AIDS病人眼底病变的相关性研究

Study on the correlation of fundus change in HIV/AIDS patients

目的探讨艾滋病病毒感染者及艾滋病病人(HIV/AIDS病人)眼底病变的发生情况,及其与CD4+T细胞计数的相关性。方法对313例HIV/AIDS病人进行间接检眼镜检查,并对其中有眼底改变的病人的临床表现及CD4+T细胞计数进行描述和分析。结果 313例HIV/AIDS病人中,有120例出现眼底改变,总发病率为38.3%。其中单眼发病32例,双眼发病88例。累及视网膜的114例,占所有病人的36.4%(313/114)。视网膜受损主要表现为视网膜棉絮斑及视网膜出血。最后诊断巨细胞病毒(CMV)性视网膜炎58例,结核性眼病20例,HIV相关性眼病33例,分别占所有HIV/AIDS病人的18.5%、6.4%、10.5%。有视力改变者74例,主要表现为视物模糊、视力下降等,其中66例眼底检查发现有眼底改变,占89.2%。239例眼部无症状的病人中,经眼底镜检查发现54例有眼底改变,占22.6%。所有病人经治疗后均未出现眼部症状。眼底病变在CD4+T细胞计数≤50个/μL的病人中的发病率,明显高于CD4+T细胞计数>50个/μL的病人(P=0.016)。另外,年龄≥60岁的病人眼底病变发生率为48.1%,高于年龄<60岁的病人(36.3%),但是差异无统计学意义(χ2=2.656,P=0.103)。结论眼底病变多发生于AIDS晚期病人,主要累及视网膜,有相当一部分HIV/AIDS病人在视力未发生改变时,其眼底早就发生病变,因此对于HIV/AIDS病人常规行眼底检查,对于眼底病变的早期发现、早期诊断、早期治疗。改善预后有着重要的意义。

Objective To investigate fundus change and the relationship between fundus manifestations and CD4^＋ T cell count in HIV/AIDS patients.Methods The fundus was examined in 313 HIV/AIDS patients by indirect ophthalmoscopy,and the clinical symptoms and CD4^＋ T cell count of the patients with fundus change were analyzed.Results There were 120 patients with fundus change,with the total rates of 38.3%,which included 32 patients with one eye involved and 88 patients with two eyes involved.There were 114 cases with retina involvement in 313 patients（36.4%）.And the main clinical feature of retinal lesion was cotton wool spot and hemorrhage of retina.There were 58 patients with CMV retinitis（18.5%）,20 patients with ocular tuberculosis（6.4%） and 33 patients with HIV-related eye diseases（10.5%） in 313 HIV/AIDS patients.The vision of 74 patients was changed,in which there were 66 patients（89.2%） with fundus involvement.Fundus change was present in 22.6% of 239 asymptomatic patients and all of these patients did not develop clinical symptoms after treatment.Most patients complained of blurred vision or floating.The rates of fundus change in the patients with CD4^＋ T cell count below 50 cell/mm^3 was significantly higher than in the patients with CD4^＋ T cell count above 50 cell/mm^3（P=0.016）.Otherwise,the rates of fundus change in the patients with age above 60 years was higher than that in the patients with age below 60 years,but was not significantly different（48.1% vs.36.3%,Х^2=2.656,P=0.103）.Conclusions Fundus change usually occurs in the late stage of AIDS patients and mainly involves retina.A number of HIV/AIDS patients have fundus change without vision change.Routine fundus examination is important for early diagnosis and treatment of fundus change in HIV/AIDS patients,which may improve their prognosis and outcome.