获得性免疫缺陷综合征合并巨细胞病毒视网膜炎80例患者的临床特点

Clinical characteristic and treatment of cytomegalovirus retinitis in 80 patients with acquired immunodeficiency syndrome

目的 探讨获得性免疫缺陷综合征（AIDS）合并巨细胞病毒视网膜炎（CMVR）的临床特点.方法 回顾性系列病例研究.收集2006年12月至2011年12月就诊于上海市公共卫生临床中心的80例（118只眼）CMVR患者的实验室检查和临床诊治资料,分析其与细胞免疫的关系、CMVR发生的危险因素、临床表现、治疗方法及预后.不同CD4＋T淋巴细胞计数水平间CMVR发病率两两比较采用x2检验.结果 80例（118只眼）AIDS患者中,男性71例,女性9例,年龄18～ 60岁,平均年龄（38±10）岁.本组病例CD4＋T淋巴细胞计数＞100个/μl组患者的患病率与计数低于100个/μl的患者两组比较差异有统计学意义（x2=15.567、32.469,P=0.00、0.00）.发生CMVR时80例患者的CD4＋T淋巴细胞计数为0～141个/μl,65例低于50个/μl.8例（10.0％） AIDS以CMVR为首发临床表现.20例（25.0％） 26只眼经眼科常规检查发现视网膜病变.首诊时34只眼（54.2％）的视力低于0.3,其中74只眼（62.5％）因后极部视网膜坏死引起.51只眼治疗后视力有不同程度提高,其中48只眼于出现症状3个月内接受治疗;35只眼治疗后视力下降或无改善,其中15只眼出现症状3个月后接受治疗.CD4＋T淋巴细胞达150个/μl并持续3个月时停止抗CMV治疗.86.9％眼治愈,15只眼视网膜脱离,14只眼免疫重建葡萄膜炎,24只眼并发性白内障,6只眼视神经萎缩.治疗后34只眼视力低于0.05,其中24只眼由视网膜脱离、并发性白内障、视神经萎缩等CMVR并发症引起.结论 CD4＋T淋巴细胞计数较低是CMVR危险因素.高效抗病毒治疗及抗CMV治疗可使CMVR达临床治愈.应对AIDS患者,尤其是CD4＋T淋巴细胞计数低于100个/μl的患者进行常规眼科检查.

Objective To investigate the clinical characteristics of cytomegalovirus retinitis （CMVR） in acquired immunodeficiency syndrome （AIDS） patients.Methods Retrospective case-series study.The clinical and laboratory data of 80 AIDS patients （118 eyes） with findings of CMVR were collected from Shanghai Public Health Clinical Center from December 2006 to December 2011.The relationship between CMVR and cellular immunity,the high risk factor,clinical characteristics,treatment and prognosis of CMVR were analyzed in this study.x2 test was used to check the incidence of CMVR in different CD4 ＋ T lymphocyte count groups.Results There was 80 AIDS patients （118 eyes） totally,71 males and 9 females.Their age was from 18 to 60 years old,which mean value was （38 ± 10）years old.The incidence in the group of CD4 ＋ T lymphocyte count over 100 cells/μl was lower than the two groups of CD4＋ T lymphocyte count less than 100 cells/μl （x2 =15.567,32.469; P =0.00,0.00）.CD4＋ T lymphocyte count was always ranged from 0 to 141 cells/μl in CMVR patients.It was less than 50 cells/μl in 81.3% cases.In 10.0% AIDS patients,CMVR was the first manifestation.In 25% AIDS patients （26 eyes）,lesions in retina was found by routine eye examination.In 54.2% patients,the best corrected visual acuity was less than 0.3.Retinal necrosis was involvement near the posterior pole in 62.5% CMVR patients.The visual acuity of 51 eyes was improved after treatment within 94.1% cases which were treated within 3 months.However,BCVA of 35 eyes decreased or with less change within 42.9% cases which were treated after symptoms appeared 3 months.The anti-CMV treatment included induction and maintenance of ganciclovir or foscarnet stopped when the CD4 ＋T lymphocyte count was more than 150 cells/μl in 3 continuous months.86.9% eyes were cured clinically.Retinal detachment,immune reconstitution uveitis and complicated cataract was found in 13.1%,12.1% and 20.5% cases respectively.Optic atrophy occurred in 6 eyes.The visual acuity of 28.9% eyes was 0.05 or less,71.3% of that caused by retinal detachment,cataract and optic atrophy.Conclusions CD4 ＋ T lymphocyte count reduction is the risk factor for CMVR.HAART and anti-CMV therapy will cure the CMVR clinically.Routine eye examinations should be performed in all AIDS patients to get early diagnosis of CMVR or other opportunistic infections to avoid vision loss,especially in those CD4 ＋ T lymphocyte count lower than 100 cells/μl.