乌鲁木齐市93例艾滋病患者眼科临床特征分析

Clinical features of ocular manifestations of 93 AIDS patients in Urumqi

目的:探讨乌鲁木齐市艾滋病(acquired immune deficiency syndrome,AIDS)患者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93例AIDS患者进行眼底检查,并对其中有眼底改变患者的临床表现及CD4+T细胞计数进行描述和分析。结果:AIDS患者93例中,有13例出现眼底改变,总检出率为14.0%。其中单眼发病4例,双眼发病9例。有视力改变7例,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4例,HIV相关性眼底病变9例。CD4+T淋巴细胞计数≤100个/μL合并眼底改变的检出率(18.9%,7/37)明显高于CD4+T>100个/μL合并眼底改变的检出率(10.7%,6/56),差异有统计学意义(P<0.05)。结论:HIV相关视网膜病临床表现无特异性。有相当一部分AIDS患者在视力未发生改变时,其眼底早就发生病变,因此对AIDS患者应常规行眼底检查,有利于眼底病变的早期发现、早期诊断、早期治疗。

AIM： To investigate the clinical features of acquired immune deficiency syndrome （ AIDS） patients associated ocular diseases in Urumqi and the relationship between ocular fundus manifestations and CD4＋T cell count. METHODS： The fundus of 93 AIDS patients were examined by indirect ophthalmoscopy. The clinical symptoms and CD4＋T cell count of those patients with fundus changes were analyzed. RESULTS： Thirteen patients were found having fundus changes which occurred in one eye of 4 patients and two eyes of 9 patients, respectively, and the total detection rate was 14. 0%. Seven patients had vision changes, and the main clinical features of retinal lesion were cotton wool spot and hemorrhage of retina. Four patients were diagnosed as retinitis with cytomegalovirus （ CMV ） infection and 9 patients were diagnosed as HIV related retinopathy diseases. Seven patients among 37 patients with CD4＋T cell count ≤100cell/μL had fundus changes related AIDS, and the detection rate was 18. 9%; while 6 patients among 56 patients with CD4＋T cell count 〉100cell/μL had fundus changes related AIDS, and the detection rate was 10. 7%. There was statistical difference between the two detection rates （P〈0. 05）. CONCLUSION： No specificity was found of those patients with the clinical manifestation of HIV- related retinopathy, and those patients are easy to be missed diagnosis. A number of AIDS patients have fundus changes without any vision changes. Therefore, it is very useful for AIDS patients to be carried out the routine fundus examination for the early diagnosis and treatment.