获得性免疫缺陷综合征并发巨细胞病毒视网膜炎患者抗病毒治疗前后视功能的变化

Changes of visual function in patients infected cytomegalovirus retinitis associated with acquired immunodeficiency syndrome before and after antiviral therapy

目的探讨获得性免疫缺陷综合征并发巨细胞病毒（cytomegalovirus,CMV）视网膜炎的患者在抗病毒治疗前后视功能的变化。方法对11例感染人类免疫缺陷病毒并且第1次发生CMV视网膜病变的患者,给予膦甲酸钠和更昔洛韦治疗。治疗前、治疗后1个月、3个月,通过多焦视网膜电图对每例患者的视功能进行评估,以未感染人类免疫缺陷病毒的正常人眼作为正常对照组,观察患眼视功能的改善情况。结果 CMV视网膜炎患者mf ERG一阶反应中心区域N1-P1的振幅密度,治疗前为（36.98±17.93）n V·deg^-2,治疗1个月后为（41.33±16.78）nV·deg^-2,治疗3个月后为（36.12±15.46）n V·deg^-2,正常对照组为（76.99±11.27）n V·deg^-2。患眼发病时与正常对照组相比较,1~4环区域mf ERG的一阶反应N1-P1的振幅密度均显著降低,差异有统计学意义（均为P〈0.05）。患眼在治疗后1个月和3个月,1~6环区域mf ERG的一阶反应N1波和P1波的潜时,以及N1-P1的振幅密度与治疗前相比均没有明显改变,差异均无统计学意义（均为P〉0.05）。结论 CMV视网膜炎的患者在经过积极地抗病毒治疗后,视力虽然能够得到不同程度上的恢复,但视网膜外层仍然受到不可逆的损伤,视网膜的功能显著降低。

Objective To investigate the changes of visual function in patients with acquire immunodeficiency syndrome （AIDS） complicated cytomegalovirus （CMV） retinitis before and after antiviral therapy. Methods Eleven patients infected with human immunodeficiency virus （HIV）and occurred with CMV retinitis for the first time, were given foscarnet and ganciclovir therapy. Before and after therapy for 1 month and 3 months, the multifocal electroretinogram （nffERG）was used to evaluate the visual function of each patient. The eye was not infected HIV as normal control group. The improvement of visual function of patient was observed. Results N1-P1 amplitude densities of mfERG first order kernel in central area （ ring 1 ） in CMV retimtis patients before therapy was （36.98 ± 17.93）nV·deg^-2 ,after therapy for 1 month was （41.33 ± 16.78 ） nV·deg^-2 ,after therapy for 3 months was （ 35.12 ± 15.45 ） nV·deg^-2 ,normal control group was （75.99 ± 11.27 ）nV·deg^-2. Suffering from eye disease compared with normal controls,the N1-P1 amplitude densities of mfERG first order kernel from ring 1 to ring 4 were significantly decreased, there were statistically significant differences （all P 〈0.05）. There was no significant difference in latencies of N1 and PI wave,and N1-P1 order kernel from ring 1 to ring 6 among the three grouos （ all P 〉 0.05 ）. Conclusionamplitude densities of mfERG first order kernel from ring 1 to ring 6 among the three groups （ all P 〉 0.05 ）. Conclusion The patients with CMV retinitis regain vision to some extent after the highly active antiretroviral therapy. However,the outer retinal layers is still subject to irreversible damage and the retinal function significantly decrease.