人类免疫缺陷病毒(HIV)感染者眼表情况与CD4^+T淋巴细胞的相关性分析

Correlation between manifestation of ocular surface and CD4 + T-cells count in HIV-infected patients

目的探讨人类免疫缺陷病毒(human immune deficiency virus,HIV)感染者眼表情况、干眼症的发病情况与全身免疫情况是否存在相关性。方法对病例组(15例)和对照组(15例)分别行泪液分泌试验I(Schirmer I test,SIT)、泪膜破裂时间(break-up time,BUT)、角膜荧光素染色(fluorescein staining,FLS)计分、结膜印迹细胞学(conjunctival impression cytology,CIC)检查,以了解正常眼、HIV感染者的眼表情况。病例组中以患者+-1-1CD4T淋巴细胞数-150μL为界分为A(≥50μL)、B(<50μL)两组进行分析。结果 BUT结果 :对照组(10.80±2.48)s,A组(7.00±3.74)s,B组(6.44±4.19)s,总体比较各组间BUT结果差异有统计学意义(F=5.882,P=0.008),A组及B组与对照组差异均有统计学意义(P值分别为0.025、0.004),A组与B组间差异无统计学意义(P=0.753)。SIT结果 :对照组每5 min(11.73±2.46)mm,A组(8.33±2.58)mm,B组(8.67±4.44)mm,各组间总体比较SIT结果差异有统计学意义(F=3.910,P=0.032),A组及B组与对照组差异均有统计学意义(P值分别为0.034、0.028),A组与B组间差异无统计学意义(P=0.845)。各病例组和对照组之间角膜FLS检查总体差异有统计学意义(χ2=10.903,P=0.004),病例组与对照组之间差异有统计学意义(χ2=7.500,P=0.006),A组与B组间差异无统计学意义(χ2=2.269,P=0.132)。各病例组和对照组之间结膜CIC检查总体差异有统计学意义(χ2=15.000,P=0.001),病例组与对照组之间差异有统计学意义(χ2=13.393,P=0.000),A组与B组间差异无统计学意义(χ2=3.462,P=0.063)。HIV感染者易出现BUT变短、SIT减少、角结膜FLS重,印迹细胞学分级有显著的差异,对照组分级主要集中于0级、Ⅰ级,病例组主要集中于Ⅱ级和Ⅲ级。对照组干眼症的患病率为6.7%(1/15),病例组干眼症的患病率为40.0%(6/15)。两组间发病率的差异有统计学意义(χ2=4.658,P=0.031)。结论 HIV感染者易出现眼表异常及眼表细胞的损害,其干眼症发病率明显增高,眼表改变情况、干眼症发病率与CD4+T淋巴细胞数可能存在密切关系。

Objective To study the correlation of the manifestation of ocular surface and dry eye with general immunity in HIV-infected patients, Methods Schirm- er I test （SIT） ,tear film break-up time （BUT）and corneal fluorescein staining （FLS）, conjunctival impression cytology（CIC） were performed and the manifestation of the oc- ular surface was studied in 15 patients and 15 normal controls. The 15 patients were di- vided into group A （ CD4 ＋ T-ceils count ≥ 50 μL-1 ） and group B（ CIM ＋ T-ceils count 〈 50 μL- 1 ）. Results Result of BUT： The mean value of BUT were （ 10.80 ± 2.48 ） sec- onds, （ 7.00 ± 3.74 ） seconds, （ 6.44 ± 4.19 ） seconds in control group, group A and group B, respectively. The difference of BUT ammong groups was significant （ F = 5. 882, P = 0. 008 ）. The difference of BUT between group A or group B and control group were sig- nificant （P = 0. 025 ,0. 004 ）and not between group A and B （P=0.753 ）. Result of SITI： The mean value of SIT were （ 11.73 ± 2.46） mm/5 rain, （8. 33 ± 2.58） ram/5 rain, （8.33 ± 2.58 ）ram/5 rain in control group, group A and group B, respectively. The differ- ence of SIT among groups was significant （F=3.910,P=0. 032）. The difference of SIT between group A or group B and control group were significant （P =0. 034,0. 028 ） ,and not between group A and group B （ P = 0. 845 ）. The difference of FLS among groups was significant （X2 = 10. 903,P = 0. 004）. The difference of FLS between patients and controls was significant （X2 = 7. 500 ,P = 0. 006 ）, and not between group A and group B （X2 = 2. 269, P = 0. 132 ）. The difference of CIC among groups was significant （X 2= 15.00,P =0.001 ）. The difference of CIC between patients and controls was significant （X2 = 13.393 ,P =0. 000） ,and not between group A and group B （X2 =3.462,P =0. 063）. The HIV infection was prone to result in BUT and SIT more less, FLS was impression. The difference was significant in the conjunctival impression cytology of each group. The normal controls presented the grade 0 to I ,the patients presented the grade 11 to 11I. The incidence of dry eye was 6.7% （1/15） ,40.0% （6/15）in normal controls and pa- tients, respectively. The difference in incidence of dry eye between groups was signifi- cant （X2 =4.658 ,P = 0. 031 ）. Conehlsion The HIV infection is prone to ocular sur- face abnormalities and ocular surface cell damage. The incidence of dry eye increase significantly, there may be a close relationship between the manifestation of the ocular surface,the incidence of dry eye with CD4 ＋ T-cells count.