获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎71例临床分析

Clinical characteristics of cytomegaloviral retinitis in 71 cases with AIDS

目的探讨获得性免疫缺陷综合征（AIDS）合并巨细胞病毒性视网膜炎（CMVR）患者的临床特点以及视力下降可能的危险因素。设计回顾性病例系列。研究对象2009年8月至2014年8月就诊于北京地坛医院的AIDS合并CMVR患者71例。方法对71例AIDS合并CMVR患者进行与艾滋病相关的免疫性检测（人类免疫缺陷病毒抗体，CD4＋T淋巴细胞计数）；所有患者进行视力、眼压、裂隙灯以及眼底照相等眼科检查，并观察其临床特征。主要指标视力、眼底、CD4＋T细胞计数。结果71例患者中54例（76％）CD4＋T细胞≤50个／μl，7例（10％）CD4＋T细胞〉50～100个／山，10例（14％）CD4＋T细胞〉100个／μl。视力≤0．3的49眼中，34眼（70％）视网膜病变以后极部为主，24眼（24％）最终视力〈0．05，其中8眼（33％）视网膜脱离，12眼（50％）后极部视网膜坏死严重累及黄斑（包括9眼视神经萎缩），6眼（25％）并发性白内障，其中4眼为全葡萄膜炎合并白内障，2眼为视网膜脱离合并白内障。结论CD4＋T淋巴细胞计数较低是CMVR危险因素。后极部视网膜坏死是AIDS视力损害的主要原因。

Objective To investigate the characteristics of cytomegalovirus retinitis （CMVR） and to characterize the risk factors for visual acuity loss in the patients with AIDS. Design Retrospective case series. Participants 71 AIDS patients （99 eyes） with active cytomegalovirus retinitis. Methods All 71 patients were evaluated with ophthalmic examination, including the visual acuity, introcular pressure, slip-light, and fundus phtography, HIV test and CD4＋ cells count were examed as well. The clinical characteristics were analyzed. Main Outcome Measures Visual acuity, CD4＋T lymphocyte counts, ocular fundus changes. Results In 71 patients, 54 cases （76%） of CD4＋T cells is ≤50 eells/μl, 7 cases （10%） of CD4＋T cells 〉 50-100 cells/μl, 10 cases （14%） of CD4＋T cells 〉100 cells/μl. In 49 eyes whose best corrected visual acuity were less than 0.3, the retinal necrosises in 34 cases （70%） involved the posterior pole. The visual acuity in 24% eyes was 0.05 or less at the end of following time. The posterior pole retinal necrosis involved macula （including optic atrophy ） in 9 eyes, 6 eyes （25%） complicated cataract, in which 4 eyes were panuveitis with cataract, 2 eyes were retinal detachment with cataract. Conclusion CD4＋T lymphocyte count reduction is the risk factor for CMVR clinically. The posterior poleretinal necrosis is the main reason of vision loss.