193例HIV/AIDS合并视网膜炎的临床特征分析

Clinical characteristics of HIV/AIDS coinfection with retinitis: repot of 193 cases

目的分析人类免疫缺陷病毒(human immunodeficiency virus,HIV)/获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者视网膜炎发生的临床特征及治疗后反应。方法收集2015-2017年在重庆市公共卫生医疗救治中心住院的193例HIV/AIDS合并视网膜炎的患者,男性156例,女性37例,年龄(43.9±11.9)岁;分为巨细胞病毒视网膜炎(cytomegalovirus retinitis,CMV R)组和HIV微血管病(HIV microangiopathy,HIV M)组,对其临床资料、检测指标、眼科检查结果及抗病毒治疗效果进行回顾性分析。结果 HIV/AIDS合并有视网膜炎的患者,CD4+T细胞计数明显低于非视网膜患者,而HIV RNA显著高于非视网膜患者(t=5.6、-2.3,P<0.05)。HIV M和CMV R无眼科症状的患者分别占44.4%、41.7%;CMV R以双眼病变为主,占77.4%;视网膜炎的总发生率为45.7%,并随着CD4+T细胞的降低逐渐增高,CD4+T细胞<200个/μL时视网膜炎的发生率为30%,CD4+T细胞<50个/μL时视网膜炎发生率最高,达58.6%。人巨细胞病毒DNA(human cytomegalovirus DNA,HCMV DNA)阳性的视网膜炎患者给予抗巨细胞病毒治疗后HCMV DNA转阴率在70%以上;CMV R视力恢复及病灶吸收率明显高于HIV M患者(χ2=9.526、24.206,P<0.05)。结论 HIV/AIDS患者发生视网膜炎的风险与CD4+T细胞水平密切相关,呈负相关性;对于CD4+T细胞<200个/μL的患者推荐行眼科相关检查,对于CD4+T细胞<50个/μL的患者建议常规开展眼科相关检查;全身抗巨细胞病毒治疗可有效控制病毒,改善眼部症状,提高生活质量。

Objective To investigate the clinical characteristics of retinitis in hospitalized HIV/AIDS patients and explore their therapeutic reactions. Methods Totally 193 retinitis patients who suffered from human immunodeficiency virus （HIV）/acquired immunodeficiency syndrome （AIDS） and were admitted in our center from 2015 to 2017 were subjected in this study. They were 156 males and 37 females, at an average age of 43.9±11.9 years. They were divided into cytomegalovirus retinitis group and HIV microangiopathy group. Their clinical data, laboratory indexes, results of ophthalmological examination and efficacies of antiviral treatment were retrospectively collected and analyzed. Results The CD4 ＋ T cell counts in the HIV/ AIDS patients with retinitis were significantly lower than those without retinitis, but the former patients had significantly higher HIV RNA level than the latter （ t = 5.6, - 2.3, P 〈 0.05 ）. There were 44.4% and 41.7% patients having no eye problem, respectively in the HIV microangiopathy and cytomegalovirus retinitis groups. While, those with cytomegalovirus retinitis mainly represented as impairment of both eyes, accounting for 77.4%. The total incidence of retinitis was 45.7% and elevated with the decrease of CD4 ＋ T cell count. The peak incidence was 58.6% when the CD4 ＋ T cell count was 〈 50/txL. Over 70% retinitis patients positive to human cytomegalovirus-DNA turned into negative after antiviral therapy. The patients withcytomegalovirus retinitis obtained better visual recovery and absorption than those of HIV microangiopathy （Chi-square = 9. 526, 24. 206, P 〈 0.05）. Conclusion The risk of retinitis in HIV/AIDS hospitalized patients is closely associated with CD4＋ T cells, in a negative correlation. For those with CD4＋ T cell count 〈 200/μL, ophthalmic examinations are needed, while those 〈 50/μL, regular examination are recommended. Systematic antiviral therapy is effective in controlling virus infection, improving ophthalmic symptoms, and promoting quality of life.