343例获得性免疫缺陷综合征患者眼底情况的临床分析

Fundus characteristics of 343 cases of patients with acquired immunodeficiency syndrome

目的探讨获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者的眼底病变特点及其与全身伴发疾病的关系。设计回顾性病例系列。研究对象2015年3月至2016年12月就诊于北京地坛医院的AIDS患者343例。方法对343例AIDS患者进行全身及眼科检查,包括视力、眼压、裂隙灯、双目间接检眼镜以及眼底照相等,并观察其临床特征,按照眼底表现分为:巨细胞病毒性视网膜炎(cytomegalovirus retinitis,CMVR)组、人类免疫缺陷病毒(human immunodeficiency virus,HIV)视网膜病变组、对照组。主要指标视力、眼底、CD4+T细胞计数、外周血HIV病毒载量。结果343例患者中46例(56眼)为CMVR,74例(154眼)为HIV视网膜病变,对照组与CMVR组及HIV微血管病变组相比,经过6个月以上高效抗逆转录病毒治疗(highly active anti-retroviral therapy,HAART)者更多。CMVR组CD4+细胞计数为(53.86±101.14)/μL,HIV视网膜病变组为(33.69±47.06)/μL,对照组为(120.28±175.80)/μL,CD4+细胞数低于50/μL是CMVR的危险因素(P=0.000)。65例出现结核感染,20例出现隐球菌脑膜炎,68例伴随梅毒感染。共39眼视力≤0.3。所有患眼中出现视盘水肿19眼,视神经萎缩14眼,玻璃体混浊28眼,白内障8眼,陈旧性CMVR 12眼,视网膜脱离12眼。视盘水肿与隐球菌性脑膜炎、梅毒感染有关(P=0.000)。视神经萎缩与隐球菌性脑膜炎、陈旧CMVR病灶相关(P=0.000),CMVR与视网膜脱离、玻璃体混浊相关(P=0.000)。结论CD4+T淋巴细胞计数较低是CMVR危险因素。AIDS伴发疾病导致的眼底损害需要重视。

Objective To investigate the characteristics of fundus lesions in patients with acquired immunodeficiency syndrome(AIDS)and their relationship with systemic concomitant diseases.Design Retrospective case series.Participants 343 AIDS patients admitted to Beijing Ditan Hospital from March 2015 to December 2016.Methods A total of 343 AIDS patients were examined by systemic and ophthalmic examination,including visual acuity,intraocular pressure,slit lamp,binocular indirect ophthalmoscope and fundus photography,and their clinical characteristics were observed.According to their fundus manifestations,they were divided into the following groups:cytomegalovirus retinitis(CMVR)group,human immunodeficiency virus(HIV)retinopathy group and control group.Main Outcome Measures Visual acuity,fundus,CD4+T cell count,peripheral blood HIV viral load.Results Among the 343 patients,46 eyes showed CMVR and 74 eyes showed HIV retinopathy.More patients in the control group received HAART more than 6 months.CD4+T cell count was 53.86±101.14/μl in the CMVR group,33.69±47.06/μl in the HIV retinopathy group,and 120.28±175.80/μl in the control group.CD4+T cell count lower than 50/μl was a risk factor for CMVR(P=0.000).Tuberculosis infection occurred in 65 cases,cryptococcal meningitis in 20 cases,and syphilis in 68 cases.A total of 39 eyes had visual acuity less than 0.3.Ophthalmic examination found optic disc edema in 19 eyes,optic nerve atrophy in 14 eyes,vitreous opacity in 28 eyes,cataract in 8 eyes,cured CMVR in 12 eyes,and retinal detachment in 12 eyes.Optic disc edema was associated with cryptococcal meningitis and syphilis infection(P=0.000).Optic nerve atrophy was associated with cryptococcal meningitis and cured CMVR lesions(P=0.000),and CMVR was associated with retinal detachment and vitreous opacity(P=0.000).Conclusion Low CD4+T cell count is a risk factor for CMVR.Ophthalmologist should pay attention to the fundus damage caused by accompanied diseases with AIDS.