艾滋病合并巨细胞病毒性视网膜炎73例的临床特征及其预后影响因素分析

Clinical features and prognostic factors in 73 cases of acquired immunodeficiency syndrome complicated with cytomega-lovirus retinitis

目的分析艾滋病合并巨细胞病毒性视网膜炎(cytomega-lovirus retinitis,CMVR)患者的临床特点及其预后影响因素。方法收集2016年1月至2019年12月重庆市公共卫生医疗救治中心诊断为艾滋病合并CMVR患者的基本信息、临床特点、眼底表现、治疗和预后情况,采用logistic单因素回归和多因素回归分析影响患者预后的因素。结果73例艾滋病合并CMVR患者中,男54例,女19例,年龄为(41.3±12.1)岁。CD4^(+)T淋巴细胞计数的中位数为34.0/μL,CD4^(+)T淋巴细胞计数>200.0/μL者5例(6.85%)。血液巨细胞病毒(cytomegalovirus,CMV)DNA阳性者40例(54.79%)。35例(47.95%)患者入院时有眼部症状,病灶以单眼受累为主(53.42%,39/73),检眼镜检查显示呈中央型病变者41例(56.16%),伴渗出病变者63例(86.30%),有出血病变者52例(71.23%)。67例患者接受抗CMV治疗,46例治疗后好转出院,2例未治疗患者随访期间病变好转,中位住院时间为25 d。logisitic单因素分析显示,相对于单独使用抗CMV药物(膦甲酸钠或更昔洛韦)治疗的患者,使用抗CMV药物联合地塞米松治疗的患者预后更好[比值比(odds ratio,OR)=0.308,P=0.038]。相较于年龄<30岁的患者,年龄>50岁的患者预后较差(OR=14.667,P=0.009)。多因素分析显示,年龄>50岁是影响CMVR预后的独立危险因素(OR=18.183,P=0.009)。结论CMVR好发于CD4+T淋巴细胞计数较低的艾滋病患者,但CD4+T淋巴细胞计数>200.0/μL的患者仍有可能发生CMVR,且并非所有患者血液CMV DNA均呈阳性,故艾滋病患者有必要常规行眼底筛查。CMVR总体预后较好,年龄>50岁是影响预后的独立危险因素,适量使用地塞米松联合抗CMV药物治疗可改善预后。

Objective To analyze the clinical characteristics and prognostic factors of acquired immunodeficiency syndrome(AIDS)patients with cytomega-lovirus retinitis(CMVR).Methods The basic information,clinical features,fundus manifestations,treatment and prognosis of AIDS patients complicated with CMVR from January 2016 to December 2019 in Chongqing Public Health Medical Center were collected.Logistic single factor regression and multivariate regression analysis were used to analyze the factors affecting the prognosis of patients.Results A total of 73 AIDS patients with CMVR were enrolled,including 54 males and 19 females.They were(41.3±12.1)years old.The median of CD4^(+)T lymphocyte counts was 34.0/μL,and there were five cases(6.85%)with CD4^(+)T lymphocyte counts>200.0/μL.Forty cases(54.79%)were positive for cytomegalovirus(CMV)DNA in blood.Thirty-five patients(47.95%)were admitted with ocular symptoms,and monocular involvement was common(53.42%,39/73).The results of ophthalmoscope showed that 41 cases(56.16%)had central lesions,63 cases(86.30%)had exudative lesions and 52(71.23%)had bleeding lesions.Sixty-seven patients were treated with anti-CMV therapy,and 46 patients were discharged with improved after treatment,and two patients were improved without treatment during follow-up.The median hospitalization time was 25 days.Logistic single factor regression analysis showed that the prognosis of patients with combination of anti-CMV drugs and dexamethasone was better than that of patients who were treated with anti-CMV drugs(sodium phosphonate or ganciclovir)alone(odds ratio(OR)=0.308,P=0.038).Compared with patients aged<30 years old,the prognosis of patients aged>50 years old was worse(OR=14.667,P=0.009).The multivariate analysis showed that age>50 years old was the independent risk factor influencing the prognosis of CMVR(OR=18.183,P=0.009).Conclusions CMVR is frequently found in AIDS patients with low CD4+T lymphocyte counts,but CMVR may still occur in patients with CD4+T lymphocyte counts>200.0/μL.However,not all patients have positive CMV DNA results in blood.Therefore,it is necessary for AIDS patients to receive examination of ocular fundus.The overall prognosis of CMVR is good.Age>50 years old is an independent risk factor affecting prognosis.Appropriate use of dexamethasone combined with anti-CMV treatment can improve the prognosis.