AIDS并发巨细胞病毒性视网膜炎

Cytomergalovirus retinitis as a complication of AIDS.

目的 探讨艾滋病 (AIDS)并发巨细胞病毒 (CMV)性视网膜炎的临床特点和治疗转归。方法 观察分析北京协和医院确诊为AIDS并发CMV视网膜炎的 5例患者的临床和实验室资料、治疗转归。结果 5例CMV视网膜炎患者的 9只眼均经眼底散瞳检查确诊。全部患者均为AIDS晚期患者 ,CD+ 4 T淋巴细胞计数 3～ 36 /mm3 ,在确诊CMV视网膜炎时均已合并其它机会性感染。平均年龄 2 9 2± 5 1岁。临床症状有视物模糊、视力下降等。眼底检查有典型的视网膜血管炎 ,表现为沿血管分布的黄白色病损、黄白色颗粒及视网膜出血 ,但玻璃体透明或轻微混浊。 4例接受更昔洛韦 (GCV)治疗的患者病情均得到控制 ,眼底病变消退 ,但其中 1例视力丧失 (失明 )无法恢复 ;1例患者未特殊治疗死于多种机会感染。结论 中国CMV视网膜炎的表现和国外文献报道的类似 ,多发生于晚期AIDS患者 ,不及时治疗将导致视力丧失 ,早期诊治非常重要。建议 :对于CD+ 4 T细胞计数 <5 0 /mm3 以及存在眼外CMV感染的AIDS患者 ,应常规作眼底检查 ;反之 ,对于拟诊CMV视网膜炎的所有患者 ,均应常规筛查血清HIV抗体。

objective To investigate the clinical characteristics and therapeutic outcomes of cytomegalovirus (CMV) retinitis in patients with acquired immunodefi ciency syndrome(AIDS). Methods clinical and laboratory data of 5 AIDS patients diagnosed as CMV retinitis in our hospital were analyz ed. Results Nine eyes in the 5 AIDS patients were diagnosed a s CMV retinitis, ma inly based upon their typical ophthalmologic features. All the 5 patients with r etinitis were at advanced stage of AIDS, with CD + 4 T lymphocyte count betwee n 3- 36 cell/mm 3, and all had other opportunistic infections (OIs) in addition to CMV retinit is. Most patients complained of blurred vision or floating. The main clinical fe ature was progressive retinitis without involvement of the anterior-chamber and vitreous. One patient died of multiple OIs when gancyclovir was not yet availabl e in our hospital. Three patients treated with gancyclovir made improvement, whi le the remaining patient lost his vision forever although gancyclovir was given both systematically and locally. Conclusions CMV retinitis is o ne of the severe complications for AIDS patients. It usually occurs in the late stage, and patien ts would loss their visions if no proper therapy was given. Early diagnosis and proper therapy are quite important for keeping them free from loss of sight. So we suggest that a routine fundus check-up should be given to those AIDS patie nts with CD + 4 T lymphocyte count below 50 cell/mm 3, and the serum HIV antibo dy should be screened for those patients whose fundus giv e a typical appearance of CMV retinitits.