获得性免疫缺陷综合征并发巨细胞病毒性视网膜炎的临床分析  

Cytomegalovirus retinitis associated with Acquired immunodeficiency syndrome

作　　者：叶俊杰[1] 李海燕[1] 孙鼎[2] 闵寒毅[1] 韩宝玲[1] 胡天圣[1] 

机构地区：[1]中国协和医科大学中国医学科学院北京协和医院眼科眼科研究中心,100730 [2]山东省临沂市人民医院眼科

出　　处：《中华眼科杂志》2005年第9期803-806,共4页Chinese Journal of Ophthalmology

摘　　要：目的探讨获得性免疫缺陷综合征(acquiredimmunodeficiencysyndrome,AIDS)并发巨细胞病毒(cytomegalovirus,CMV)性视网膜炎的眼底表现特点、全身症状及治疗预后。方法观察8例(15只眼)AIDS并发CMV性视网膜炎的临床表现,分析其眼底、视力、荧光素眼底血管造影及CD4+T淋巴细胞检测结果,并对其中2例(4只眼)行更昔洛韦玻璃体腔注药治疗。随访时间2～34个月,平均16个月。结果初诊视力≤0.2者10只眼(66.7%),其中无光感者2只眼,眼前光感者2只眼,0.04～0.20者6只眼;0.8和0.9者各1只眼(13.3%);≥1.0者3只眼(20.0%)。12只眼的眼底表现为视网膜血管炎特点,呈沿血管分布的浓厚黄白色病损,其上有片状出血,边缘为不规则的黄白色颗粒,可形象描述为“奶酪加番茄酱样视网膜炎”;玻璃体透明或反应轻微。2只眼的眼底呈晚期表现,视网膜萎缩呈灰色,视网膜血管硬化、狭窄,视网膜色素上皮萎缩,可透见脉络膜血管及视神经萎缩。1只眼视网膜脱离。8例患者的CD4+T淋巴细胞计数在0～36个/mm3之间,平均(15.0±12.9)个/mm3。4只眼玻璃体注药后视力均显著提高。眼底病变明显消退,出血吸收。结论CMV性视网膜炎是AIDS最常见、最严重的眼部并发症。眼底表现特点为进行性、坏死性视网膜炎伴出血,同时合并有视网膜血管炎。但玻璃体反应无或轻微。对原因不明的黄白色病损、视网膜出血及视网膜血管炎应行血清人类免疫缺陷病毒(humanimmunodeficiencyvirus,HIV)抗体检测。反之,HIV阳性者应常规进行眼底检查。(中华眼科杂志,2005,41:803806)Objective To investigate the fundus characteristics, systemic features and therapeutic outcomes of cytomegalovirus （CMV） retinitis associated with acquired immunodeficiency syndrome （AIDS）. Methods Fundus features, visual acuity, fundus fluorescence angiography （FFA） and CD4 ^＋ T-lymphocyte counts of 15 eyes （8 patients） of CMV retinitis associated with AIDS were analyzed. The time of average follow-up was 16 months. Intravitreal injection of ganciclovir （400 μg） was performed in 4 eyes （2 patients）. Results In the initial examination, visual acuity of the patients was as following： ≤ 0. 2,10 eyes （66.7%） ;no light perception （NLP） （2 eyes） ; light perception （LP） （2 eyes） ;0. 04 -0. 2,6 eyes; ≥1.0,3 eyes （20.0%） and0.8 or0.9 each for 1 eye （13.3%）. The fundus manifestation includes：the retinal vasculitis; dense, full-thickness, yellow-white lesions along vascular distribution, and hemorrhage on the retinal surface; granular with irregular border featured as “cheese and ketchup retiuitis” was revealed in 12 eyes;the vitreous was clear or light opaque. Late stage of the retinopathy was demonstrated in 2 eyes characterized as grayish atrophic retina, vessel-sclerotic and attenuated, retinal pigment epithelium （RPE） atrophy, prominent choroid vasculature, and optic nerve atrophy. Retinal detachment was found in 1 eye. CD4 ^＋T-lymphocytes counts in peripheral blood were between 0 - 36/mm^3, average （ 15.0 ± 12. 9 ） mm^3. Visual acuity improved, fundus lesions disappeared observably and hemorrhage was absorbed in the 4 eyes after intravitreal injection of ganciclovir. Conclusions CMV retinitis is the severest and the most common intraocular complication in patients with AIDS. For the patients with yellow-white retinal lesions, hemorrhage and retinal vasculitis of underfined cause, the antibody of serum anti- human immunodeficiency virus （HIV） should be screened. Routing eye examination should be performed if the serological test of HIV i

关 键 词：获得性免疫缺陷综合征 巨细胞病毒性视网膜炎 临床分析 眼底检查 玻璃体反应 

分 类 号：R774.1[医药卫生—眼科] R512.91[医药卫生—临床医学]