艾滋病合并巨细胞病毒感染23例临床分析  

Twenty-three cases of cytomegalovirus infection in acquired immunodeficiency syndrome

作　　者：陶梅梅[1] 叶俊杰[2] 匡季秋[1] 韩扬[1] 谢静[1] 邱志峰[1] 左玲燕[1] 李雁凌[1] 李太生[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院感染科,100730 [2]中国医学科学院中国协和医科大学北京协和医院眼科,100730

出　　处：《中华内科杂志》2008年第10期802-804,共3页Chinese Journal of Internal Medicine

基　　金：国家科技攻关计划课题（2004BA719A10）;卫生部部属（管）医院临床学科重点项目（2007-2009）

摘　　要：目的探讨AIDS合并巨细胞病毒（CMV）感染的临床特点、治疗转归和外周血T淋巴细胞亚群变化情况。方法回顾性分析1985—2005年北京协和医院收治的96例AIDS患者，对其中23例CMV感染患者的临床特点、外周血T淋巴细胞亚群、血清学指标、治疗及预后情况进行分析。结果23例合并CMV感染的AIDS患者中，临床表现为：发热（18例）、咳嗽（11例）、胸闷（9例）、腹泻（8例），13例出现CMV视网膜炎，其中7例以视力下降、视物模糊等眼部症状为首发表现。18例合并肺孢子菌肺炎、结核等多种机会性感染。15例（65．2％）CMV血清学阳性，CMVpp65的阳性率为43．5％，特异性CMVIgM抗体的阳性率为30．4％。CMV感染组的CDfT细胞数量[14（4，39）个／μl]明显低于非CMV感染组[48（12，128）个／μl]，P=0．005；CDSCD未T细胞比例高于非CMV感染组。结论CMV感染多发生于晚期AIDS患者，当AIDS患者的CD4T细胞〈100个／μl时，应常规检测CMVpp65抗原和特异性IgM抗体，筛查眼底；若青壮年患者以发热、视力下降、视物模糊等就诊，应警惕AIDS合并CMV感染的可能。Objective To investigate the clinical features, therapeutic approaches, outcomes and alterations of peripheral lymphocytes subsets in cytomegalovirus （CMV） infections in patients with AIDS. Methods Ninety-six cases of AIDS were treated in Peking Union Medical College Hospital and 23 of them had CMV infection. We analyzed the clinical features, peripheral lymphocytes subsets, outcomes, CMV pp65 antigen and/or specific anti-CMV IgM. Results In the 23 CMV patients, nonspecific symptoms including fever, cough, chest distress and diarrhea occurred in 18, 11,9 and 8 patients, respectively. Thirteen patients had retinitis identified by ophthalmofundoscopy, 7 of them had blurred vision or floating as primary symptoms. Pneumocystis pneumonia, tuberculosis infection and other infection appeared in 18 patients. Fifteen（65.2% ）of the patients had positive serum tests. The positive rates for CMV pp65 and specific anti- CMV-IgM were 43.5% and 30. 4%, respectively. CD4＋ T cell count in CMV patients was remarkably decreased than that in non-CMV patients[ 14 （4,39） cells/μl vs （48 （12,128） cells/μl, P = 0. 005 ] and the proportion of CD8＋ CD38^＋ T cells in CMV patients was higher than that in non-CMV patients,whereas the difference of CD8^＋ T cell was not statistically different between the 2 groups. Conclusions CMV infection often occurrs in advanced AIDS patients. In HIV/AIDS patients with CD4^＋ T cell count ≤ 100 cells/μl, routine check for CMV pp65 antigen, specific anti-CMV IgM and ophthalmofundoscopy are recommended. Whenever encountering a young patient presenting with fever, blurred vision or floating, CMV complicating AIDS should be considered.

关 键 词：获得性免疫缺陷综合征 巨细胞病毒感染 T淋巴细胞亚群 

分 类 号：R686[医药卫生—骨科学]