人类免疫缺陷病毒感染及获得性免疫缺陷综合征患者眼部病变的诊断与治疗  

Diagnosis and treatment of eye diseases associated with HIV infection and AIDS

作　　者：耿爽[1] 叶俊杰[1] 刘丽秋[1] 徐海燕[1] 王伟伟[1] 王淑然[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院眼科,100730

出　　处：《中华眼科杂志》2009年第12期1093-1098,共6页Chinese Journal of Ophthalmology

摘　　要：目的探讨人类免疫缺陷病毒（HIV）感染及获得性免疫缺陷综合征（AIDS）患者的眼部病变特点、临床症状及治疗原则。方法回顾性系列病例研究。回顾性分析110例（220只眼）HIV感染和AIDS患者的临床资料，包括患者视力、眼前节、眼底检查和荧光素眼底血管造影及外周血CD4^＋T淋巴细胞检测结果，其中2例（4只眼）AIDS合并巨细胞病毒（CMV）性视网膜炎患者施行了更昔洛韦玻璃体腔注药治疗。患者年龄、HIV感染时间与HIV视网膜病变及CMV性视网膜炎的相关性采用Pearson相关分析法，性别与HIV视网膜病变及CMV性视网膜炎的相关性采用Pearson ChiSquare分析法，正常眼底组、HIV视网膜病变组、CMV性视网膜炎组间CD4^＋T淋巴细胞计数比较采用多个独立样本的秩和检验。结果患者初诊视力为无光感者5只眼，光感至0．04者10只眼，0．05—0．2者14只眼，0．3～0．7者62只眼，0．8及以上者129只眼。110例（220只眼）HIV感染和AIDS患者中，有25只眼角膜后有灰白色细小或色素性沉着物。22只眼房水闪光（＋）或（＋＋）。4只眼虹膜后粘连。28只眼晶状体混浊。34只眼确诊为HIV视网膜病变，眼底表现为棉絮斑、视网膜出血及微血管瘤。32只眼确诊为AIDS合并CMV性视网膜炎，26只眼的眼底表现为沿血管分布的浓厚黄白色病损区，其上片状出血，边缘有不规则黄白色颗粒。3只眼为眼底病变晚期，表现为视网膜萎缩、视网膜血管硬化和狭窄、视神经萎缩。3只眼合并视网膜脱离。正常眼底的HIV感染者及AIDS患者CD4^＋T淋巴细胞计数中位数为100．0个／mm^3，HIV视网膜病变患者CD4^＋T淋巴细胞计数中位数为41．0个／mm^3，CMV性视网膜炎患者CD4^＋T淋巴细胞计数中位数为18．0个／mm^3。CD4^＋T淋巴细胞计数比较，正常眼底组与HIV视网膜病变组相比，差异有统计学意义（χ^2=4．848，P=0．028）�Objective To investigate the manifestations and treatment principles of ocular diseases associated with human immunodeficiency virus infection （ HIV ） and acquired immunodeficiency syndrome （AIDS）. Methods It was a retrospective ease series. One hundred and ten patients were recruited. Two hundred and twenty eyes underwent ophthalmologic examination that included vision acuity, anterior segment and fundus examinations with papillary dilation and fundus fluorescein angiography. CD4^＋ T-lymphocyte was counted in peripheral blood of 110 patients. Intravitreal injection of ganciclovir 400 μg was performed in 4 eyes （2 patients） with cytomegalovirus （CMV） retinitis associated with AIDS. All statistical analyses were performed using SPSS 13.0 software. The association between the age, duration of HIV infection and HIV/AIDS related ocular manifestations was analyzed by Pearson Correlation Analysis. The association between the gender and HIV/AIDS related ocular manifestations was analyzed by Pearson Chi-Square test. For comparison of the CD4^＋ T cells counts of the patients with normal fundus, HIV retinopathy, CMV retinitis, Kruskal-Wallis Test for Several Independent Samples was used. Results Baseline visual acuity： no light perception （NLP） 5 eyes; light perception （LP） to O. 04, 10 eyes; 0. 05 to 0. 2, 14 eyes; 0. 3 to 0. 7, 62 eyes and ≥0, 8, 129 eyes. Small grayish keratie precipitates or pigment keratic precipitates were present in 25 eyes, 22 eyes had positive aqueous flare, 4 eyes had posterior syneehia of the iris, 28 eyes had cataract. HIV retinopathy was present in 34 eyes. Cotton-wool spots, retinal hemorrhages, and retinal microaneurysms were found in eyes with HIV retinopathy. CMV retinitis was present in 32 eyes. The fundus manifestations of CMV retinitis included retinal vasculitis; dense, full-thickness, yellow-white lesions along vascular distribution with irregular granules at the border, and hemorrhage on the retinal surface in 26 eyes. Late stage retinopathy was

关 键 词：获得性免疫缺陷综合征 HIV感染 视网膜疾病 巨细胞病毒视网膜炎 更昔洛韦 

分 类 号：R686[医药卫生—骨科学]