艾滋病合并巨细胞病毒性视网膜炎的误诊分析  

Misdiagnosis of cytomegalovirus retinitis with acquired immune deficiency syndrome

作　　者：孙挥宇[1] 彭晓燕[2] 勇志鹏[3] 毛菲菲[1] 李丹[1] 许雪静[1] 柳月红[1] 陈帆[1] 

机构地区：[1]首都医科大学附属北京地坛医院眼科,100015 [2]首都医科大学附属北京同仁医院北京同仁眼科中心 [3]北京仁和医院

出　　处：《眼科》2011年第5期352-355,共4页Ophthalmology in China

基　　金：首都医学发展基金资助项目(编号2009-3155)

摘　　要：目的分析艾滋病合并巨细胞病毒性视网膜炎的误诊病例,以减少误诊。设计回顾性病例系列。研究对象具有误诊史的艾滋病合并巨细胞病毒性视网膜炎的患者9例。方法回顾性分析在北京地坛医院确诊的具有误诊史的艾滋病合并巨细胞病毒性视网膜炎患者的眼部和全身情况。主要指标误诊眼疾病,误诊时间,合并全身疾病。结果艾滋病患者巨细胞病毒性视网膜炎误诊为其他眼病的患者9例（12眼）,其中误诊为Coats病者1例,视网膜中央静脉阻塞者1例,Eales病者1例,孔源性视网膜脱离者1例,视盘血管炎者2例（3眼）,葡萄膜炎者2例（4眼）,曾先后误诊为急性视网膜坏死、葡萄膜炎和玻璃体混浊者1例。发病一周内误诊者3例,1周~3个月内误诊者2例,3个月以上病程者误诊4例。9例误诊患者中5例不曾进行高效抗逆转录病毒治疗（HAART）的患者CMV-IgM检测阳性;5例患者合并有贫血,5例患者合并其他部位的感染,4例患者合并肝肾功能异常,9例患者的CD4均〈200个/μL,其中6例患者的CD4〈50个/μL。结论艾滋病合并巨细胞病毒性视网膜炎受到病程、艾滋病抗病毒治疗和我们对疾病的认识等多种因素的影响易出现误诊。对于临床诊断有困难的疾病应考虑到这种疾病的可能,其正确的诊断需要结合全身情况综合判断。Objective To analyze the problems in the diagnosis of cytomegalovirus retinitis and its main causes of misdiagnosis.Design Retrospective case series.Participants 9 patients with cytomegalovirus retinitis who had been misdiagnosed.Methods We evaluated the patients with general and ophthalmic examinations and analyzed the causes of their misdiagnosis.Main Outcome Measures Misdiagnosed ocular diseases,the duration of the disease when presenting,systemic complications.Results There were 12 eyes of 9 AIDS patients with cytomegalovirus retinitis,who had been misdiagnosed.One of them was misdiagnosed as Coats.One was misdiagnosed as CRVO.One was misdiagnosed as Eales.One was misdiagnosed as RRD.One was misdiagnosed as optic disc vasculitis.Two were misdiagnosed as uveitis.One was misdiagnosed as ARN,uveitis and vitreous opacity sequentially.The duration of 3 patient＇s were a week,of 2 patients were from a week to a month;of 4 patients were over 3 months.Five out of 9 patients had CMV-IgM positive who had accepted HAART.Five of them were accompanied with anemia.Five of them were accompanied with other infection of the body.The CD4 counts of all patients were less than 200/μL,and 6 of them were less than 50/μL.Conclusion It is common to misdiagnose cytomegalovirus retinitis due to the variation of the disease duration,HAART,and the limited knowledge about the disease.When facing complex fundus diseases,we should take cytomegalovirus retinitis into account,and give the patients a thorough general and ophthalmic examinations.

关 键 词：巨细胞病毒性视网膜炎 艾滋病 视网膜疾病 误诊 

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