人类免疫缺陷病毒感染合并获得性免疫缺陷综合征眼部病变的眼底特征  

Fundus characteristics of human immunodeficiency virus with acquired immune deficiency

作　　者：罗静[1,2] 曾静[1,2] 张慧明[1] 陈司莹[1] 杨叶蓁[1] 魏为[1] 邓静[3] 唐罗生[1] 

机构地区：[1]中南大学湘雅二医院眼科,长沙410011 [2]广西医科大学第一附属医院眼科 [3]中南大学公共卫生学院流行病学教研室

出　　处：《中华眼底病杂志》2012年第6期581-584,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察人类免疫缺陷病毒感染合并获得性免疫缺陷综合征（HIV／AIDs）的眼部病变眼底特征。方法1041例HIV／AIDS患者纳入研究。其中，男性882例，占88．70％；女性159例，占11．30％；年龄12～73岁，平均年龄4l岁。发现HIV感染时间为1个月～10年，平均HIV感染时间为12个月。传播方式为性传播475例，占45．63％；针头注射传播508例，占48．80％；输血传播44例，占4．25％；母婴传播14例，占1．34％。所有患者均进行视力、裂隙灯显微镜及眼底检查；发现眼底异常改变时行眼压、眼底照相及荧光素眼底血管造影（FFA）检查。观察不同眼部病变的眼底特征。结果1041例HIV／AIDS患者中，发现眼部病变247例，占23．73％。其中，HIV视网膜微血管病变是最为常见的眼部病变，共132例，占眼部病变患者的53．44％；其次为巨细胞病毒性视网膜炎（CMVR），共70例，占眼部病变患者的28．34％。眼底检查发现，HIV视网膜微血管病变眼底表现为视网膜微动脉瘤，沿血管走行的灶状出血、棉绒斑；CMVR眼底表现为不规则干燥外观，颗粒状边沿，有的累积视神经。FFA检查发现，HIV视网膜微血管病变表现为出血斑呈遮蔽荧光，出血中心轻度强荧光，无荧光渗漏；CMVR表现为大片出血遮蔽荧光，血管荧光渗漏和（或）脉络膜透见荧光，视盘及病变区域荧光着染。结论HIV／AIDS可发生多种眼部病变，以HIV视网膜微血管病变和CMVR最为常见。HIV视网膜微血管病变主要表现为灶状出血和（或）棉绒斑，CMVR主要表现为不规则干燥外观病变，有时合并大片出血。Objective To observe the fundus characteristics of human immunodeficiency virus with acquired immune deficiency （HIV/AIDS）. Methods A total of 1041 HIV/AIDS patients were enrolled in this study. The patients included 882 males （88.70%） and 159 females （11.30%o）. The patients＇ ages ranged from 12 to 73 years, with a mean age of 41 years. The median time of HIV/AIDS diagnosis was 12 months, which ranged from one month to 10 years. HIV infection was acquired through sexual contact, intravenous drug use, blood transfusion or mother-to-child transmission in 475 patients （45.63%）, S08 patients （48.80%）, 44 patients （4.25%） and 14 patients （1.34%）, respectively. Ocular examinations （vision acuity, slit lamp microscope and fundus examination） were performed on recruited patients with HIV/AIDS. Additional exams （intraocular pressure, fundus photography and fundus fluorescein angiography） were done if abnormal ocular fundus was found. The ocular manifestations were diagnosed according to clinic reference. Results Ocular manifestations of HIV/AIDS were detected in 247 patients （23.73%）. Of 247 patients, the most common ocular manifestation was HIV retinopathy, which was present in 132 patients （53.44%）; cytomegalovirus retinitis （CMVR） was second place, affecting 70 participants （28.34%）. Clinic findings of HIV retinopathy included retina microaneurysm, hemorrhage along the blood vessel with cotton-wool spots, while irregular dry edge, granular appearing border, were present in CMVR, and the optic nerve may be affected. Fluorescein angiogram of HIV retinopathy demonstrated that hemorrhage was shown as sheltered fluorescence, with strong fluorescence without leakage in center of hemorrhage. Fluorescein angiogram of CMVR demonstrated significant hemorrhageappearing as sheltered fluorescence with leakage and/or lesioned area were stained with fluorescence. Conclusions transparent fluorescence. The optic disk and There are various HIV/AIDS related ocular manifestation. HIV

关 键 词：获得性免疫缺陷综合征 并发症 HIV感染 并发症 视网膜变性 诊断 疾病特征 

分 类 号：R77[医药卫生—眼科] R51[医药卫生—临床医学]