获得性免疫缺陷综合征合并人类免疫缺陷病毒视网膜病变的眼底病变特征分析  

Fundus characteristics of acquired immune deficiency syndrome in human immunodeficiency virus retinopathy

作　　者：毛菲菲[1] 孙挥宇[1] 李丹[1] 许雪静[1] 刘彬彬[1] 柳月红[1] 

机构地区：[1]首都医科大学附属北京地坛医院眼科,100015

出　　处：《中华眼底病杂志》2012年第6期585-587,共3页Chinese Journal of Ocular Fundus Diseases

基　　金：首都医学科研发展基金（2009-3155）

摘　　要：目的观察获得性免疫缺陷综合征（AIDS）合并人类免疫缺陷病毒（AIDS／HIV）视网膜病变的眼底病变特征。方法AIDS／HIV视网膜病变患者52例80只眼纳入研究。其中，男性42例67只眼，女性10例13只眼，男女比例为4．2：1；年龄16～78岁，平均年龄（43±12）岁。所有患者均进行矫正视力、眼压、裂隙灯显微镜、散瞳间接检眼镜、眼底彩色照相检查及CD4＋T淋巴细胞检测。眼底检查由具有丰富经验的眼底病医生完成。观察所有患者的眼底病变特征。17例患者24只眼随访时间2d～2年，随访时间中位数125d；其余35例患者56只眼因死亡或在外地未能复诊。观察随访患者的眼底病变发展情况。结果52例患者80只眼中，双眼发病28例56只眼，占患眼的70．0％；单眼发病24例24只眼，占患眼的30．0％。眼底检查发现，52例患者80只眼中，眼底表现为棉绒斑46例72只眼，占患眼的90．0％，其多位于视盘旁颞上或颞下血管附近，少数可散布于全后极部血管旁；单纯视网膜出血6例8只眼，占患眼的10．0％，表现为后极部火焰状、点状出血或Roth斑。表现为棉绒斑的72只眼中，单纯棉绒斑57只眼；合并视网膜出血15只眼，其出血部位多位于棉绒斑旁。完成随访的17例24只眼中，随访时间小于2周病灶无明显变化3例3只眼；原有棉绒斑或出血1～3个月后在未经治疗的情况下消失11例18只眼，其中5只眼在后极部其他部位出现新棉绒斑或出血；起初表现为棉绒斑样病变，但在随访1～5个月后原病变发展为巨细胞病毒性视网膜炎3例3只眼。结论AIDS／HIV视网膜病变的最常见眼底表现为棉绒斑。Objective To observe the fundus characteristics of acquired immune deficiency syndrome （AIDS） with human immunodeficiency virus （HIV） retinopathy. Methods Eighty eyes of 52 AIDS patients with H1V retinopathy were enrolled in this study. The patients included 42 males （67 eyes） and 10 females （13 eyes）. The patients ages ranged from 16 to 78 years, with a mean age of （43＋12） years. All patients＂ visual acuity, intraocular pressure, slit-lamp microscopy and mydriatic indirect ophthalmoscopy, fundus color photography and CD4＋ T cell count was documented. Experienced ocular fundus doctors carried out fundus examinations. Retinopathy characteristics were recorded. Seventeen patients （24 eyes） were followed for a period between two days to two years, with a median of 125 days. We failed to follow up the remaining 35 patients （56 eyes） due to death or moving away. Results Among 52 patients （80 eyes）, 28 patients （56 eyes, 70.0%） had bilateral HIV retinopathy and 24 patients （24 eyes, 30.0%） had unilateral HIV retinopathy. Cotton-wool spots （CWS）, mostly located close to temporal peripapillary vessels, were found in 46 patients （72 eyes, 90.0%）. Six patients （eight eyes, 10.0%） were found to have flaming or spotting hemorrhage located in posterior pole. Among 72 eyes with CWS, 57 eyes were found to have CWS only and 15 eyes were found to also have retinal hemorrhage, mostly located near CWS. Among 24 eyes of 17 followed-up patients, three eyes of three patients were found with no significant changes during the less than two week follow-up. In 18 eyes of 11 patients, CWS or hemorrhage disappeared after one to three months without treatment and in five eyes new CWS or hemorrhage were found in other parts of the posterior pole. Three eyes of three patients initially considered as lint plaquelike lesions were eventually detected withCMVR as lesions during one to five months follow-up. Conclusion CWS are the most common ocular lesions in HIV retinopathy.

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]