巨细胞病毒性视网膜炎  

Cytomegalovirus retinitis in immunosupressed hosts

作　　者：王保君[1] 扬华[1] 孔丽[1] 郭晓文[1] 李顺元[1] 

机构地区：[1]河南省新乡医学院第一附属医院眼科,453100

出　　处：《中国实用眼科杂志》2002年第7期511-513,共3页Chinese Journal of Practical Ophthalmology

摘　　要：探讨免疫功能低下患者中巨细胞病毒性视网膜炎的临床表现、诊断及治疗。方法 :观察分析 6 1例巨细胞病毒 (cytomeglovirus ,CMV)性视网膜炎患者 10 4只眼 ,对其眼底、视力、T辅助细胞的细胞受体4(CD4+ )计数及预后进行观察随访 2周～ 18个月。结果 :6 1例CMV视网膜炎中 ,5 6例为获得性免疫缺陷综合征 (acquiredimmunodeficiencysyndrome ,AIDS)患者 ,1例为应用免疫抑制剂的肾移植患者 ,1例为接受化疗的急性淋巴细胞性白血病患者 ,3例为白血病同时合并AIDS患者。 10 4眼 6 1例患者中 ,眼底病灶表现为颗粒型者 5 8眼 ,其中 46眼位于周边部 ;爆发型者 2 8眼 ,均位于后极部 ,视网膜坏死灶致密伴斑片状出血和血管炎 ;颗粒型与爆发型病灶混合存在者 18眼 ;其中 7眼合并有视神经乳头炎 ;患者就诊时视力为眼前指数至 0 5 ,病变广泛者及病变位于后极部者视力下降尤为严重。 30例患者CD4+ 细胞计数为 0～ 30个 /μl,平均 15± 9个 /μl。接受更喜洛韦治疗组患者视力多数提高 ,CD4+ T细胞计数明显升高 ,未治疗组患者 93 %病变呈进行性发展 ,视力显著下降。结论 :CMV视网膜炎是免疫功能严重低下患者 ,尤其AIDS病的主要眼部并发症 ,临床上以坏死性视网膜炎伴出血及血管炎为特征 ,治疗目前主要用更昔洛韦。Objective:To evaluate the clinical processes of cytomegalovirus (CMV) retinitis in immunosupressed hosts. Methods:A total of 104 eyes of 61 patients with cytomegalovirus retinitis were studied.The fundus features,visual acuity and CD4 + T-lymphocyte counts were analyzed and the follow-up ranged from 2 weeks to 18 months. Results:The underlying causes of immunity disturbances in the 61 cases were acquired immunodeficiency syndrome (AIDS) (n=56),immunosuppressive therapy after renal transplantation (n=1),chemotherapy for acute lymphocytic leukemia (n=1),and leukemia with AIDS (n=3).In the initial examination,the granular form of CMV retinal lesion was noted in 58 eyes (55.7%),in which retinal lesion of 46 eyes was peripheral.The fulminant form of CMV retinitis was found in28 eyes (26.9%) at the posterior pole and consisted of dense opaque retinal lesions with blotchy hemorrhage and vasculitis.The overlap between these two presentations was noted in 18 eyes,in which papillitis was complicated in 7 eyes.The vision ranged from finger counting to 0.5.The CD4 + T-lymphocyte counts of 30 patients was 0～30 (mean,15±9/ul).In the group treated with ganciclorvir the vision was improved and CD4\++ T-lymphocyte counts was significantly higher.The condition of CMV retinitis,however,was worse and the vision decreased in the control group. Conclusions:Diagnosis of CMV retinitis is based on the characteristic of necrotizing retinitis that was typically associated with retinal hemorrhage and vasculitis.Ganciclorvir is usually used for the treatment of CMV retinitis.

关 键 词：巨细胞病毒性视网膜炎 免疫功能 临床表现 诊断 治疗 

分 类 号：R774.11[医药卫生—眼科]