合并人免疫缺陷病毒感染的梅毒性葡萄膜视网膜炎的临床表现  

Ocular manifestations of syphilitic uveoretinitis in patients co-infected with human immunodeficiency virus

作　　者：张锐[1] 钱江[1] 王朱健[2] 袁一飞[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科上海市视觉损害与重建重点实验室,200031 [2]复旦大学附属眼耳鼻喉科医院检验科,200031

出　　处：《中华眼科杂志》2015年第10期739-745,共7页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金青年基金（81100656/H1203）;国家自然科学基金面上项目（81371042/H1205）;上海市自然科学基金（14411961800）

摘　　要：目的 探讨合并人免疫缺陷病毒（HIV）感染的梅毒性葡萄膜视网膜炎患者的临床表现.方法 回顾性系列病例研究.收集2008年1月至2014年12月在复旦大学附属眼耳鼻喉科医院就诊的葡萄膜视网膜炎患者,对其进行梅毒、HIV血清学检查.选择苍白螺旋体颗粒凝集试验和快速血浆反应素试验（RPR）均为阳性,且RPR＞ 1：8,同时HIV病毒检测阳性者,排除其他原因引起的葡萄膜视网膜炎.所有患者均行全面的眼部检查,包括最佳矫正视力、眼前节、眼底、眼压及眼部B超检查,除因玻璃体混浊或因全身因素不能耐受者,均行FFA检查,部分患者行OCT检查.同时进行全身检查.结果 共收集病例26例,其中男性24例（92.3％）,女性2例（7.7％）,就诊年龄为20～63岁,平均（39.3±13.2）岁.RPR滴度为1：32～1：512.其中3例为单眼发病（11.5％）,23例为双眼发病（88.5％）,共49只眼.最佳矫正视力为0.6至手动.全葡萄膜炎是最常见的表现,39只眼（79.6％）,仅出现前葡萄膜炎者2只眼（4.1％）,后葡萄膜炎8只眼（16.3％）.前房炎症细胞（-）～（＋＋＋）,玻璃体混浊轻度至重度.眼底病变表现为视神经视网膜炎16只眼（32.7％）、玻璃体炎27只眼（55.1％）、视网膜脉络膜炎5只眼（10.2％）、视神经炎5只眼（10.2％）、视网膜炎5只眼（10.2％）,其中包括坏死性视网膜炎2只眼（4.1％）、视网膜血管炎4只眼（8.2％）、后部鳞状脉络膜视网膜炎2只眼（4.1％）,多灶性脉络膜炎2只眼（4.1％）.5只眼（10.2％）眼压升高.全身表现包括：皮疹5例（19.2％）,阴部溃疡5例（19.2％）,下疳3例（11.5％）,头痛2例（7.7％）,双下肢无力2例（7.7％）,发热2例（7.7％）,口腔溃疡1例（3.8％）,脱发1例（3.8％）.结论 合并HIV感染的梅毒性葡萄膜视网膜炎的临床表现缺乏特异性,最常见的眼底表现为视神经视网膜炎,多数患者同时伴有玻璃�Objective To investigate the clinical manifestations of syphilitic uveoretinitis in patients co-infected with human immunodeficiency virus （HIV）.Methods Uveoretinitis patients presenting between January 2008 and December 2014 at Eye and ENT Hospital of Fudan University were collected.Patients were selected with positive serologic tests, including rapid plasma regain titer （RPR） 〉 1 ： 8, treponema pallidum particle agglutination assay （TPPA） and human immunodeficiency virus （HIV）.Other causes of uveoretinitis were excluded.Each patient underwent complete ophthalmologic examination including best-corrected visual acuity （BCVA）, slit-lamp biomicroscopy, ophthalmoscopy, applanation tonometry and B-scan ultrasonography.Fundus fluorescein angiography were obtained in each case except for patients whose fundus was blurred with dense vitritis.Optical coherence tomography （OCT） was performed in selected patients.Thorough physical examination was performed simultaneously.Results Twenty six patients were included in this study including 24 male （92.3%） and 2 female （7.7%）.The mean age at presentation was 39.3±13.2 （range 20 to 63 years）.RPR titres ranged from 1：32 to 1：512.There were 49 eyes altogether and ocular involvement was bilateral in 23 patients （88.5%） and unilateral in 3 patients （11.5%）.Panuveitis was the most common ophthalmic presentation （n=39, 79.6%）.Only two eyes were anterior uveitis （4.1%） and 8 eyes were posterior uveitis （16.3%）.Anterior chamber cells＋＋＋ and mild to severe vitreous opacities were observed.Sixteen eyes presented with neuroretinitis （32.7%）, 27 eyes had vitritis （55.1%）, 5 eyes had retinochoroiditis （10.2%）, 5 eyes had optic neuritis （10.2%）, 5 eyes had retinitis （10.2%） including 2 eyes with necrotizing retinitis （4.1%）, 4 eyes had retinal vasculitis （8.2%）.Two eyes （11.5%） presented with posterior placoid chorioretinitis （4.1%） and multifocal choroiditis （4.1%）.Systemic manifest

关 键 词：HIV感染 梅毒 葡萄膜炎 视网膜炎 

分 类 号：R512.91[医药卫生—内科学]