人类免疫缺陷病毒和梅毒螺旋体双重感染的眼部表现  

The ocular manifestations of human immunodeficiency virus and syphilis coinfection

作　　者：周慧颖[1] 狄宇 叶俊杰[1] 徐海燕[1] Zhou Huiying;Di Yu;Ye Junjie;Xu Haiyan(Department of Ophthalmology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院眼科,100730

出　　处：《中华眼科杂志》2019年第4期267-272,共6页Chinese Journal of Ophthalmology

摘　　要：目的探讨人类免疫缺陷病毒(HIV)感染与梅毒螺旋体双重感染的眼部表现及诊断。方法回顾性系列病例研究。收集2006至2017年在北京协和医院眼科门诊就诊的27例(54只眼)经感染内科确诊为HIV和梅毒螺旋体双重感染的患者的眼部表现。其中男性26例,女性1例。年龄(40.4±12.9)岁。常规检查视力、裂隙灯显微镜检查眼前节、散大瞳孔查眼底并拍摄眼底图像。结果初诊视力为无光感者2只眼,光感者4只眼,手动者1只眼,指数者1只眼,0.01~0.09者2只眼,0.1~0.2者8只眼,0.25~0.4者12只眼,0.5~0.9者15只眼,1.0~1.5者9只眼。27例(54只眼)HIV和梅毒螺旋体双重感染的患者中,角膜后沉着物20只眼,房水闪光阳性20只眼,浮游体阳性15只眼,虹膜后粘连7只眼。19只眼确诊为梅毒性葡萄膜炎,包括梅毒性前葡萄膜炎2只眼,梅毒性全葡萄膜炎17只眼,其中,玻璃体炎性混浊19只眼,视盘萎缩2只眼,视盘水肿1只眼,玻璃体积血1只眼,视网膜脱离2只眼,视网膜出血、静脉白线1只眼。HIV视网膜病变8只眼,均表现为棉絮斑。巨细胞病毒性视网膜炎4只眼,3只眼的眼底表现为视网膜黄白色病灶,1只眼为眼底病变晚期,表现为视网膜色素沉着。HIV和梅毒螺旋体双重感染发病率增加,男性同性恋人群发病率增加,最常见的眼部表现为梅毒性全葡萄膜炎。6例患者首诊眼科查出HIV和梅毒螺旋体双重感染。结论HIV和梅毒螺旋体双重感染患者眼部表现多样化,既可表现为眼底坏死性病变,又可同时存在前后节炎性反应。对于HIV感染者需常规行梅毒血清学检测,反之梅毒阳性患者应做HIV血清抗体的检测,以期提高HIV和梅毒螺旋体双重感染的诊断水平。Objective To investigate the ocular manifestations of human immunodeficiency virus(HIV)and syphilis coinfection.Methods A retrospective analysis of the ocular manifestations was carried out in 27 patients(54 eyes)diagnosed as syphilis and HIV coinfection by the Department of Infectious Medicine in Peking Union Medical College Hospital during the years of 2006-2017.The research included 26 males and 1 female,aging from 24 to 76 years old,with a mean age of 40.40±12.94 years old.Ocular anterior segments were examined with slit-lamp microscope.Fundus examinations were conducted with papillary dilation,fundus photography.Results At the first visit,there were 2 eyes without light perception,4 eyes with light perception,1 eye with hand movement,1 eye with finger counting,2 eyes with 0.01-0.09 eyesight,8 eyes with 0.1-0.2 eyesight,12 eyes with 0.25-0.4 eyesight,15 eyes with 0.5-0.9 eyesight,9 eyes with 1.0-1.5 eyesight.Among the 27 patients(54 eyes)coinfected with HIV and syphilis,keratic precipitates were identified in 20 eyes,aqueous flare positive in 20 eyes,float positive in 15 eyes,and iris posterior synechias in 7 eyes.Nineteen eyes were diagnosed as syphilis uveitis,including 2 eyes with syphilis anterior uveitis and 17 eyes with syphilis panuveitis,among which,vitreous inflammatory opacity was observed in all 19 eyes,disk atrophy in 2 eyes,optic edema in 1 eye,vitreous hemorrhage in 1 eye,retinal detachment in 2 eyes,retinal hemorrhage and white vein in 1 eye.In addition,8 eyes were diagnosed as HIV retinopathy,all manifested as cotton-wool spot.Among the 8 eyes,4 were diagnosed as cytomegalovirus retinitis,3 showed retinal yellow-white lesions,and 1 was in late phase which showed retinal pigmentation.The incidence of both HIV and syphilis coinfection patients and male homosexuality population increased.The most common ocular manifestation of HIV and syphilis coinfection was syphilis panuveitis.Six patients first visited the Department of Ophthalmology,and were then diagnosed as HIV and syphilis coinfection.Con

关 键 词：HIV感染 梅毒 同时感染 葡萄膜炎 视网膜疾病 

分 类 号：R512.91[医药卫生—内科学]