获得性免疫缺陷综合征患者视网膜微血管病变与巨细胞病毒视网膜炎对比研究  

A comparative study of microvascular retinopathy and cytomegalovirus retinitis in acquired immunodeficiency syndrome patients

作　　者：谢连永[1] 陈超[1] 孔文君 杜葵芳 董宏伟[1] 郭纯刚[1] 魏文斌 XIE Lian-Yong;CHEN Chao;KONG Wen-Jun;DU Kui-Fang;DONG Hong-Wei;GUO Chun-Gang;WEI Wen-Bin(the Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院

出　　处：《眼科新进展》2019年第6期553-556,共4页Recent Advances in Ophthalmology

基　　金：首都医科大学重点实验室开放研究课题(编号:2017YKSJ04);首都医科大学基础-临床科研合作基金(编号:16JL73)~~

摘　　要：目的分析获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者视网膜微血管病变与巨细胞病毒视网膜炎(cytomegalovirus retinitis,CMVR)的疾病特征。方法回顾性病例分析。选取就诊于首都医科大学附属北京佑安医院眼科并经感染科专科医师确诊的AIDS患者145例,其中合并视网膜微血管病变者75例为微血管病变组,合并CMVR者70例为CMVR组。所有患者均进行AIDS相关病史询问,同时行血人类免疫缺陷病毒(HIV)载量和CD4+T细胞检测,并行最佳矫正视力、眼压、裂隙灯检查、散瞳眼底检查及彩色眼底照相等眼科检查。对全身情况允许的微血管病变组25例、CMVR组70例进行血液和房水CMV-DNA检测。结果视网膜微血管病变组最佳矫正视力为0.91±0.16,13例(17.33%)患者已开始高效联合抗反转录病毒治疗(HAART),CD4+T细胞数为22(0~506)个·μL^-1,8例(10.67%)患者有眼前节反应;CMVR组患者最佳矫正视力为0.63±0.37,34例(48.57%)患者已开始HAART,CD4+T细胞数为13(1~48)个·μL^-1,23例(32.85%)患者有眼前节反应,上述指标两组相比差异均有统计学意义(均为P=0.000)。微血管病变组25例中房水CMV-DNA阳性0例,血液CMV-DNA阳性8例(32.00%);CMVR组70例中房水CMV-DNA阳性60例(85.71%),血液CMV-DNA阳性33例(47.14%);两组血液中CMV-DNA阳性率相比差异无统计学意义(P=0.227),但房水中阳性率两组相比差异有统计学意义(P=0.000)。结论 AIDS合并CMVR患者比AIDS合并视网膜微血管病变患者视力更差,CD4+T细胞计数更低,眼前节反应及房水CMV-DNA阳性率更高,且视网膜微血管病变患者未接受HAART的人数明显高于CMVR患者。Objective To analyze the characteristics of microvascular retinopathy and cytomegalovirus retinitis(CMVR) in patients with acquired immunodeficiency syndrome(AIDS).Methods Retrospective case analysis was conducted on 145 patients with AIDS who were treated in the ophthalmology department of Beijing Youan Hospital affiliated to Capital Medical University and confirmed by infectious specialists.Among them,75 were microvascular retinopathy and 70 were CMVR.All patients were inquired about AIDS-related medical history.At the same time,the blood human immunodeficiency virus(HIV) load and CD4 + T cells were detected,and the best corrected visual acuity,intraocular pressure,slit lamp examination,dilated fundus examination and color fundus photography were performed.CMV-DNA in blood and aqueous humor was detected in 25 patients with microvascular disease and 70 patients with CMVR.Results The best corrected visual acuity of microvascular retinopathy group was 0.91±0.16,13(17.33%) patients had begun highly active antiretroviral therapy(HAART),the median of CD4+T cells was 22(0-506)cells·μL^-1,8(10.67%) patients had positive anterior segment examination;the best corrected visual acuity of CMVR group was 0.63±0.37,34(48.57%) patients had begun HAART treatment,and the median of CD4+T cells was 13(1-48) cells·μL^-1,23(32.85%) patients had anterior segment reactions,and the differences between the two groups were statistically significant(all P=0.000).Among 25 patients with microvascular retinopathy,No patient was CMV-DNA positive in aqueous humor and 8 patients(32.00%) were CMV-DNA positive in blood.Among 70 patients in CMVR group,60 patients(85.71%) were CMV-DNA positive in aqueous humor and 33 patients(47.14%) were CMV-DNA positive in blood.There was no significant difference in the positive rate of CMV-DNA in blood between the two groups(P=0.227),but there was significant difference in the positive rate of aqueous humor between the two groups(P=0.000).Conclusion AIDS patients with CMVR has worse visual acuity and lowe

关 键 词：获得性免疫缺陷综合征 巨细胞病毒视网膜炎 视网膜微血管病变 CD4+T细胞 

分 类 号：R774.1[医药卫生—眼科]