玻璃体内注射联合全身应用更昔洛韦治疗AIDS合并巨细胞病毒视网膜炎的临床疗效  

Clinical efficacy of intravitreal injection combined with systemic application of ganciclovir in the treatment of AIDS with cytomegalovirus retinitis

作　　者：卢淑文[1] 蔡洁[1] 唐东永[1] 谢子康 王芬[1] 梁皓[1] LU Shu-Wen;CAI Jie;TANG Dong-Yong;XIE Zi-Kang;WANG Fen;LIANG Hao(Department of Ophthalmology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西医科大学第一附属医院眼科

出　　处：《眼科新进展》2019年第9期840-844,共5页Recent Advances in Ophthalmology

基　　金：卫生和计划生育委员会自筹经费科研课题(编号:Z2基金项目:广西壮族自治区016325);广西艾滋病防治研究重点实验室开放基金项目(编号:gklapt201302)~~

摘　　要：目的观察玻璃体内注射联合全身应用更昔洛韦治疗AIDS合并巨细胞病毒视网膜炎(cytomegalovirus retinitis,CMVR)的临床疗效。方法收集2016年1月至2018年1月在广西医科大学第一附属医院收治的AIDS合并CMVR患者7例13眼。患者全身用药为更昔洛韦和膦甲酸钠注射液,更昔洛韦 5.0~7.5 mg·kg^-1,每天2次静脉滴注;成人每次给予膦甲酸钠3 g,每天3次静脉滴注;同时在局部玻璃体内注射更昔洛韦。治疗前后对比的指标有:最佳矫正视力、眼压、眼底照相情况、视觉诱发电位、眼电图和视网膜电图等检查;检测指标包括CD4+T细胞计数,血液、前房水、玻璃体CMV-DNA病毒载量等。通过检查结果辅助判断治疗效果。结果 6例患者治疗后最佳矫正视力为(0. 72±0. 83) logM AR,较治疗前(1. 14±0. 83) logM AR提高(P=0. 001),其中1例患者经过全身和局部抗病毒治疗后视力不提高。患者治疗前后眼压均在正常范围内,治疗前为(13. 62±3. 04) mmH g(1 kP a=7. 5 mmH g),治疗后为(12. 77±2. 89) mmH g,差异无统计学意义(P=0. 119)。注药后患者眼底病变范围逐渐变小(P <0. 05)。治疗1个月后,患者视觉诱发电位N2-P2振幅及眼电图光峰电位较治疗前升高(均为P <0. 05),视觉诱发电位P2潜伏期和视网膜电图(明适应) a波及b波潜伏期和振幅治疗前后差异均无统计学意义(均为P>0. 05)。3例患者治疗前血液中CMV-DNA病毒载量检测为阴性,1例患者2眼经过治疗后眼内液中CMV-DNA病毒载量检测为阴性。治疗前玻璃体CMV-DNA病毒载量均明显高于前房水,而前房水CMV-DNA病毒载量又明显高于血液(均为P <0. 05),说明三个部位的CMV-DNA病毒载量从高到低的排列顺序为玻璃体>前房水>血液。治疗后玻璃体、前房水CMV-DNA病毒载量均低于治疗前,差异均有统计学意义(均为P <0. 05)。治疗前后血液CMV-DNA病毒载量差异无统计学意义(P> 0. 05)。治疗前后CD4+T细胞计数差异无统计学�Objective To observe the clinical efficacy of intravitreal injection combined with systemic application of ganciclovir in the treatment of AIDS with cytomegalovirus retinitis(CMVR).Methods Totally 7 patients(13 eyes) with AIDS-combined CMVR of the First Affiliated Hospital of Guangxi Medical University from January 2016 to January 2018 were collected.The systemic administration of the patients was ganciclovir and sodium foscarnet injection,ganciclovir 5.0 mg·kg^-1 to 7.5 mg·kg-1,two intravenous drip per day and the adult administration of sodium foscarnet 3 g intravenous drip three times a day.At the same time,intravitreal injection of ganciclovir.The observe indicators before and after treatment were:best corrected visual acuity(BCVA),intraocular pressure(IOP),fundus condition and fundus photography,visual evoked potential(VEP),electrooculogram(EOG) and electroretinogram(ERG).Test indicators included CD4+ T cell count,the CMV-DNA viral load in the blood,anterior chamber fluid and vitreum.The therapeutic effect was assisting to judge by the results of examination.Results The BCVA [(0.72±0.83)logMAR] in 6 patients was higher than that before treatment [(1.14±0.83)logMAR](P=0.001),and 1 patient had no improvement in visual acuity after systemic and local antiviral therapy.The IOP of the patients before and after treatment was within the normal range,(13.62±3.04) mmHg(1 kPa=7.5 mmHg) before treatment and(12.77±2.89) mmHg after treatment.The difference of IOP was not statistically significant(P=0.119).The scope of fundus lesions gradually decreased after injection(P<0.05).After 1 month of treatment,the amplitude of the VEP N2-P2 and the EOG peak potential were higher than before treatment(both P<0.05).There were no significant differences in the VEP P2 latency and the ERG(adaptation) a wave and b wave before and after treatment(both P>0.05).Three patients had negative CMV-DNA viral load in the blood before treatment,and the CMV-DNA viral load in the intraocular fluid was negative in 1 patient(2 eyes)after treat

关 键 词：获得性免疫缺陷综合征 巨细胞病毒视网膜炎 玻璃体内注射 更昔洛韦 

分 类 号：R774.1[医药卫生—眼科]