基于房水病毒学和炎性细胞因子检测的巨细胞病毒性视网膜炎治疗模式的初步研究  

Regime for cytomegalovirus retinitis based on aqueous virology and inflammatory cytokine determination

作　　者：余盈盈[1] 赵明威[1] 苗恒[1] Yu Yingying;Zhao Mingwei;Miao Heng(Department of Ophthalmology&Clinical center of Optometry,Peking University People's Hospital,Eye diseases and optometry institute,Beijing Key Laboratory Diagnosis and Therapy of Retina and Choroid Diseases,College of Optometry,Peking University Health Science Center,Beijing 100044,China)

机构地区：[1]北京大学人民医院眼视光中心、眼科眼病与视光医学研究所视网膜脉络膜疾病诊治研究北京市重点实验室北京大学医学部眼视光学院,100044

出　　处：《中华眼底病杂志》2020年第1期1-4,共4页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金(新)(81800847);第十届北京大学人民医院“学术新星”(RS2018-05)。

摘　　要：目的观察异基因骨髓造血干细胞移植(Allo-HSCT)后巨细胞病毒(CMV)性视网膜炎(CMVR)患者房水中CMV-DNA载量和IL-8水平,初步探讨房水CMV-DNA载量和IL-8水平对Allo-HSCT后CMVR患者治疗后疗效终止的安全性和有效性。方法前瞻性病例系列研究。2016年1月至2018年12月于北京大学人民医院眼科检查确诊的Allo-HSCT后CMVR患者14例22只眼纳入研究。患者均在确诊后给予玻璃体腔注射60 mg/ml更昔洛韦0.05 ml(含更昔洛韦3 mg)治疗。负荷阶段为2次/周,共4次;维持阶段为1次/周。每周于首次更昔洛韦注射的同时抽取前房水,荧光定量PCR和酶联免疫吸附试验法测定其中CMV-DNA载量和IL-8水平。若房水中CMV-DNA载量转阴(<10^3拷贝/ml)或IL-8水平<30 pg/ml则终止眼局部治疗,其后每2周随诊1次,至少6个月。每次玻璃体腔注射药物前和随访时均行BCVA、眼压、眼底检查。BCVA检查采用国际标准视力表,统计时换算为logMAR视力。基线、末次随访时BCVA和眼压比较采用Student t配对检验。结果14例22只眼中,单眼6例6只眼,双眼8例16只眼。CMVR确诊时,患眼平均logMAR BCVA为0.814±0.563;平均眼压为(17.2±7.8)mmHg(1 mmHg=0.133 kPa);房水平均CMV-DNA载量为(3.43±4.96)×10^5拷贝/ml,平均IL-8水平为(518±541)pg/ml。眼局部治疗终止时,玻璃体腔注射更昔洛韦中位次数为5次。房水中CMV-DNA载量转阴者9只眼,其中IL-8水平同时<30 pg/ml者7只眼;CMV-DNA载量阳性但IL-8水平<30 pg/ml者13只眼。视网膜病灶完全瘢痕化1只眼。治疗终止后6个月时,患眼平均logMAR BCVA为0.812±0.691;平均眼压为(14.8±5.4)mmHg。与基线时logMAR BCVA、眼压比较,差异均无统计学意义(t=-0.107、1.517,P=0.916、0.137)。因系统性Epstein-Barr病毒感染致CMVR复发1只眼;视网膜病灶完全瘢痕化20只眼。22只眼中,因治疗过程中血小板计数过低(<30×10^9个/ml)而发生医源性玻璃体积血4只眼;治疗终止6个月时,积血吸收眼底清Objective To observe the safety and efficacy of regime that based on aqueous cytomegalovirus-DNA(CMV-DNA)load and IL-8 determination for therapeutic monitoring and local treatment cessation of cytomegalovirus retinitis(CMVR)patients after allogeneic hematopoietic stem cell transplantation(HSCT).Methods A prospective case series study.A total of 14 CMVR patients(22 eyes)after allogeneic HSCT diagnosed in Ophthalmology Department of Peking University People's Hospital between January 2016 and December 2018 were involved in this study.All patients were CMV-DNA seronegative at baseline and were treated with intravitreous injection of ganciclovir(IVG,3 mg in 0.05 ml)twice per week for 4 times in the induction stage and once a week in the maintenance stage.Aqueous humor sample was collected during the first time of IVG every week.CMV-DNA and the level of IL-8 were measured by real time quantitative PCR and ELISA,respectively.During follow-up,negative CMV-DNA(<10^3/ml)or level of IL-8<30 pg/ml in aqueous sample was set as local treatment cessation.Then patients were followed every 2 weeks for at least 6 months.BCVA,intraocular pressure and fundus examination were taken for each visit.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logMAR visual acuity.BCVA and intraocular pressure at the baseline and the last follow-up were compared by the Student t matching test.Results Of the 14 CMVR patients(22 eyes)after allogeneic HSCT,8 patients(16 eyes)were bilateral,6 patients(6 eyes)were unilateral.At the baseline,the mean logMAR BCVA was 0.814±0.563,the intraocular pressure was 17.2±7.8 mmHg(1 mmHg=0.133 kPa),the mean aqueous CMVDNA load was(3.43±4.96)×10^5/ml,the mean level of IL-8 was 518±541 pg/ml.At cessation of local treatment,the median number of intravitreal injections was 5 times.Nine eyes showed negative CMV-DNA in aqueous humor,of which,7 eyes showed negative IL-8 in aqueous.CMV-DNA could still be detected in 13 eyes,while IL-8 was negative.Only o

关 键 词：巨细胞病毒性视网膜炎 眼房水 病毒学 白细胞介素8 

分 类 号：R774.11[医药卫生—眼科]