两种不同诱因所致巨细胞病毒视网膜炎预后的临床观察  

Comparison of prognosis of cytomegalovirus retinitis induced by AIDS and HSCT postoperation

作　　者：孔文君 陶勇 陈超 谢连永 杜葵芳 Kong Wenjun;Tao Yong;Chen Chao;Xie Lianyong;Du Kuifang(Department of Optlidlmology,Beijing You an Hosptidl,Capital Medical University,Beijing 100069,China;Department of Opthdlmology Beijing Chaoyang Hosptial,Capital Medical University,licijing 100020,Chiiui)

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730 [2]首都医科大学附属北京佑安医院眼科北京市感染性眼病诊疗中心,100069

出　　处：《中华眼科医学杂志（电子版）》2020年第1期13-19,共7页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

基　　金：北京市教育委员会科研计划项目(KM202010025020);北京朝阳医院“1351人才培养计划”项目(CYXX-2017-21);国家高技术研究发展计划项目(2015AA020949);中国初级卫生保健基金会佑安肝病艾滋病基金项目(YNKT20160038);首都医科大学北京市重点实验室开放性课题(2016YKSJ04)。

摘　　要：目的 探讨两种不同病因诱发的巨细胞病毒视网膜炎(CMVR)的预后情况.方法 观察2015 年5 月至2019年10 月首都医科大学附属北京佑安医院眼科和北京朝阳医院眼科确诊为CMVR患者32例(52 只眼).其中,男性27 例(44 只眼),女性5 例(8 只眼),平均年龄(25.4±7.8)岁.根据常见病因,分为获得性免疫缺陷综合征(AIDS)组和造血干细胞移植(HSCT)术后组两组.全部患者均行更昔洛韦和(或)膦甲酸钠玻璃体腔注药联合全身治疗,随访6 个月.检查并记录治疗前和治疗6个月后患者的最佳矫正视力(BCVA)、眼压、眼底彩色照相、房水中巨细胞病毒脱氧核糖核酸(CMV-DNA)含量及外周血CD4+T淋巴细胞计数等指标.眼压以均数±标准差描述,以t检验进行比较.BCVA、外周血CD4+T淋巴细胞计数、房水CMV-DNA含量以中位数(最小值,最大值)描述,以Wilcoxon秩和检验进行比较.注药次数用频数或率(%)表示,组间比较采用卡方检验.结果 治疗前AIDS 组患者和 HSCT 术后组患者 BCVA 分别为0.36(0.02,1.00)和0.21(0.01,0.60);治疗后AIDS组和HSCT术后组患者BCVA分别为0.53(0.05,1.00)和0.36(0.02,0.80).经秩和检验,治疗前两组患者BCVA比较,差异无统计学意义(Z=-0.23,P>0.05);治疗后AIDS组患者BCVA高于HSCT术后组,差异具有统计学意义(Z=-2.05,P<0.05).治疗前AIDS组和HSCT术后组患者眼压分别为(1 1.9±2.8)mmHg(1 mmHg=0.133 kPa)和(12.8±2.2)mmHg;治疗后AIDS组和HSCT术后组患者眼压分别为(13.4±2.7)mmHg和(13.9±3.5)mmHg.经t检验,治疗前和治疗后两组患者眼压比较,差异无统计学意义(t=-0.94,-0.54;P>0.05).治疗前AIDS组和HSCT术后组患者外周血CD4+T淋巴细胞计数分别为54(0,213)个/μl和47(2,87)个/μl;治疗后AIDS组和HSCT术后组患者外周血CD4+T淋巴细胞计数分别为139(32,371)个/μl和76(21,212)个/μl.经秩和检验,治疗前两组患者外周血CD4+T淋巴细胞计数比较,差异无统计学意义(Z=-0.65,P>0.05).治疗后AIDS组患者外周�Objective To explore the prognosis of eytomegalovirus retinitis(CMVR)induced by Iwo different etiologies.Methods Frorm May 2015 to October 2019,32 CMVR patients(52 eyes)diagnosed in the department of Ophthalmology of Beijing You'an Hospital and Beijing Chaoyang Hospital affiliated to Capital Medical University.There were 27 males and 5 females,with an average ageof(25.4±7.8)years.According to common causes,patients were divided into two groups;one group was acquired immune deficiency syndrome(AIDS)and the other group with the postoperative hematopoietic stem cell transplantation(HSCT)。32 patients were treated with ganciclovir and(or)sodium phosphonate intrav itreal injection combined with systemic therapy and followed up for 6 months.Analysis of the best corrected visual acuity(BCVA),intraocular pressure,fundus and cy tomnegalovirus virus(CMV)-DNA in anterior chamber.CD4+T cells in blood was made before and after the treatment.Intraocular pressure was represented as expressed in mean±SD and compared with 1 test.BCVA,the number of CD4+T cells in blood and the content of CMV-DNA in aqueous humor were expressed in median(minimum,maximum)and compared with Wilcoxon rank sum test.Counting data was expressed by frequency or rate(%)and compared with Chi-square test.Results Before*treatment,the BCVA of patients in the AIDS group and tlie HSCT postoperative group were 0.36(0.02,1.00)and 0.21(0.01,0.60).After treatment,the BCVA of patients in the AIDS group and the HSCT postoperative group were 0.53(0.05,1.00)and 0.36(0.02,0.80).With Wilcoxon rank sum test,there was no significant difference in BCVA between lwo groups of patients before treatment(Z=-0.23,P>0.05).The BCVA in the AIDS group was higher than that in llie HSCT postoperative group after treatment(Z=-2.05,P<0.05).Before treatment,the intraocular pressure of patients in the AIDS group and in the HSCT postoperative group were(11.9±2.8)mniHg(1mmHg=0.133 kPa)and(12.8±2.2)mmHg.After treatment,the intraocular pressure of patients in the AIDS group and HSCT postope

关 键 词：巨细胞病毒视网膜炎 获得性免疫缺陷综合征 造血干细胞移植术后 

分 类 号：R774.11[医药卫生—眼科]