获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎超广角眼底影像特征分析  

Analysis of ultra-wide-field fundus manifestations of cytomegalovirus retinitis in acquired immunodeficiency syndrome patients

作　　者：杜葵芳 黄晓婕 陈超[1] 孔文君 谢连永[1] 魏文斌 Du Kuifang;Huang Xiaojie;Chen Chao;Kong Wenjun;Xie Lianyong;Wei Wenbin(Beijing Infectious Ophthalmopathy Center,Department of Ophthalmology of ENT Center,Beijing You'an Hospital,Capital Medical University,Beijing 100069,China;Department of Infectious Diseases,Beijing You'an Hospital,Capital Medical University,Beijing 100069,China;Beijing Tongren Eye Center,Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment,Beijing Ophthalmology and Visual Sciences Key Lab,Beijing Tongren Hospital,Capital Medical University,Beijing Infectious Ophthalmopathy Center,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京佑安医院五官中心眼科北京市感染性眼病诊疗中心,100069 [2]首都医科大学附属北京佑安医院感染中心一科,100069 [3]首都医科大学附属北京同仁医院,北京同仁眼科中心,眼科与视觉科学北京市重点实验室,北京市感染性眼病诊疗中心,100730

出　　处：《中华眼底病杂志》2020年第9期669-674,共6页Chinese Journal of Ocular Fundus Diseases

基　　金：国家"十三五"科技重大专项(2017ZX10201101);国家自然科学基金(81701984);北京市优秀人才计划(2018000021223ZK04);北京佑安医院2018年度院内中青年人才孵化项目(YNKTQN20180201)。

摘　　要：目的观察获得性免疫缺陷综合征(AIDS)合并巨细胞病毒性视网膜炎(CMVR)的超广角眼底影像特征。方法回顾性研究。2017年7月至2019年11月在首都医科大学附属北京佑安医院眼科确诊为AIDS合并CMVR的86例患者124只眼纳入研究。其中,男性80例(93.0%),女性6例(7.0%);年龄17~58岁,平均年龄(36.86±8.82)岁。单眼发病48例(55.8%),双眼发病38例(44.2%)。所有患眼均行间接检眼镜眼底检查和欧堡超广角眼底照相检查。根据CMVR在超广角眼底像中的特征表现分为经典型、颗粒型、霜样树枝状血管炎和视神经视网膜炎。观察分析患眼眼底分型情况。按眼底像中涡静脉位置将病变按后极部或周边部记录。病灶范围划分为≤1个象限,>1个象限且≤2个象限(1~2个象限),>2个象限且≤3个象限(2~3个象限),>3个象限且≤4个象限(3~4个象限)。分别以黄斑上下血管弓或盘沿为界,分别记录黄斑区或视盘是否被累及。同时记录玻璃体是否有明显混浊。不同分型组患者之间CD4+T淋巴细胞计数比较采用单因素方差分析,血CMV-DNA载量比较采用χ2检验;组间两两比较采用最小显著差法。结果124只眼中,CMVR分型为经典型35只眼(28.2%)、颗粒型68只眼(54.8%)、霜样树枝状血管炎3只眼(2.4%)、视神经视网膜炎18只眼(14.5%)。病灶同时累及后极部和周边部83只眼(66.9%),局限在后极部22只眼(17.7%),局限在周边部19只眼(15.3%);病灶范围≤1个象限76只眼(61.3%),1~2个象限23只眼(18.5%),2~3个象限7只眼(5.6%),3~4个象限18只眼(14.5%)。54只眼(43.5%)病灶累及黄斑区;52只眼(41.9%)病灶累及视盘;33只眼(26.6%)可见明显玻璃体炎性混浊。86例患者中,82例患者平均CD4+T淋巴细胞数为1~168个/μl,平均为(33.60±40.02)个/μl;其余4例患者(4.7%)不详。不同分型组患者之间CD4+T淋巴细胞计数和血CMV-DNA载量比较,差异均无统计学意义(F=0.863、0.926,P=0.462、0.431)。结论AIDS合并CMVR的�Objective To observe the ultra-wide-angle fundus imaging characteristics of acquired immunodeficiency syndrome(AIDS)combined with cytomegalovirus retinitis(CMVR).Methods This study was a retrospective study.From July 2017 to November 2019,124 eyes of 86 patients diagnosed with AIDS and CMVR at the Department of Ophthalmology,Beijing You'an Hospital,Capital Medical University,were included in the study.Among them,80 patients were males(93.0%)and 6 patients were females(7.0%)with 17-58 years old.The average age was(36.86±8.82)years old.There were 48 cases(55.8%)in one eye and 38 cases(44.2%)in both eyes.All the affected eyes underwent indirect ophthalmoscope fundus examination and Aalborg ultra-wide-angle fundus photography examination.According to the characteristics of CMVR in ultra-wide-angle fundus images,it can be divided into classic type,granular type,frost-like dendritic vasculitis and optic neuroretinitis.We observed and analyzed the type of fundus of the affected eye.According to the position of the vortex vein in the fundus image and record of the lesion as the posterior pole or peripheral part,the scope of the lesion was divided into≤1 quadrant,>1 quadrant and≤2 quadrants(1-2 quadrants),>2 quadrants and≤3 quadrants(2-3 quadrants),>3 and≤4 quadrants(3-4 quadrants).The upper and lower vascular arches or disc edges of the macula were used as boundaries to record whether the macular area or optic disc was involved.At the same time,we recorded whether the vitreous body had obvious turbidity.The comparison of CD4+T lymphocyte count between patients of different types was performed by one-way analysis of variance,and the comparison of the positive rate of blood CMV-DNA was performed by theχ2 test;pairwise comparisons between groups were performed by the least significant difference method.Results Among the 124 eyes,CMVR was classified into 35 eyes(28.2%)with classic type,68 eyes with granular type(54.8%),3 eyes with frost-like dendritic vasculitis(2.4%),and 18 eyes with optic neuroretinitis(14.5%).Th

关 键 词：获得性免疫缺陷综合征/并发症 巨细胞病毒视网膜炎 超广角眼底成像 

分 类 号：R512.91[医药卫生—内科学] R774.11[医药卫生—临床医学]