获得性免疫缺陷综合征并发进行性外层视网膜坏死的临床分析  

Clinical analysis of progressive outer retinal necrosis with acquired immunodeficiency syndrome

作　　者：孔文君 魏文斌 谢连永[1] 陈超[1] 杜葵芳 Kong Wenjun;Wei Wenbin;Xie Lianyong;Chen Chao;Du Kuifang(Department of Ophthalmology,Beijing You’an Hospital,Capital Medical University,Beijing Infectious Eye Disease Diagnosis and Treatment Center,Beijing 100069,China;Beijing Tongren Eye Centre,Beijing Key Laboratory of Ophthalmology and Visual Sciences,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]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 [2]首都医科大学附属北京同仁医院,北京同仁眼科中心,眼科学与视觉科学北京市重点实验室,100730

出　　处：《眼科》2020年第5期375-379,共5页Ophthalmology in China

基　　金：中国初级卫生保健基金会佑安肝病艾滋病基金(YNKT20160038);首都医科大学北京市重点实验室开放性课题(2016YKSJ04)。

摘　　要：目的探讨获得性免疫缺陷综合征(AIDS)并发进行性外层视网膜坏死(PORN)的全身情况、眼底特点、治疗方法及预后。设计回顾性病例系列。研究对象2015年4月-2019年11月北京佑安医院AIDS合并PORN患者6例(11眼)。方法分析其最佳矫正视力(BCVA)、裂隙灯、眼底照相、相干光断层扫描(OCT)及房水中水痘带状疱疹病毒脱氧核糖核酸(VZV-DNA)含量,外周血CD4+T淋巴细胞计数和人免疫缺陷病毒(HIV)病毒载量。3眼行更昔洛韦或膦甲酸钠玻璃体注射联合全身治疗。随诊3~26个月。主要指标AIDS合并PORN的眼底变化、房水中VZV-DNA值、玻璃体注药前后眼底变化、外周血CD4+T淋巴细胞计数和HIV病毒载量。结果患者均为男性,平均年龄(27.6±3.2)岁。11眼均表现为无痛性视力下降,9眼(81.8%)初诊BCVA均≤0.2。眼底表现为进行性周边环形视网膜坏死,多灶性边界清楚的黄白色坏死灶向心性进展,无或轻微玻璃体反应。6眼合并渗出性视网膜脱离。早期病变OCT仅累及视网膜外层,后期出现外层视网膜变薄。11眼房水VZV-DNA含量均阳性,外周血CD4+T淋巴细胞计数平均(10.8±2.5)个/μl,HIV病毒载量平均(246289±462.7)拷贝/ml。3眼更昔洛韦和(或)膦甲酸钠玻璃体注射联合全身抗病毒治疗周期72~123天,病灶控制,视力好转(1眼由光感到手动,1眼由指数到0.1,1眼保持0.5)。结论PORN是AIDS患者严重的眼部机会性感染,病变累及视网膜外层,前房及玻璃体反应无或轻微,病情进展速度快,预后差。眼内液病毒核酸检测有助于诊断。Objective To investigate the systemic condition,fundus characteristics,treatment methods and prognosis of progressive outer retinal necrosis(PORN)with acquired immunodeficiency syndrome(AIDS).Design Retrospective case series.Participants 6 cases(11 eyes)of PORN with AIDS in Beijing You'an Hospital from 2015 to 2019.Methods Visual acuity,fundus,optical coherence tomography(OCT)and varicella zoster virus(VZV)-DNA,CD4+T lymphocytes in blood and human immunodeficiency virus(HIV)viral load were analyzed.3 eyes underwent intravitreal injection of ganciclovir and(or)phosphonate combined with systemic therapy.The follow-up was for 3~26 months.Main Outcome Measures Fundus changes of AIDS combined with PORN,VZV-DNA values in aqueous humor,fundus changes after intravitreal injection,peripheral blood CD4+T lymphocyte count,and HIV viral load.Results The 6 patients were all males,average age 27.6±3.2 years old.9 eyes(81.8%)had a best corrected visual acuity of≤0.2 at the first diagnosis.11 eyes showed painless vision loss.The fundus showed progressive peripheral circular retinal necrosis,yellow-white necrotic foci with clearer multifocal borders progressed concentrically,no or slight vitreous reaction,6 eyes with exudative retinal detachment.Early lesions on OCT only affect the outer layer of the retina,and later the outer layer becomes thinner.The levels of VZV-DNA in the aqueous humor of the 11 eyes were all positive.CD4+T lymphocyte count in peripheral blood of patients was average(10.8±2.5)/μl.The HIV viral load was average(246289±462.7)copies/ml.The treatment period of combined with systemic antiviral therapy,intravitreal injection of ganciclovir and(or)sodium phosphonate in 3 eyes was 72~123 days,and their fundus lesions were controlled and vision was improved(1 eye recovered from light perception to hand movement,1 eye returned to 0.1 from count fingers,and 1 eye remained at 0.5).Conclusion PORN is the most serious eye opportunistic infection in AIDS patients;the fundus shows early lesions involving the outer lay

关 键 词：进行性外层视网膜坏死 获得性免疫缺陷综合征 水痘带状疱疹病毒 

分 类 号：R512.91[医药卫生—内科学] R774.1[医药卫生—临床医学]