2mg与3mg更昔洛韦玻璃体注射治疗AIDS患者巨细胞病毒性视网膜炎的效果比较  

Efficacy comparison of 2 mg or 3 mg doses of ganciclovir intravitreal injection on cytomegalovirus retinitis in acquired immunodeficiency syndrome

作　　者：刘夕瑶 李丹 毛菲菲 鲁丹 王胜男 孙挥宇 Liu Xiyao;Li Dan;Mao Feifei;Lu Dan;Wang Shengnan;Sun Huiyu(Department of Ophthalmology,National Clinical Key Department of Infectious Disease,Beijng Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院眼科、感染病科国家临床重点专科,100015

出　　处：《眼科》2021年第3期227-231,共5页Ophthalmology in China

基　　金：北京市医院管理中心科研培育计划(PX2018061);北京市医管中心项目(DFL20191802);北京市医院管理局临床医学发展专项(ZYLX202126)。

摘　　要：目的比较玻璃体注射2 mg和3 mg更昔洛韦治疗获得性免疫缺陷综合征(AIDS)患者巨细胞病毒性视网膜炎(CMVR)的有效性和安全性。设计前瞻性比较性病例系列。研究对象2016-2020年北京地坛医院AIDS合并CMVR患者63例(86眼)。方法患者随机分为2 mg组(41眼)和3 mg组(45眼),在接受更昔洛韦静脉滴注的同时,进行玻璃体更昔洛韦注射2 mg或3 mg。玻璃体注射前抽取房水进行巨细胞病毒PCR检测。玻璃体注射每周1次直到眼底病变得到控制稳定,且房水中巨细胞病毒PCR转阴性。主要指标视网膜坏死病灶控制情况、房水巨细胞病毒载量[log(CMV DNA)]、注射次数、最佳矫正视力、并发症。结果2 mg组和3 mg组中所有活跃视网膜坏死病变均被控制,逐渐转变为萎缩灶。房水中的巨细胞病毒载量每周降低,最终均转为阴性。2 mg组的房水巨细胞病毒载量在初始治疗前、治疗1、2、3、4周分别为(3.90±0.73)copies/mL、(3.88±0.82)copies/mL、(3.06±0.93)copies/mL、(2.85±0.75)copies/mL、(2.32±0.50)copies/mL(F=28.54,P<0.01);3 mg组为(4.10±0.94)copies/mL、(3.76±0.90)copies/mL、(3.50±0.81)copies/mL、(2.90±0.91)copies/mL、(2.57±0.79)copies/mL(F=18.21,P<0.01)。2 mg(r=0.69,P<0.01)和3 mg组(r=0.82,P<0.01)中初始CMV病毒载量与注射次数均呈正相关。2 mg组41眼中31眼最佳矫正视力提高或保持不变,3 mg组45眼中33眼最佳矫正视力提高或保持不变(χ^(2)=0.06,P=0.81)。所有患者均未出现严重并发症。两组在病灶控制率、巨细胞病毒载量、注射次数和并发症方面均无显著差异(P均>0.05)。结论玻璃体注射更昔洛韦2 mg或3 mg联合静脉给药均可有效治疗CMVR。为了降低视网膜毒性,玻璃体注射更昔洛韦治疗CMVR时,2 mg是相对安全有效的剂量。(眼科,2021,30:227-231)Objective To compare the efficacy and safety of 2 mg and 3 mg ganciclovir intravitreal injection on cytomegalovirus retinitis(CMVR)in patients with acquired immunodeficiency syndrome(AIDS).Design Prospective comparative case series.Participants 63 cases(86 eyes)of patients with AIDS complicated with CMVR in Beijing Ditan Hospital from 2016 to 2020.Methods All patients were randomly divided into 2 mg group(41 eyes)and 3 mg group(45 eyes)and received ganciclovir intravitreal injection of 2 mg or 3 mg based on the systemic ganciclovir treatment.Before vitreous injection,aqueous humor was extracted for PCR detection of cytomegalovirus.Intravitreous injection was given once a week until the fundus lesion was controlled and cytomegalovirus PCR in the aqueous humor was negative.Main Outcome Measures The fundus statues,cytomegalovirus(CMV)load in aqueous humor[log(CMV DNA)],the frequencies of the injection,visual acuity,complications.Results All the active retinal necrosis lesions were controlled and gradually transformed into atrophy lesions.Viral load in aqueous humor decreased weekly and eventually turned negative.The viral loads of CMV in the 2 mg group was 3.90±0.73 copies/ml,3.88±0.82 copies/ml,3.06±0.93 copies/ml,2.85±0.75 copies/ml and 2.32±0.50 copies/ml respectively before initial treatment,and at the first,second,third and fourth weeks of treatment(F=28.54,P<0.01).In 3 mg group,the viral loads of CMV was 4.10±0.94 copies/ml,3.76±0.90 copies/ml,3.50±0.81 copies/ml,2.90±0.91 copies/ml,2.57±0.79 copies/ml,respectively(F=18.21,P<0.01).Initial CMV viral load was positively correlated with the frequency of injection in both 2 mg groups(r=0.69,P<0.01)and 3 mg groups(r=0.82,P<0.01).Visual acuity improved or remained unchanged in 31 of 41 eyes in the 2 mg group and 33 of 45 eyes in the 3 mg group(χ^(2)=0.06,P=0.81).No serious complications occurred in any of the patients.There were no significant differences in lesion recovery rate,viral load in aqueous humor,number of injections,complications between the tw

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

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