获得性免疫缺陷综合征伴巨细胞病毒性视网膜炎患者欧堡全景激光扫描检眼镜与房水检测的诊断分析  

Diagnostic analysis of Optos panoramic laser scanning ophthalmoscope and aqueous humor detection in patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis

作　　者：毛菲菲[1] 孙挥宇[1] 李丹[1] 鲁丹 王胜男[1] 刘夕瑶 Mao Feifei;Sun Huiyu;Li Dan;Lu Dan;Wang Shengnan;Liu Xiyao(Department of Ophthalmology,Beijing 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,100015

出　　处：《中华眼底病杂志》2021年第7期509-512,共4页Chinese Journal of Ocular Fundus Diseases

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(DFL 20191802);北京市医院管理局临床医学发展专项(ZYLX202126)。

摘　　要：目的观察并初步探讨获得性免疫缺陷综合征(AIDS)伴巨细胞病毒性视网膜炎(CMVR)患者眼底活动性病灶面积与房水巨细胞病毒(CMV)-DNA载量之间的关系。方法回顾性临床分析。2019年11月至2020年12月于首都医科大学附属北京地坛医院眼科检查确诊的AIDS合并活动性CMVR患者22例31只眼纳入研究。所有患者均为男性,平均年龄(38.0±8.7)岁。接受高活性抗逆转录病毒治疗(HAART)者13例,治疗时间中位数4个月;未接受HAART者9例。采用英国欧堡P200T激光扫描检眼镜行超广角眼底成像检查。应用设备自带软件测量活动性病灶面积。所有患眼行前房穿刺,抽取房水100μl,聚合酶链反应定量检测CMV-DNA载量。同时行外周血CD4+T淋巴细胞、CMV-DNA载量检测19例;行人类免疫缺陷病毒(HIV)-RNA载量检测17例。CMV及HIV病毒载量均以lg表示。以活动性病灶面积为自变量,房水CMV-DNA载量为因变量构建线性回归函数。结果所有患眼均为活动性CMVR,其病灶面积为1~264个视盘直径(DD),中位数43 DD.31只眼中,30只眼(96.8%,30/31)房水CMV-DNA载量中位数为1.3×104拷贝/ml,1只眼房水CMV-DNA为阴性。行外周血CD4+T淋巴细胞检测的19例患者,CD4+T淋巴细胞中位数18个/μl;检测出CMV-DNA载量4例(21.1%,4/19)。行HIV-RNA载量检测的17例患者,HIV-RNA载量中位数Y为4.1×104拷贝/ml。相关性分析结果显示,lg(房水CMV-DNA载量)与眼底活动性病灶面积大小明显相关(r=0.601,P<0.001),与CD4+T淋巴细胞以及lg(血CMV-DNA载量)、lg(HIV-RNA载量)均无明显相关(r=0.125、0.202、-0.096,P>0.05)。回归方程为:lg(房水CMV-DNA载量)=3.38+0.01×活动性病灶面积。结论房水CMV-DNA载量与眼底活动性病灶面积大小明显相关,可反映眼底病灶活动度。Objective To observe and preliminarily explore the relationship between the area of active fundus lesions and aqueous cytomegalovirus(CMV)-DNA in patients with acquired immunodeficiency syndrome(AIDS)with cytomegalovirus retinitis(CMVR).Methods A retrospective study.From November 2019 to December 2020,the study population consisted of 22 AIDS patients(31 eyes)with active CMVR at the Beijing Ditan Hospital,Capital Medical University.All the patients were male.The age of the patients was 38.0±8.7 years.In total,13 patients accepted highly active antiretroviral therapy(HAART).The median duration of treatment was 4 months.There were 9 cases that did not receive HAART.Ultra-wide-angle fundus imaging examination was performed using Optos P200T laser scanning ophthalmoscope.The software was used that comes with the device to measure the area of active lesions.Anterior chamber puncture was performed in all the affected eyes,100μl of aqueous humor was extracted,and the CMV-DNA load was quantitatively detected by polymerase chain reaction.At the same time,19 cases of peripheral blood CD4+T lymphocytes and CMV-DNA load were tested;17 cases of the human immunodeficiency virus(HIV)-RNA load were tested.The area of active lesions was used as the independent variable,and the CMV-DNA load of aqueous humor was used as the dependent variable to construct a linear regression function.Results All eyes were active CMVR,with lesions ranging from 1 to 264 optic disc diameters,with a median of 43 optic disc diameters.Among 31 eyes,30 eyes(96.8%,30/31)had a median aqueous CMV-DNA load of 1.3×104 copies/ml,and one eye was negative for CMV-DNA in aqueous humor.In 19 patients who underwent peripheral blood CD4+T lymphocyte detection,the median CD4+T lymphocytes were 18 cells/μl;4 cases(21.1%,4/19)were detected with CMV-DNA load.In the 17 patients who underwent HIV-RNA load testing,the median HIV-RNA load was 4.1×104 copies/ml.The results of correlation analysis showed that the amount of CMV-DNA in aqueous humor was significantly correl

关 键 词：巨细胞病毒视网膜炎 获得性免疫缺陷综合征 眼房水 

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