获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎初发期患者临床特征分析  

Clinical manifestations of the initial-stage 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,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China;Department of Infectious Diseases,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China;Beijing Tongren Eye Center,Beijing Ophthalmology and Visual Sciences Key Lab,Beijing Infectious Eye Disease Diagnosis and Treatment Center,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佑安医院感染中心,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》2021年第7期513-517,共5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(YNKTQN 20180201)。

摘　　要：目的观察获得性免疫缺陷综合征(AIDS)合并巨细胞病毒(CMV)性视网膜炎(CMVR)初发期患者的临床表现。方法回顾性病例系列研究。2017年7月至2019年11月于首都医科大学附属北京佑安医院眼科检查确诊的AIDS合并CMVR初发期患者21例22只眼纳入研究。其中,男性19例19只眼,女性2例3只眼;平均年龄(34.3±9.6)岁。患者平均CD4+T淋巴细胞计数(26.1±23.2)个/μl。常规眼底筛查发现17例,对侧眼病变就诊时检查发现4例。双眼CMVR 13例(61.9%,13/21);其中,双眼均为初发期CMVR 1例,对侧眼为CMVR早期(图2A)12例。对侧眼为人类免疫缺陷病毒相关视网膜微血管病变2例,视盘水肿1例,眼底检查未见明显异常5例。所有患者均行裂隙灯显微镜、超广角眼底照相检查;同时行光相干断层扫描(OCT)检查18只眼。首诊前1周内行血液CMV-DNA检测17例;首诊后1周内行房水CMV-DNA检测7只眼。眼底检查后1周内,接受、未接受全身抗CMV治疗分别为8例8只眼和7例8只眼;治疗情况不明6例6只眼。治疗后接受随访17例18只眼。随访时间0.5~28个月。结果所有患眼眼前节检查未见明显异常;玻璃体透明。眼底病灶<1个视盘直径(DD),呈白色颗粒样、聚集成簇、边缘模糊,其中病灶周边有颗粒样卫星灶18只眼(81.8%,18/22)。病灶位于2区19只眼(86.4%,19/22),同时累及1区和2区1只眼(4.5%,1/22),位于3区2只眼(9.1%,2/22)。行OCT检查18只眼中,因病灶不在常规扫描范围内而未能获取到影像资料12只眼;获取到影像资料的6只眼,表现为内层或全层视网膜增厚或萎缩凹陷,结构破坏,伴局部玻璃体点状强反射影。行血液CMV-DNA检测的17例患者中,CMV-DNA阴性、阳性分别为1(5.9%,1/17)、16(94.1%,16/17)例。行房水CMV-DNA检测的7只眼,结果均为阴性。接受随访的18只眼中,病灶无扩大,其中逐渐消退吸收4只眼(22.2%,4/18),出现不同程度病灶扩大14只眼(77.8%,14/18)。结论AIDS合并CMVR初发期患�Objective To investigate the clinical manifestations of acquired immunodeficiency syndrome(AIDS)patients with initial-stage cytomegalovirus(CMV)retinitis(CMVR).Methods Retrospective case series study.From July 2017 to November 2019,21 patients with 22 eyes of AIDS combined with CMVR in the initial stage of AIDS and CMVR diagnosed in the eye examination in the study.Among them,there were 19 males with 19 eyes and 2 females with 3 eyes;the average age was 34.3±9.6 years.The average CD4+T lymphocyte count of patients was 26.1±23.2/μl.Routine fundus screening revealed 17 cases,and the contralateral eye disease was found in 4 cases.There were 13 cases of CMVR in both eyes(61.9%,13/21).Among them,both eyes were in the initial stage of CMVR,and the contralateral eyes were in the early stage of CMVR in 12 cases.The contralateral eye included 2 cases of human immunodeficiency virus-related retinal microangiopathy,1 case of optic disc edema,and 5 cases of no obvious abnormality on fundus examination.All patients underwent slit lamp microscopy and ultra-wide-angle fundus photography examination.At the same time,18 eyes underwent optical coherence tomography(OCT).Blood CMV-DNA detection was performed in 17 cases within 1 week before the first diagnosis;aqueous CMV-DNA detection was performed in 7 eyes within 1 week after the first diagnosis.Within 1 week after the fundus examination,8 eyes of 8 cases and 8 eyes of 7 cases were received and not received systemic anti-CMV treatment;the treatment status was unknown in 6 cases and 6 eyes.After treatment,18 eyes of 17 cases were followed up.The follow-up time was 0.5-28 months.Results There were no obvious abnormalities in the anterior segment examination of all the affected eyes;the vitreous body was transparent.The fundus lesions were less than 1 optic disc diameter(DD),and they were white granular,clustered,with blurred edges.Among them,there were granular satellite lesions around the lesion in 18 eyes(81.8%,18/22).The lesions were located in 19 eyes(86.4%,19/22)in zone 2,1

关 键 词：获得性免疫缺陷综合征 巨细胞病毒视网膜炎 初发期 

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