婴儿巨细胞病毒感染的眼部临床特征  

Clinical features of infant cytomegalovirus infection

作　　者：刘婷[1] 卢跃兵 余继锋[2] 李萍[1] 孙爽[1] 曹鸿会 郭艳红[1] 孙先桃 Liu Ting;Lu Yuebing;Yu Jifeng;Li Ping;Sun Shuang;Cao Honghui;Guo Yanhong;Sun Xiantao(Department of Ophthalmology,Children's Hospital Affiliated of Zhengzhou University,Henan Children's Hospital,Zhengzhou Children's Hospital,Zhengzhou 450000,China;Department of Ophthalmology,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院,郑州儿童医院眼科,郑州450000 [2]首都医科大学附属北京儿童医院眼科,北京100045

出　　处：《中华眼底病杂志》2022年第7期573-577,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察婴儿巨细胞病毒(CMV)感染的眼部临床特征。方法回顾性临床研究。2019年3月至2021年7月于河南省儿童医院眼科就诊的CMV感染患儿438例876只眼纳入研究。其中,男性254例,女性184例;年龄3 d~11个月;出生孕周28~42周;出生体重1120~8900 g。足月、早产儿分别为384、54例。内科会诊后行眼底检查385例770只眼;早产儿常规眼底筛查53例106只眼。CMV性视网膜炎(CMVR)分为颗粒型、暴发型。合并有中-重度症状的CMV相关疾病者给予静脉滴注和(或)口服更昔洛韦治疗;眼底血管炎严重者联合玻璃体腔注射更昔洛韦治疗。随访时间4~28个月,观察患儿眼部病变特征、全身合并疾病及治疗转归情况。结果眼底正常258例516只眼(58.9%,258/438);CMVR 180例291只眼(41.1%,180/438),其中双眼、单眼分别为111(61.7%,111/180)、69(38.3%,69/180)例。CMVR 291只眼中,颗粒型281只眼(96.6%,281/291),眼底表现为黄白色点片状混浊病灶和(或)视网膜片状出血;暴发型10只眼(3.4%,10/291),眼底呈典型"奶酪番茄酱样"及血管白鞘样改变。180例CMVR患儿中,给予全身静脉滴注和(或)口服更昔洛韦治疗72例118只眼;玻璃体腔注射更昔洛韦治疗5例10只眼,均为暴发型CMVR。末次随访时,眼底病变显著消退61例100只眼;存在陈旧性病灶或视网膜色素不均11例18只眼。未治疗108例。结论婴儿CMV感染眼底表现最常见为颗粒型CMVR;暴发型CMVR病情较重,及时抗病毒治疗后病变可显著消退。Objective To observe the ocular clinical features of infantile cytomegalovirus(CMV)infection.Methods A retrospective clinical study.From March 2019 to July 2021,876 eyes of 438 children with CMV infection who visited Department of Ophthalmology of Henan Provincial Children's Hospital were included in the study.Among them,there were 254 males and 184 females;the age ranged from 3 days to 11 months;the gestational weeks were 28 to 42 weeks;the birth weight was 1120 to 8900 g.There were 384 and 54 full-term and premature infants,respectively.Fundus examination was performed in 385 cases(770 eyes)after medical consultation;53 cases(106 eyes)of premature infants were routinely screened.CMV retinitis(CMVR)was divided into granular type and fulminant type.Patients with CMV-related diseases with moderate to severe symptoms were given intravenous drip and/or oral ganciclovir;patients with severe fundus vasculitis were combined with intravitreal injection of ganciclovir.The follow-up period was from 4 to 28 months,and the characteristics of eye lesions,systemic comorbid diseases and treatment outcomes were observed.Results There were 516 eyes of 258 cases with normal fundus(58.9%,258/438);291 eyes of 180 cases with CMVR(41.1%,180/438),of which binocular and monocular were 111(61.7%,111/180)and 69(38.3%,69/180)cases.Among the 291 eyes of CMVR,281 eyes(96.6%,281/291)of granular type;yellow-white point-like opacity and/or retinal hemorrhage;10 eyes(3.4%,10/291)of fulminant type;fundus Showed a typical"cheese ketchup-like"and vascular white sheath-like changes.Among the 180 children with CMVR,72 patients(118 eyes)were given systemic intravenous drip and/or oral ganciclovir;5 patients(10 eyes)were given intravitreal ganciclovir,all of which were fulminant CMVR.At the last follow-up,fundus lesions regressed significantly in 100 eyes of 61 cases;18 eyes of 11 cases had old lesions or uneven retinal pigment;108 cases were not treated.Conclusion The most common fundus manifestation of CMV infection in infants is granular retinitis,

关 键 词：婴儿 巨细胞病毒感染 巨细胞病毒视网膜炎 更昔洛韦 

分 类 号：R771.3[医药卫生—眼科]