HIV感染者合并眼梅毒的眼部特点及实验室标本检测  

Clinical Feature of Ocular and Detection of Different Laboratory Samples from HIV Infector with Ocular Syphilis

作　　者：孔文君 谢连永[1] 杜葵芳 樊倩 冯霞[3] 李小娜[1] 张彤 Wenjun Kong;Lianyong Xie;Kuifang Du;Qian Fan;Xia Feng;Xiaona Li;Tong Zhang(Department of Opthalmology,Beijing You'an Hosptial,Capital Medical University,Beijing 100069,China;Department of Opthalmology,Tianjin Eye Hospital,Tianjin 300020,China;Department of Clinical Laboratory,Beijing You'an Hosptial,Capital Medical University,Beijing 100069,China;Department of Infection Center,Beijing You'an Hosptial,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院眼科,北京100069 [2]天津市眼科医院,天津300020 [3]首都医科大学附属北京佑安医院检验科,北京100069 [4]首都医科大学附属北京佑安医院感染中心,北京100069

出　　处：《中华眼视光学与视觉科学杂志》2023年第7期492-498,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：北京市医院管理中心“青苗”项目(QML20211703)。

摘　　要：目的:探讨人类免疫缺陷病毒(HIV)感染合并眼梅毒患者的眼部特点及不同实验室标本的检测分析。方法:系列病例研究。采用简单随机抽样,招募2022年1—9月首诊于首都医科大学附属北京佑安医院眼科和感染中心确诊为HIV感染合并眼梅毒患者8例(11眼),就诊前未接受过任何梅毒治疗,均已进行高效抗逆转录病毒治疗(HAART)。采用标准对数视力表、非接触眼压计、裂隙灯显微镜、超广角眼底照相、光学相干断层扫描仪观察患者最佳矫正视力、眼压以及眼前节、眼底状况,并给予抽血、腰椎穿刺和前房穿刺进行血液、脑脊液和房水的检测,通过TP明胶颗粒凝集试验(TPPA)和快速血浆反应素环状卡片试验(RPR)方法检测患者血液、脑脊液、房水中的梅毒感染情况。8例患者按照神经梅毒的治疗原则给予静脉青霉素驱梅治疗。随诊3~6个月。结果:8例患者均为HIV感染者,其中男6例,女2例,11眼中10眼为梅毒性视神经视网膜炎,1眼为梅毒性前葡萄膜炎。患者外周血CD4+T淋巴细胞计数平均147(67,318)个/μL,HIV病毒载量平均1295(0,4801)拷贝/mL。8例患者中血液中TPPA、RPR滴度均为阳性;8例脑脊液中TPPA为阳性,7例脑脊液中RPR滴度为阳性;11眼房水中TPPA为阳性,10眼RPR滴度为阳性。8例患者经过正规驱梅治疗后,3~6个月后复查,最佳矫正视力均好转。结论:血液、脑脊液和房水TPPA和RPR检测是诊断HIV感染者合并眼梅毒的重要实验室检测方法,房水TPPA和RPR检测有助于首诊眼科HIV感染合并眼梅毒患者的确诊。Objective:To explore the methods of clinical feature of ocular and detection of different samples in laboratory from patients from human immunodeficiency virus(HIV)-infected patients with ocular syphilis.Methods:This was a case series study.From January 2022 to September 2022,using random sampling method,8 patients(11 eyes)with HIV and ocular syphilis who were first diagnosed in the Ophthalmology Department and Infection Center Department of Beijing You'an Hospital were recruited,and had not received any treatment for syphilis before the visit.All patients have received highly active antiretroviral therapy(HAART).The standard logarithmic visual acuity chart,non-contact tonometer,slit lamp,ultrawide angle fundus photography and optical cohrence tomography(OCT)were used to observe the best corrected vision,intraocular pressure,anterior segment and fundus of the patient.Blood,cerebrospinal fluid and aqueous humor were extracted by blood extraction,lumbar puncture and paracentesis of anterior chamber.Syphilis infection in the blood,cerebrospinal fluid and aqueous humor of the patients were detected by rapid plasma regain(RPR)and Treponema pallidum particle agglutination(TPPA).According to the treatment principle of neurosyphilis,8 cases of ocular syphilis were treated with penicillin by intravenous drip.Follow up for 3-6 months.Results:All 8 patients were HIV-infected,including 6 males and 2 females.Ten eyes of 11 patients were syphilitic optic neuroretinitis,and 1 eyes were syphilisrelated anterior uveitis.The number of CD4+T lymphocytes count in peripheral blood of patients was average 147(67,318)cell/μL.The HIV viral load was average 1295(0,4801)copies/mL.Eight patients showed positive TPPA and RPR in blood,TPPA in cerebrospinal fluids were positive in 8 cases,and RPR in cerebrospinal fluids were positive in 7 cases.The TPPA in aqueous humor of 11 eyes were positive,and the RPR in aqueous humor of 10 eyes were positive.After regular treatment of penicillin,the best corrected vision of 8 patients were significantl

关 键 词：人类免疫缺陷病毒 眼梅毒 检测 

分 类 号：R512.91[医药卫生—内科学] R759.1[医药卫生—临床医学]