中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2008年
10期
802-804
,共3页
陶梅梅%叶俊杰%匡季秋%韩扬%谢静%邱志峰%左玲燕%李雁凌%李太生
陶梅梅%葉俊傑%劻季鞦%韓颺%謝靜%邱誌峰%左玲燕%李雁凌%李太生
도매매%협준걸%광계추%한양%사정%구지봉%좌령연%리안릉%리태생
获得性免疫缺陷综合征%巨细胞病毒感染%T淋巴细胞亚群
穫得性免疫缺陷綜閤徵%巨細胞病毒感染%T淋巴細胞亞群
획득성면역결함종합정%거세포병독감염%T림파세포아군
Acquired immunodeficiency syndrome%Cytomegalovims infections%T lymphocyte subsets
目的 探讨AIDS合并巨细胞病毒(CMV)感染的临床特点、治疗转归和外周血T淋巴细胞亚群变化情况.方法 回顾性分析1985～2005年北京协和医院收治的96例AIDS患者,对其中23例CMV感染患者的临床特点、外周血T淋巴细胞亚群、血清学指标、治疗及预后情况进行分析.结果 23例合并CMV感染的AIDs患者中,临床表现为:发热(18例)、咳嗽(11例)、胸闷(9例)、腹泻(8例),13例出现CMV视网膜炎,其中7例以视力下降、视物模糊等眼部症状为首发表现.18例合并肺孢子菌肺炎、结核等多种机会性感染.15例(65.2%)CMV血清学阳性,CMV pp65的阳性率为43.5%,特异性CMV IgM抗体的阳性率为30.4%.CMV感染组的CD4+ T细胞数量[14(4,39)个/μl]明显低于非CMV感染组[48(12,128)个/μl],P=0.005;CD8+CD38+T细胞比例高于非CMV感染组.结论 CMV感染多发生于晚期AIDS患者,当AIDS患者的CD4+细胞<100个/μl时,应常规检测CMV pp65抗原和特异性IgM抗体,筛查眼底;若青壮年患者以发热、视力下降、视物模糊等就诊,应警惕AIDS合并CMV感染的可能.
目的 探討AIDS閤併巨細胞病毒(CMV)感染的臨床特點、治療轉歸和外週血T淋巴細胞亞群變化情況.方法 迴顧性分析1985～2005年北京協和醫院收治的96例AIDS患者,對其中23例CMV感染患者的臨床特點、外週血T淋巴細胞亞群、血清學指標、治療及預後情況進行分析.結果 23例閤併CMV感染的AIDs患者中,臨床錶現為:髮熱(18例)、咳嗽(11例)、胸悶(9例)、腹瀉(8例),13例齣現CMV視網膜炎,其中7例以視力下降、視物模糊等眼部癥狀為首髮錶現.18例閤併肺孢子菌肺炎、結覈等多種機會性感染.15例(65.2%)CMV血清學暘性,CMV pp65的暘性率為43.5%,特異性CMV IgM抗體的暘性率為30.4%.CMV感染組的CD4+ T細胞數量[14(4,39)箇/μl]明顯低于非CMV感染組[48(12,128)箇/μl],P=0.005;CD8+CD38+T細胞比例高于非CMV感染組.結論 CMV感染多髮生于晚期AIDS患者,噹AIDS患者的CD4+細胞<100箇/μl時,應常規檢測CMV pp65抗原和特異性IgM抗體,篩查眼底;若青壯年患者以髮熱、視力下降、視物模糊等就診,應警惕AIDS閤併CMV感染的可能.
목적 탐토AIDS합병거세포병독(CMV)감염적림상특점、치료전귀화외주혈T림파세포아군변화정황.방법 회고성분석1985～2005년북경협화의원수치적96례AIDS환자,대기중23례CMV감염환자적림상특점、외주혈T림파세포아군、혈청학지표、치료급예후정황진행분석.결과 23례합병CMV감염적AIDs환자중,림상표현위:발열(18례)、해수(11례)、흉민(9례)、복사(8례),13례출현CMV시망막염,기중7례이시력하강、시물모호등안부증상위수발표현.18례합병폐포자균폐염、결핵등다충궤회성감염.15례(65.2%)CMV혈청학양성,CMV pp65적양성솔위43.5%,특이성CMV IgM항체적양성솔위30.4%.CMV감염조적CD4+ T세포수량[14(4,39)개/μl]명현저우비CMV감염조[48(12,128)개/μl],P=0.005;CD8+CD38+T세포비례고우비CMV감염조.결론 CMV감염다발생우만기AIDS환자,당AIDS환자적CD4+세포<100개/μl시,응상규검측CMV pp65항원화특이성IgM항체,사사안저;약청장년환자이발열、시력하강、시물모호등취진,응경척AIDS합병CMV감염적가능.
Objective To investigate the clinical features, therapeutic approaches, outcomes and alterations of peripheral lymphecytos subsets in cytomegalovirus (CMV) infections in patients with AIDS.Methods Ninety-six cases of AIDS were treated in Peking Union Medical College Hospital and 23 of them had CMV infection. We analyzed the clinical features, peripheral lymphocytes subsets, outcomes, CMV pp65 antigen and/or specific anti-CMV lgM. Results In the 23 CMV patients, nonspacific symptoms including fever,cough,chest distress and diarrhea occurred in 18, 11,9 and 8 patients, respectively. Thirteen patients had retinitis identified by ophthalmofundoscepy, 7 of them had blurred vision or floating as primary symptoms. Pneumocystis pneumonia, tuberculosis infection and other infection appeared in 18 patients.Fifteen(65. 2% )of the patients had positive serum tests. The positive rates for CMV pp65 and specific anti-CMV-IgM were 43.5% and 30. 4%, respectively. CD4+T cell count in CMV patients was remarkably decreased than that in non-CMV patients [14 (4,39) cells/μl vs (48 ( 12,128 ) cells/p J, P = 0. 005] and the proportion of CD8+ CD38+ T cells in CMV patients was higher than that in non-CMV patients,whereas the difference of CD8+T cell was not statistically different between the 2 groups. Conclusions CMV infection often occurrs in advanced AIDS patients. In HIV/AIDS patients with CD4+ T cell count ≤ 100 cells/μl,routine check for CMV pp65 antigen, specific anti-CMV IgM and ophthalmofundoscopy are recommended.Whenever encountering a young patient presenting with fever, blurred vision or floating, CMV complicating AIDS should be considered.
