CAJ | 학술논문

目的探讨获得性免疫缺陷综合征(AIDS)合并巨细胞病毒视网膜炎(CMVR)的临床特点.方法回顾性系列病例研究.收集2006年12月至2011年12月就诊于上海市公共卫生临床中心的80例(118只眼)CMVR患者的实验室检查和临床诊治资料,分析其与细胞免疫的关系、CMVR发生的危险因素、临床表现、治疗方法及预后.不同CD4+T淋巴细胞计数水平间CMVR发病率两两比较采用x2检验.结果 80例(118只眼)AIDS患者中,男性71例,女性9例,年龄18～ 60岁,平均年龄(38±10)岁.本组病例CD4+T淋巴细胞计数＞100个/μl组患者的患病率与计数低于100个/μl的患者两组比较差异有统计学意义(x2=15.567、32.469,P=0.00、0.00).发生CMVR时80例患者的CD4+T淋巴细胞计数为0～141个/μl,65例低于50个/μl.8例(10.0％) AIDS以CMVR为首发临床表现.20例(25.0％) 26只眼经眼科常规检查发现视网膜病变.首诊时34只眼(54.2％)的视力低于0.3,其中74只眼(62.5％)因后极部视网膜坏死引起.51只眼治疗后视力有不同程度提高,其中48只眼于出现症状3个月内接受治疗;35只眼治疗后视力下降或无改善,其中15只眼出现症状3个月后接受治疗.CD4+T淋巴细胞达150个/μl并持续3个月时停止抗CMV治疗.86.9％眼治愈,15只眼视网膜脱离,14只眼免疫重建葡萄膜炎,24只眼并发性白内障,6只眼视神经萎缩.治疗后34只眼视力低于0.05,其中24只眼由视网膜脱离、并发性白内障、视神经萎缩等CMVR并发症引起.结论 CD4+T淋巴细胞计数较低是CMVR危险因素.高效抗病毒治疗及抗CMV治疗可使CMVR达临床治愈.应对AIDS患者,尤其是CD4+T淋巴细胞计数低于100个/μl的患者进行常规眼科检查.
목적 탐토획득성면역결함종합정(AIDS)합병거세포병독시망막염(CMVR)적림상특점.방법 회고성계렬병례연구.수집2006년12월지2011년12월취진우상해시공공위생림상중심적80례(118지안)CMVR환자적실험실검사화림상진치자료,분석기여세포면역적관계、CMVR발생적위험인소、림상표현、치료방법급예후.불동CD4+T림파세포계수수평간CMVR발병솔량량비교채용x2검험.결과 80례(118지안)AIDS환자중,남성71례,녀성9례,년령18～ 60세,평균년령(38±10)세.본조병례CD4+T림파세포계수＞100개/μl조환자적환병솔여계수저우100개/μl적환자량조비교차이유통계학의의(x2=15.567、32.469,P=0.00、0.00).발생CMVR시80례환자적CD4+T림파세포계수위0～141개/μl,65례저우50개/μl.8례(10.0％) AIDS이CMVR위수발림상표현.20례(25.0％) 26지안경안과상규검사발현시망막병변.수진시34지안(54.2％)적시력저우0.3,기중74지안(62.5％)인후겁부시망막배사인기.51지안치료후시력유불동정도제고,기중48지안우출현증상3개월내접수치료;35지안치료후시력하강혹무개선,기중15지안출현증상3개월후접수치료.CD4+T림파세포체150개/μl병지속3개월시정지항CMV치료.86.9％안치유,15지안시망막탈리,14지안면역중건포도막염,24지안병발성백내장,6지안시신경위축.치료후34지안시력저우0.05,기중24지안유시망막탈리、병발성백내장、시신경위축등CMVR병발증인기.결론 CD4+T림파세포계수교저시CMVR위험인소.고효항병독치료급항CMV치료가사CMVR체림상치유.응대AIDS환자,우기시CD4+T림파세포계수저우100개/μl적환자진행상규안과검사.
Objective To investigate the clinical characteristics of cytomegalovirus retinitis (CMVR) in acquired immunodeficiency syndrome (AIDS) patients.Methods Retrospective case-series study.The clinical and laboratory data of 80 AIDS patients (118 eyes) with findings of CMVR were collected from Shanghai Public Health Clinical Center from December 2006 to December 2011.The relationship between CMVR and cellular immunity,the high risk factor,clinical characteristics,treatment and prognosis of CMVR were analyzed in this study.x2 test was used to check the incidence of CMVR in different CD4 + T lymphocyte count groups.Results There was 80 AIDS patients (118 eyes) totally,71 males and 9 females.Their age was from 18 to 60 years old,which mean value was (38 ± 10)years old.The incidence in the group of CD4 + T lymphocyte count over 100 cells/μl was lower than the two groups of CD4+ T lymphocyte count less than 100 cells/μl (x2 =15.567,32.469; P =0.00,0.00).CD4+ T lymphocyte count was always ranged from 0 to 141 cells/μl in CMVR patients.It was less than 50 cells/μl in 81.3％ cases.In 10.0％ AIDS patients,CMVR was the first manifestation.In 25％ AIDS patients (26 eyes),lesions in retina was found by routine eye examination.In 54.2％ patients,the best corrected visual acuity was less than 0.3.Retinal necrosis was involvement near the posterior pole in 62.5％ CMVR patients.The visual acuity of 51 eyes was improved after treatment within 94.1％ cases which were treated within 3 months.However,BCVA of 35 eyes decreased or with less change within 42.9％ cases which were treated after symptoms appeared 3 months.The anti-CMV treatment included induction and maintenance of ganciclovir or foscarnet stopped when the CD4 +T lymphocyte count was more than 150 cells/μl in 3 continuous months.86.9％ eyes were cured clinically.Retinal detachment,immune reconstitution uveitis and complicated cataract was found in 13.1％,12.1％ and 20.5％ cases respectively.Optic atrophy occurred in 6 eyes.The visual acuity of 28.9％ eyes was 0.05 or less,71.3％ of that caused by retinal detachment,cataract and optic atrophy.Conclusions CD4 + T lymphocyte count reduction is the risk factor for CMVR.HAART and anti-CMV therapy will cure the CMVR clinically.Routine eye examinations should be performed in all AIDS patients to get early diagnosis of CMVR or other opportunistic infections to avoid vision loss,especially in those CD4 + T lymphocyte count lower than 100 cells/μl.