中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2015年
10期
739-745
,共7页
张锐%钱江%王朱健%袁一飞
張銳%錢江%王硃健%袁一飛
장예%전강%왕주건%원일비
HIV感染%梅毒%葡萄膜炎%视网膜炎
HIV感染%梅毒%葡萄膜炎%視網膜炎
HIV감염%매독%포도막염%시망막염
HIV infections%Syphilis%Uveitis%Retinitis
目的 探讨合并人免疫缺陷病毒(HIV)感染的梅毒性葡萄膜视网膜炎患者的临床表现.方法 回顾性系列病例研究.收集2008年1月至2014年12月在复旦大学附属眼耳鼻喉科医院就诊的葡萄膜视网膜炎患者,对其进行梅毒、HIV血清学检查.选择苍白螺旋体颗粒凝集试验和快速血浆反应素试验(RPR)均为阳性,且RPR＞ 1:8,同时HIV病毒检测阳性者,排除其他原因引起的葡萄膜视网膜炎.所有患者均行全面的眼部检查,包括最佳矫正视力、眼前节、眼底、眼压及眼部B超检查,除因玻璃体混浊或因全身因素不能耐受者,均行FFA检查,部分患者行OCT检查.同时进行全身检查.结果 共收集病例26例,其中男性24例(92.3％),女性2例(7.7％),就诊年龄为20～63岁,平均(39.3±13.2)岁.RPR滴度为1:32～1:512.其中3例为单眼发病(11.5％),23例为双眼发病(88.5％),共49只眼.最佳矫正视力为0.6至手动.全葡萄膜炎是最常见的表现,39只眼(79.6％),仅出现前葡萄膜炎者2只眼(4.1％),后葡萄膜炎8只眼(16.3％).前房炎症细胞(-)～(+++),玻璃体混浊轻度至重度.眼底病变表现为视神经视网膜炎16只眼(32.7％)、玻璃体炎27只眼(55.1％)、视网膜脉络膜炎5只眼(10.2％)、视神经炎5只眼(10.2％)、视网膜炎5只眼(10.2％),其中包括坏死性视网膜炎2只眼(4.1％)、视网膜血管炎4只眼(8.2％)、后部鳞状脉络膜视网膜炎2只眼(4.1％),多灶性脉络膜炎2只眼(4.1％).5只眼(10.2％)眼压升高.全身表现包括:皮疹5例(19.2％),阴部溃疡5例(19.2％),下疳3例(11.5％),头痛2例(7.7％),双下肢无力2例(7.7％),发热2例(7.7％),口腔溃疡1例(3.8％),脱发1例(3.8％).结论 合并HIV感染的梅毒性葡萄膜视网膜炎的临床表现缺乏特异性,最常见的眼底表现为视神经视网膜炎,多数患者同时伴有玻璃体炎.
目的 探討閤併人免疫缺陷病毒(HIV)感染的梅毒性葡萄膜視網膜炎患者的臨床錶現.方法 迴顧性繫列病例研究.收集2008年1月至2014年12月在複旦大學附屬眼耳鼻喉科醫院就診的葡萄膜視網膜炎患者,對其進行梅毒、HIV血清學檢查.選擇蒼白螺鏇體顆粒凝集試驗和快速血漿反應素試驗(RPR)均為暘性,且RPR＞ 1:8,同時HIV病毒檢測暘性者,排除其他原因引起的葡萄膜視網膜炎.所有患者均行全麵的眼部檢查,包括最佳矯正視力、眼前節、眼底、眼壓及眼部B超檢查,除因玻璃體混濁或因全身因素不能耐受者,均行FFA檢查,部分患者行OCT檢查.同時進行全身檢查.結果 共收集病例26例,其中男性24例(92.3％),女性2例(7.7％),就診年齡為20～63歲,平均(39.3±13.2)歲.RPR滴度為1:32～1:512.其中3例為單眼髮病(11.5％),23例為雙眼髮病(88.5％),共49隻眼.最佳矯正視力為0.6至手動.全葡萄膜炎是最常見的錶現,39隻眼(79.6％),僅齣現前葡萄膜炎者2隻眼(4.1％),後葡萄膜炎8隻眼(16.3％).前房炎癥細胞(-)～(+++),玻璃體混濁輕度至重度.眼底病變錶現為視神經視網膜炎16隻眼(32.7％)、玻璃體炎27隻眼(55.1％)、視網膜脈絡膜炎5隻眼(10.2％)、視神經炎5隻眼(10.2％)、視網膜炎5隻眼(10.2％),其中包括壞死性視網膜炎2隻眼(4.1％)、視網膜血管炎4隻眼(8.2％)、後部鱗狀脈絡膜視網膜炎2隻眼(4.1％),多竈性脈絡膜炎2隻眼(4.1％).5隻眼(10.2％)眼壓升高.全身錶現包括:皮疹5例(19.2％),陰部潰瘍5例(19.2％),下疳3例(11.5％),頭痛2例(7.7％),雙下肢無力2例(7.7％),髮熱2例(7.7％),口腔潰瘍1例(3.8％),脫髮1例(3.8％).結論 閤併HIV感染的梅毒性葡萄膜視網膜炎的臨床錶現缺乏特異性,最常見的眼底錶現為視神經視網膜炎,多數患者同時伴有玻璃體炎.
목적 탐토합병인면역결함병독(HIV)감염적매독성포도막시망막염환자적림상표현.방법 회고성계렬병례연구.수집2008년1월지2014년12월재복단대학부속안이비후과의원취진적포도막시망막염환자,대기진행매독、HIV혈청학검사.선택창백라선체과립응집시험화쾌속혈장반응소시험(RPR)균위양성,차RPR＞ 1:8,동시HIV병독검측양성자,배제기타원인인기적포도막시망막염.소유환자균행전면적안부검사,포괄최가교정시력、안전절、안저、안압급안부B초검사,제인파리체혼탁혹인전신인소불능내수자,균행FFA검사,부분환자행OCT검사.동시진행전신검사.결과 공수집병례26례,기중남성24례(92.3％),녀성2례(7.7％),취진년령위20～63세,평균(39.3±13.2)세.RPR적도위1:32～1:512.기중3례위단안발병(11.5％),23례위쌍안발병(88.5％),공49지안.최가교정시력위0.6지수동.전포도막염시최상견적표현,39지안(79.6％),부출현전포도막염자2지안(4.1％),후포도막염8지안(16.3％).전방염증세포(-)～(+++),파리체혼탁경도지중도.안저병변표현위시신경시망막염16지안(32.7％)、파리체염27지안(55.1％)、시망막맥락막염5지안(10.2％)、시신경염5지안(10.2％)、시망막염5지안(10.2％),기중포괄배사성시망막염2지안(4.1％)、시망막혈관염4지안(8.2％)、후부린상맥락막시망막염2지안(4.1％),다조성맥락막염2지안(4.1％).5지안(10.2％)안압승고.전신표현포괄:피진5례(19.2％),음부궤양5례(19.2％),하감3례(11.5％),두통2례(7.7％),쌍하지무력2례(7.7％),발열2례(7.7％),구강궤양1례(3.8％),탈발1례(3.8％).결론 합병HIV감염적매독성포도막시망막염적림상표현결핍특이성,최상견적안저표현위시신경시망막염,다수환자동시반유파리체염.
Objective To investigate the clinical manifestations of syphilitic uveoretinitis in patients co-infected with human immunodeficiency virus (HIV).Methods Uveoretinitis patients presenting between January 2008 and December 2014 at Eye and ENT Hospital of Fudan University were collected.Patients were selected with positive serologic tests, including rapid plasma regain titer (RPR) ＞ 1 : 8, treponema pallidum particle agglutination assay (TPPA) and human immunodeficiency virus (HIV).Other causes of uveoretinitis were excluded.Each patient underwent complete ophthalmologic examination including best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, ophthalmoscopy, applanation tonometry and B-scan ultrasonography.Fundus fluorescein angiography were obtained in each case except for patients whose fundus was blurred with dense vitritis.Optical coherence tomography (OCT) was performed in selected patients.Thorough physical examination was performed simultaneously.Results Twenty six patients were included in this study including 24 male (92.3％) and 2 female (7.7％).The mean age at presentation was 39.3±13.2 (range 20 to 63 years).RPR titres ranged from 1:32 to 1:512.There were 49 eyes altogether and ocular involvement was bilateral in 23 patients (88.5％) and unilateral in 3 patients (11.5％).Panuveitis was the most common ophthalmic presentation (n=39, 79.6％).Only two eyes were anterior uveitis (4.1％) and 8 eyes were posterior uveitis (16.3％).Anterior chamber cells+++ and mild to severe vitreous opacities were observed.Sixteen eyes presented with neuroretinitis (32.7％), 27 eyes had vitritis (55.1％), 5 eyes had retinochoroiditis (10.2％), 5 eyes had optic neuritis (10.2％), 5 eyes had retinitis (10.2％) including 2 eyes with necrotizing retinitis (4.1％), 4 eyes had retinal vasculitis (8.2％).Two eyes (11.5％) presented with posterior placoid chorioretinitis (4.1％) and multifocal choroiditis (4.1％).Systemic manifestations were detected.Five patients had a history of skin rash (19.2％), five (19.2％) had genital ulcers, three (11.5％) had chancre, two (7.7％) suffered from headache, two (7.7％) had a fever, one (3.8％) had oral ulcers and one patient (3.8％) lost his hair.Conclusions The clinical features are protean and lack of specificity.The most common manifestations was neuroretinitis, ususlly with vitritis.
