45例AIDS合并巨细胞病毒性视网膜炎临床特点分析

目的探究AIDS合并巨细胞病毒(cytomegalovirus,CMV)性视网膜炎临床诊断及治疗措施。方法收集2012年2月—2014年2月收治的45例AIDS合并CMV性视网膜炎患者临床资料并进行回顾性分析,分析患者一般资料、临床特征、实验室检查结果、治疗及转归。结果患者眼部常见的症状为视力下降和视物模糊,分别为41例(91.11%)和23例(51.11%),另有3例(6.67%)发生失明。眼底检查发现视网膜血管炎和视神经炎,分别为31例(68.89%)和5例(11.11%),另有5例(11.11%)发生视网膜脱离。患者CD4+T细胞计数平均为(56.3±12.6)个/μl,CMV-Ig M阳性15例(33.33%),CMV抗原阳性18例(40.00%)。应用替诺福韦+拉米夫定+依非韦伦进行抗病毒治疗后,19例治愈(42.22%),19例好转(42.22%),7例无效(15.56%)。结论 AIDS患者免疫功能缺损,易合并眼部CMV感染造成视网膜炎症,临床以视力下降和视力模糊为主,眼底检查常见为视网膜血管炎和视神经炎,积极治疗可获得显著效果。

Clinical characteristics of 45 AIDS patients with cytomegalovirus retinitis

Objective To investigate the clinical diagnosis and treatment of AIDS patients with cytomegalovirus (CMV) retinitis. Methods Forty-five AIDS patients with CMV retinitis were hospitalized from February 2012 to February 2014 in our hospital. Their clinical data were collected and analyzed retrospectively, including the general information, clinical features, laboratory findings, treatment and outcomes.Results Vision loss and vision blurred were observed in 41 patients (91.11%) and 23 patients (51.11%) , and 3 patients (6.67%) lost their sights. Fundus examination found that there were 31 patients (68.89%) and 5 patients (11.11%) with retinal vasculitis and optic neuritis, respectively, and another 5 patients (11.11%) with retinal detachment. Average CD4+ T lymphocytes were (56.3±12.6) cell/μl. Fifteen patients were CMV-IgM positive (33.33%), and CMV antigen was positive in 18 cases (40%). After the application of tenofovir + lamivudine + efavirenz antiviral treatment, 19 cases (42.22%) were cured, 19 cases (42.22%) were improved, and 7 cases (15.56%) were invalid.Conclusions With the immune function impairment, AIDS patients are easy to merge eye retinitis caused by CMV infection. Impaired vision and visual disturbance are main clinical symptoms. Retinal vasculitis and optic neuritis are common by fundus examination. Active treatment can be obtained remarkable results.