获得性免疫缺陷综合征合并梅毒患者的眼底病变构成分析

目的 分析获得性免疫缺陷综合征（AIDS）合并梅毒患者的眼底病变构成特点。设计 回顾性病例系列。研究对象 2012-2019年北京佑安医院AIDS患者395例。方法 根据是否合并梅毒分为AIDS组和AIDS合并梅毒组。患者进行最佳矫正视力(BCVA)、裂隙灯、眼压、散瞳眼底检查及彩色眼底照相等眼科检查，并行艾滋病、梅毒相关全身检查。主要指标 BCVA、眼前节反应、眼底病变情况、高效抗逆转录病毒治疗（HAART）状态、CD4+T细胞计数、血HIV-RNA载量以及血CMV-DNA。结果 AIDS组患者266例，眼底异常者163例（61.3%），其中男性149例（91.4%），HIV相关视网膜微血管病变66例（40.5%)，巨细胞病毒视网膜炎94例（57.7%)，血CD4+T细胞计数中位数27个/μl； AIDS合并梅毒组患者129例，眼底异常者93例（72.1%），与AIDS组比较，差异有统计学意义（P=0.035），其中男性92例（P=0.014），HIV相关视网膜微血管病变40例（31.0%），梅毒相关眼底改变26例（20.2%），巨细胞病毒视网膜炎25例（19.4%），眼前节阳性反应者23例 (P=0.010)，63例（67.7%）患者眼底病变位置为中央型（P=0.040），血CD4+T细胞计数中位数33.5个/μl（P=0.007），均明显高于AIDS组。结论 AIDS合并梅毒患者眼底病变患病率高于单纯AIDS组患者，且血CD4+T细胞计数更高。

Clinical constituent analysis of fundus lesions in AIDS and syphilis co-infected patients

Objective To analyze the clinical constitutions of fundus lesions in AIDS patients combined with syphilis. Design Retrospective case series. Participants 395 AIDS patients were treated in Beijing Youan Hospital from 2012 to 2019. Methods All AIDS patients were divided into AIDS group and AIDS with syphilis group according to whether they combined with syphilis or not. All patients were examined for best corrected vision acuity (BCVA), slit lamp, intraocular pressure, mydriatic fundus examination and color fundus photography. The history of AIDS and HAART treatment were recorded. Syphilis rapid plasma reagin test (RPR)，blood CD4+T cells, HIV-RNA load and CMV-DNA were tested. Compare the ocular and general conditions between the two groups. Main Outcome Measures BCVA, anterior segment reaction, funus lesion, HAART statues, blood CD4+T cell count, HIV-RNA load and CMV-DNA load. Results 266 patients in AIDS group, 163 patients (61.3%) with abnormal fundus, in which, 149 cases (91.4%) were males, 66 cases (40.5%) with HIV related microvascular retinopathy, 94 cases (57.7%) with cytomegalovirus retinitis, and the median CD4+T cell count was 27/μl. There were 129 AIDS patients with syphilis, 93 cases (72.1%) had abnormal fundus (P=0.035), 92 cases (P=0.014) were male, 40 (31.0%) with HIV related microvascular retinopathy, 26(20.2%) with syphilis related fundus changes, 25(19.4%) with cytomegalovirus retinitis. In which, 23 cases had positive reaction to anterior segment (P=0.010), 63 cases (67.7%) had central fundus lesion (P=0.040), and the median number of CD4+T cells was 33.5 /μl (P=0.007), which was significantly higher than that of AIDS group. Conclusion The incidence rate of fundus lesions and number of blood CD4+T cells in AIDS combined syphilis group was significantly higher than that in group AIDS.