获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎初发期患者临床特征分析

目的:观察获得性免疫缺陷综合征（AIDS）合并巨细胞病毒（CMV）性视网膜炎（CMVR）初发期患者的临床表现。方法:回顾性病例系列研究。2017年7月至2019年11月于首都医科大学附属北京佑安医院眼科检查确诊的AIDS合并CMVR初发期患者21例22只眼纳入研究。其中,男性19例19只眼,女性2例3只眼;平均年龄（3...     

巨细胞病毒性视网膜炎与获得性免疫缺陷综合征

目的 探讨巨细胞病毒性视网膜炎与获得性免疫缺陷综合征的关系、临床表现及诊断、治疗。 方法 观察分析56例巨细胞病毒(cytomeglovirus,CMV)性视网膜炎合并获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者95只眼，对其眼底、视力、T辅助细胞的细胞受体4（CD4 ＋）计数及预后进行观察随访2周～18个月。 结果 56例患者在诊断为巨细胞病毒性视网膜炎之前AIDS病程为4～26个月。95只眼56例患者中，眼底病灶表现为颗粒型者55只眼，其中46只眼位于周边部；爆发型者25只眼，均位于后极部，视网膜坏死灶致密伴斑片状出血和血管炎；颗粒型与爆发型病灶混合存在者15只眼；其中7只眼合并有视神经乳头炎；患者就诊时视力为眼前数指至0.5，病变广泛者及病变位于后极部者视力下降尤为严重。30例患者CD4 ＋细胞计数为0～30 个/μl,平均(15±9) 个/μl。患者存活时间为3～18个月。接受更昔洛韦(ganciclovir)治疗组患者视力多数提高，CD4 ＋T细胞计数明显升高，未治疗组患者92%病变呈进行性发展，视力显著下降。 结论 CMV性视网膜炎是AIDS病的主要眼部并发症，临床上以坏死性视网膜炎伴出血及血管炎为特征，目前治疗主要用更昔洛韦。 (中华眼底病杂志, 2002, 18: 89-91)     

获得性免疫缺陷综合征并发巨细胞性视网膜炎4例

巨细胞性视网膜炎 (CMV )是获得性免疫缺陷综合征(AIDS)的晚期常见并发症。多数报道都是在确诊CMV性视网膜炎前已证实患有AIDS ,病程长短不一。我院自 2 0 0 1年 9月至 2 0 0 3年 3月期间 ,门诊接诊四例患者均因发现具有典型的CMV性视网膜炎的临床症状被疑为AIDS ,最终通过人类免疫缺陷病毒 (HIV)抗体检验阳性而确诊 ,现报告如下。例 1　男　 40岁　职员　以双眼视力下降 3个月 ,加重半个月为主诉就诊。患者消瘦 ,乏力 ,精神欠佳。双眼视力均为光感 ,眼前节无异常。眼底可见双视盘边界模糊、充血、视网膜静脉血管有白鞘 ,后极部视…     

获得性免疫缺陷综合征患者巨细胞病毒性视网膜炎的治疗进展

巨细胞病毒性视网膜炎（CMVR）是获得性免疫缺陷综合征(AIDS)患者最常见的眼后节机会性感染以及造成视力丧失的最主要原因。抗病毒药物的应用和个体化的治疗方案对于控制感染和减少复发频率，延长复发间隔时间方面已取得明显效果。全身应用高效抗逆转录酶病毒治疗法(HAART)对CMVR的预后产生了明显影响。但是治疗过程中免疫恢复性葡萄膜炎的出现正成为新的导致视力丧失的主要原因。 (中华眼底病杂志, 2005, 21: 413-415)     

沈阳市74例获得性免疫缺陷综合征患者眼底病变的临床特征分析

目的：探讨沈阳市获得性免疫缺陷综合征(AIDS)患者眼底病变的特点、影响因素及与CD4+T细胞计数的关系。方法：回顾性病例研究。选取2021-01/12期间就诊于辽宁电力中心医院的AIDS患者74例，分析患者的眼底表现及外周血CD4+T细胞计数情况。结果：纳入AIDS患者眼底病变检出率为58%。眼底病变患者外周血CD4+T细胞计数明显低于正常眼底患者[29(6，55)/μL vs 76(35，103)/μL，P<0.01]。外周血CD4+T细胞计数≤50/μL的患者眼底病变患病率最高(74%)。Logistic回归分析显示，随着CD4+T细胞计数的增多，发生眼底病变的几率降低(OR=0.977，95%CI 0.964～0.991，P<0.01)。结论：AIDS患者眼底病变与外周血CD4+T细胞有关，外周血CD4+T细胞计数降低是AIDS患者发生眼底病变的危险因素，对AIDS患者应常规进行眼底检查，有利于眼底病变的早期发现。     

获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎的眼底病变特征分析

目的 观察获得性免疫缺陷综合征(AIDS)合并巨细胞病毒性视网膜炎(CMVR)的眼底病变特征.方法 AIDS合并CMVR者27例44只眼纳入研究.所有患者均行视力、眼压、裂隙灯显微镜、散瞳间接检眼镜眼底检查,同时行眼底彩色照相.根据眼底表现将病变分为活动性病变和陈旧性病变,活动性病变又分为中心型、周边型、同时累及后极部和周边部的混合型.结果 27例44只眼中,活动性病变者19例29只眼.其中,中心型5例6只眼,占患眼的13.6%.眼底表现为后极部渗出、出血和血管鞘.周边型9例15只眼,占患眼的34.1%.眼底表现为视网膜周边部的黄白色颗粒状病灶.混合型5例8只眼,占患眼的18.2%.眼底表现为同时累及后极部和周边部的黄白病灶和出血.陈旧性病变者8例15只眼,占患眼的34.1%.眼底表现为沿血管支配区分布的色素和瘢痕性病灶.结论 AIDS合并CMVR眼底具有不同的病变特征.

Abstract：

Objective To observe the fundus characteristics of acquired immune deficiency syndrome (AIDS) with cytomegalovirus retinitis (CMVR). Methods Twenty-seven AIDS patients (44 eyes)with CMVR were studied. All the patients had undergone the examinations of visual acuity, intraocular pressure,slit lamp microscope, indirect ophthalmoscope and color fundus photography. The fundus lesions were divided into active lesions and chronic lesions, and the active lesions were subdivided into central, peripheral and mixed types which involving both the posterior and peripheral fundus. Results Of 27 patients (44 eyes), 19 patients(29 eyes)had active lesions. Five patients (six eyes, 13.6%) had central lesions (exudation, hemorrhage and vascular sheath in the posterior retina), nine patients ( 15 eyes, 34.1%) had peripheral yellow and white granular lesions. Five patients (eight eyes, 18.2 %) had mixed lesions. Chronic lesions were found in eight patients (15 eyes, 34.1%), which showed pigment and scarring lesions along vascular branches. Conclusion The fundus lesions of AIDS with CMVR have distinct features.     

获得性免疫缺陷综合征并发巨细胞病毒性视网膜炎的药物治疗现状和进展

巨细胞病毒性视网膜炎是获得性免疫缺陷综合征晚期最常见、最严重的眼部机会性感染,是导致患者视力丧失的最主要原因.继更昔洛韦、膦甲酸在临床广泛应用后,缬更昔洛韦、西多福韦及福米韦生也已经获得美国药品与食品管理局批准,先后应用于眼科临床,取得了一定的治疗效果.目前,马立巴韦、MSL-109单克隆抗体、Cyclopropavir及BAY 38-4766 正在进行Ⅰ期、Ⅱ期或Ⅲ期临床试验,可望给临床治疗带来新的希望.     

获得性免疫缺陷综合征伴巨细胞病毒性视网膜炎患者欧堡全景激光扫描检眼镜与房水检测的诊断分析

目的:观察并初步探讨获得性免疫缺陷综合征（AIDS）伴巨细胞病毒性视网膜炎（CMVR）患者眼底活动性病灶面积与房水巨细胞病毒（CMV）-DNA载量之间的关系。方法:回顾性临床分析。2019年11月至2020年12月于首都医科大学附属北京地坛医院眼科检查确诊的AIDS合并活动性CMVR患者22例31只眼纳入研究。所有患者...     

获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎二例

随着获得性免疫缺陷综合征（acquired immunodeficiency syndrome，AIDS）患者在全球范围的不断增多，认识人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染者所表现出的各种机会感染，进而确诊AIDS患者，并开展针对性的防病治病至关重要。笔者分别于2003年11月和2004年4月在本院眼科门诊发现巨细胞病毒（cytomegalovirus，CMV）性视网膜炎，最终证实为AIDS患者2例。患者曾在当地医院诊断为“中心性浆液性视网膜炎”、“葡萄膜炎”，并实施一般性治疗达1至数个月。     

Comparative analysis of cytomegalovirus retinitis and microvascular retinopathy in patients with acquired immunodeficiency syndrome

AIM: To compare the clinical manifestation of cytomegalovirus (CMV) retinitis and microvascular retinopathy (MVR) in patients with acquired immunodeficiency syndrome (AIDS) in China. METHODS: A total of 93 consecutive patients with AIDS, including 41 cases of CMV retinitis and 52 cases of MVR were retrospectively reviewed. Highly active antiretroviral therapy (HAART) status was recorded. HIV and CMV immunoassay were also tested. CD4+ T-lymphocyte count and blood CMV-DNA test were performed in all patients. Aqueous humor CMV-DNA test was completed in 39 patients. Ophthalmological examinations including best corrected visual acuity (BCVA, by International Standard Vision Chart), intraocular pressure (IOP), slit-lamp biomicroscopy, indirect ophthalmoscopy were performed. RESULTS: In MVR group, the anterior segment examination was normal in all patients with a mean BCVA of 0.93±0.13. Blood CMV-DNA was 0 (0, 269 000) and 42 patients (80.77%) did not receive HAART. In CMV retinitis group, 13 patients (31.71%) had anterior segment abnormality. The mean BCVA was 0.64±0.35 and blood CMV-DNA was 3470 (0, 1 450 000). Nineteen patients (46.34%) had not received HAART. MVR group and CMV retinitis group the positive rates of aqueous CMV-DNA were 0 and 50%, respectively. Two patients with MVR progressed to CMV retinitis during the follow-up period. CONCLUSION: In comparison of CMV, patients with MVR have relatively mild visual function impairment. Careful ophthalmological examination and close follow-up are mandatory, especially for patients who have systemic complications, positive CMV-DNA test and without received HAART.     

[In Press] Comparative analysis of cytomegalovirus retinitis and microvascular retinopathy in patients with acquired immunodeficiency syndrome

AIM: To compare the clinical manifestation of cytomegalovirus (CMV) retinitis and microvascular retinopathy (MVR) in patients with acquired immunodeficiency syndrome (AIDS) in China. METHODS: A total of 93 consecutive patients with AIDS, including 41 cases of CMV retinitis and 52 cases of MVR were retrospectively reviewed. Highly active antiretroviral therapy (HAART) status was recorded. HIV and CMV immunoassay was also tested. CD4+ T-lymphocyte count and blood CMV-DNA test were performed in all patients. Aqueous humor CMV-DNA test was completed in 39 patients. Ophthalmological examinations including best corrected visual acuity (BCVA, by International standard vision chart), intraocular pressure (IOP), slit-lamp biomicroscopy, indirect ophthalmoscopy were performed. RESULTS:In MVR group, the anterior segment examination was normal in all patients with a mean BCVA of 0.93±0.13. Blood CMV-DNA was 0 (0, 269000) and 42 patients (80.77%) did not receive HAART. In CMV retinitis group, 13 patients (31.71%) had anterior segment abnormality. The mean BCVA was 0.64±0.35 and blood CMV-DNA was 3470 (0, 1450000). Ninety patients (46.34%) had not received HAART. MVR group and CMV retinitis group the positive rates of aqueous CMV-DNA were 0 and 50%, respectively. Two patients with MVR progressed to CMV retinitis during the follow- up period. CONCLUSION: In comparison of CMV, patients with MVR have relatively mild visual function impairment. Careful ophthalmological examination and close follow-up are mandatory, especially for patients who have systemic complications, positive CMV-DNA test and without received HAART.     

AIDS合并巨细胞病毒性视网膜炎60例临床观察

目的:探讨获得性免疫缺陷综合征(AIDS)合并巨细胞病毒性视网膜炎(CMVR)的临床特征,及CMVR相关眼部免疫重建综合征(IRIS)的临床特点.方法:回顾性分析我院感染科2010-01/2015-12收治确诊为AIDS合并CMVR患者60例103眼,对其临床表现、眼底病变、CD4+T淋巴细胞计数及预后等进行观察.结果:初诊视力≤0.1者65眼(63.1％),＞0.1 ～ ＜0.3者26眼(25.2％),≥0.3者12眼(11.7％),眼底改变表现为沿血管分布的黄白色病灶,伴片状出血,较少累及玻璃体.患者60例103眼,其中37眼(35.9％)视网膜病变主要累及后极部,45眼(43.7％)主要累及周边部,21眼(20.4％)为混合型.60例患者中CD4+T淋巴细胞计数平均38.6±12.3个/μL,其中≤50个/μL 43例(71.7％),＞50 ～ ＜100个/μL8例(13.3％),≥100个/μL9例(15.0％).经高效抗逆转录病毒治疗(HARRT)及抗巨细胞病毒(CMV)治疗后,66眼视力提高,19眼视力不变,18眼视力下降.54例患者CD4+T淋巴细胞计数升高,治疗前后CD4+T细胞变化有统计学差异(P＜0.05).5例9眼为HARRT后IRIS的CMVR,经抗病毒治疗,病情得到控制.结论:CMVR为AIDS常见眼部并发症,当CD4+T淋巴细胞计数≤50个/μL时应常规进行眼科检查.IRIS的CMVR预后较差.     

2mg与3mg更昔洛韦玻璃体注射治疗AIDS患者巨细胞病毒性视网膜炎的效果比较

目的 比较玻璃体注射2 mg和3 mg更昔洛韦治疗获得性免疫缺陷综合征(AIDS)患者巨细胞病毒性视网膜炎(CMVR)的有效性和安全性.设计 前瞻性比较性病例系列.研究对象 2016-2020年北京地坛医院AIDS合并CMVR患者63例(86眼).方法 患者随机分为2 mg组(41眼)和3 mg组(45眼),在接受更昔...     

艾滋病并发巨细胞病毒性视网膜炎32例临床分析

【摘要】 目的 分析获得性免疫缺陷综合征（艾滋病）患者发生巨细胞病毒性视网膜炎及免疫恢复 性葡萄膜炎的疾病特征。设计 回顾性病例系列。研究对象 北京佑安医院眼科诊治的艾滋病合并巨 细胞病毒性视网膜炎患者32例。方法 对上述患者进行与艾滋病相关的免疫学检测;并进行视力、 眼压、眼前节检查、彩色眼底照相及荧光素眼底血管造影等眼科检查,并观察其临床特征。主要指 标 视力、眼压、眼底、CD4+T细胞计数。结果 32例患者的视力为光感～1.0;眼压8~16 mm Hg;眼 前节检查8例患者（4例为免疫恢复性葡萄膜炎）可见眼前节反应阳性（前房闪辉及角膜后KP）;32 例患者彩色眼底像均可见典型巨细胞病毒性视网膜炎眼底改变;8例（25%）CD4+T细胞＜10个/μL ,视力为光感～0.8,其中3例发生免疫恢复性葡萄膜炎,1例发生视网膜脱离;15例（46.88%） CD4+T细胞在10～50个/μL,视力为眼前指数～1.0,其中1例发生免疫恢复性葡萄膜炎,1例发生视 网膜脱离;9例（28.12%）CD4+T细胞＞50个/μL,无患者发生免疫恢复性葡萄膜炎及视网膜脱离。 19例患者（含4例免疫恢复性葡萄膜炎患者）合并其他全身机会性感染。结论 CD4+T细胞＜50个/μ L的患者更易患巨细胞病毒性视网膜炎,其视力预后差; CD4+T细胞
＜10个/μL的患者更易发生免疫恢复性葡萄膜炎,且眼前节反应明显,更易合并其他全身机会性感 染。（眼科, 2012, 21: 405-408）     

A foveal-sparing pattern of cytomegalovirus retinitis in the acquired immunodeficiency syndrome

Purpose: We describe the clinical course of 12 eyes of 10 patients in whom recurrent cytomegalovirus (CMV) retinitis exhibited a foveal-sparing pattern.
Methods: We retrospectively reviewed the case records and photographic charts of 10 patients (12 eyes) with the acquired immunodeficiency syndrome (AIDS), in whom recurrent CMV retinitis exhibited a foveal-sparing pattern within 1500 mm of the foveola.
Results: The site of primary retinitis was temporal in 10 eyes of nine patients in whom it was known. The median number of recurrences up to the observation of foveal-sparing retinitis was two (range one to eight), and five patients had active CMV retinitis despite treatment for at least two continuous months. Once established, the median rate of progression in a non-foveal vector was 2.3 times faster than toward the fovea, and the median time to reduction in acuity to < 6/30 (or death) was 11 to 14 weeks. Three eyes of three patients retained 6/30 or better acuity up to death. Foveal CMV retinitis ultimately reduced acuity to < 6/30 in five eyes. Six eyes suffered retinal detachment, involving the fovea in five, and being the primary reason for acuity of < 6/30 in four. Four patients suffered dose-limiting toxicity.
Conclusion: Foveal-sparing CMV retinitis arises in patients with recurrent CMV retinitis resistant to treatment ('clinically resistant'), particularly that which has arisen temporally. Despite its foveolar proximity, and ultimate significant loss of function, the pattern of progression allows for preservation of useful foveal vision for longer periods than would have been expected.     

艾滋病合并巨细胞病毒性视网膜炎的误诊分析

目的分析艾滋病合并巨细胞病毒性视网膜炎的误诊病例,以减少误诊。设计回顾性病例系列。研究对象具有误诊史的艾滋病合并巨细胞病毒性视网膜炎的患者9例。方法回顾性分析在北京地坛医院确诊的具有误诊史的艾滋病合并巨细胞病毒性视网膜炎患者的眼部和全身情况。主要指标误诊眼疾病,误诊时间,合并全身疾病。结果艾滋病患者巨细胞病毒性视网膜炎误诊为其他眼病的患者9例（12眼）,其中误诊为Coats病者1例,视网膜中央静脉阻塞者1例,Eales病者1例,孔源性视网膜脱离者1例,视盘血管炎者2例（3眼）,葡萄膜炎者2例（4眼）,曾先后误诊为急性视网膜坏死、葡萄膜炎和玻璃体混浊者1例。发病一周内误诊者3例,1周~3个月内误诊者2例,3个月以上病程者误诊4例。9例误诊患者中5例不曾进行高效抗逆转录病毒治疗（HAART）的患者CMV-IgM检测阳性;5例患者合并有贫血,5例患者合并其他部位的感染,4例患者合并肝肾功能异常,9例患者的CD4均〈200个/μL,其中6例患者的CD4〈50个/μL。结论艾滋病合并巨细胞病毒性视网膜炎受到病程、艾滋病抗病毒治疗和我们对疾病的认识等多种因素的影响易出现误诊。对于临床诊断有困难的疾病应考虑到这种疾病的可能,其正确的诊断需要结合全身情况综合判断。     

获得性免疫缺陷综合征并发巨细胞病毒视网膜炎患者抗病毒治疗前后视功能的变化

目的　探讨获得性免疫缺陷综合征并发巨细胞病毒（ｃｙｔｏｍｅｇａｌｏｖｉｒｕｓ,ＣＭＶ）视网膜炎的患者在抗病毒治疗前后视功能的变化。方法　对１１例感染人类免疫缺陷病毒并且第１次发生ＣＭＶ视网膜病变的患者,给予膦甲酸钠和更昔洛韦治疗。治疗前、治疗后１个月、３个月,通过多焦视网膜电图对每例患者的视功能进行评估,以未感染人类免疫缺陷病毒的正常人眼作为正常对照组,观察患眼视功能的改善情况。结果　ＣＭＶ视网膜炎患者ｍｆＥＲＧ一阶反应中心区域Ｎ１-Ｐ１的振幅密度,治疗前为（３６．９８±１７．９３）ｎＶ?ｄｅｇ－２,治疗１个月后为（４１．３３±１６．７８）ｎＶ?ｄｅｇ－２,治疗３个月后为（３６．１２±１５．４６）ｎＶ?ｄｅｇ－２,正常对照组为（７６．９９±１１．２７）ｎＶ?ｄｅｇ－２。患眼发病时与正常对照组相比较,１～４环区域ｍｆＥＲＧ的一阶反应Ｎ１-Ｐ１的振幅密度均显著降低,差异有统计学意义（均为Ｐ＜０．０５）。患眼在治疗后１个月和３个月,１～６环区域ｍｆＥＲＧ的一阶反应Ｎ１波和Ｐ１波的潜时,以及Ｎ１-Ｐ１的振幅密度与治疗前相比均没有明显改变,差异均无统计学意义（均为Ｐ＞０．０５）。结论　ＣＭＶ视网膜炎的患者在经过积极地抗病毒治疗后,视力虽然能够得到不同程度上的恢复,但视网膜外层仍然受到不可逆的损伤,视网膜的功能显著降低。