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1.
巨细胞病毒性视网膜炎   总被引:3,自引:0,他引:3  
巨细胞病毒(cytomegalovirus,CMV)性视网膜炎是人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染/获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS,艾滋病)患者最常见的眼部机会性感染,是HIV相关性眼病引起视力丧失的最主要原因,多发生于CD4^ T淋巴细胞计数<50/mm^3的患者。本文就CMV视网膜夹的发病情况、临床特点、并发症、鉴别诊断和治疗的研究进展进行综述。  相似文献   

2.
目的:研究基线时人免疫缺陷病毒(HIV)感染者/艾滋病(AIDS)患者的临床特点,为预防和控制艾滋病机会性感染提供依据。方法采集2013年1月至2014年1月在首都医科大学附属北京佑安医院感染中心随访并初次接受艾滋病抗逆转录病毒(ART)治疗的成年HIV/AIDS患者的基线资料并分析其临床特点。结果本研究共纳入1094例HIV/AIDS患者,其中男性1012例,女性82例,以30~44岁者居多,以性传播途径为主,主要临床表现为发热、咳嗽咳痰、乏力、消瘦等,其中呼吸系统机会性感染发生率达53.3%,其次为消化系统机会性感染(28.9%)。肺部感染、PCP、口腔真菌感染、带状疱疹、CMV视网膜炎和淋巴瘤的发生率在CD4<200个/μl组显著高于CD4≥200个/μl组,差异均有统计学意义(P<0.05)。结论艾滋病的临床表现复杂多样,机会性感染以呼吸系统最为常见,CD4细胞水平与机会性感染的发生密切相关。密切观察HIV/AIDS患者的临床症状,定期检测CD4细胞,有利于早期预防和控制机会性感染,提高HIV/AIDS患者的生活质量。  相似文献   

3.
目的:探讨我院HIV/AIDS患者住院的原因,机会性感染的疾病谱及机会性感染发生与CD4+T淋巴细胞的关系。方法:收集2005年1月2013年8月在我院住院的109例次HIV/AIDS病人,就其临床及实验室资料进行回顾性分析。结果:109例次HIV/AIDS住院患者,因服用抗病毒药物出现严重副反应而住院15例次;因机会性感染而住院83例次。机会性感染以消化系统和呼吸系统的疾病为主,前三位机会性感染为细菌性呼吸系统感染30例次、念珠菌感染28例次、结核菌感染15例次;机会性感染的发生和CD4+T淋巴细胞计数有密切关系;细菌、念珠菌、结核菌在CD4+T淋巴细胞的每个区段都可发生,但CD4T淋巴细胞越低,念珠菌感染越高且重,有时波及胃、肠、皮肤和四肢,而结核菌感染则症状不典型,伴有全身或纵膈淋巴结肿大。PCP仅在CD4+T淋巴细胞<200个/mm3发生。CD4+T淋巴细胞在3502013年8月在我院住院的109例次HIV/AIDS病人,就其临床及实验室资料进行回顾性分析。结果:109例次HIV/AIDS住院患者,因服用抗病毒药物出现严重副反应而住院15例次;因机会性感染而住院83例次。机会性感染以消化系统和呼吸系统的疾病为主,前三位机会性感染为细菌性呼吸系统感染30例次、念珠菌感染28例次、结核菌感染15例次;机会性感染的发生和CD4+T淋巴细胞计数有密切关系;细菌、念珠菌、结核菌在CD4+T淋巴细胞的每个区段都可发生,但CD4T淋巴细胞越低,念珠菌感染越高且重,有时波及胃、肠、皮肤和四肢,而结核菌感染则症状不典型,伴有全身或纵膈淋巴结肿大。PCP仅在CD4+T淋巴细胞<200个/mm3发生。CD4+T淋巴细胞在350500个/mm3之间有机会性感染出现。结论:机会性感染和抗病毒药物副反应是患者就医住院的主要原因;CD4+T淋巴细胞<500个/mm3即应启动抗病毒治疗。  相似文献   

4.
目的探讨HIV/AIDS患者长期高效抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)后眼底动脉硬化情况及影响因素。方法收集2020年1月—2022年6月南宁市第四人民医院收治的203例HIV/AIDS患者HAART前后临床基本资料和眼底检查资料,评估患者眼底动脉硬化发生情况,并对其影响因素进行分析。结果203例HIV/AIDS患者出现眼底动脉硬化159例,发生率为78.33%,其中Ⅰ级33例(20.75%)、Ⅱ级87例(54.72%)、Ⅲ级28例(17.61%)、Ⅳ级11例(6.92%);HAART前,眼底动脉硬化组及正常组患者CD4^(+)T淋巴细胞计数、CD8^(+)T淋巴细胞计数、病毒载量、白细胞计数、血小板计数、血红蛋白、血肌酐、血尿素氮、三酰甘油、总胆固醇、空腹血糖、谷丙转氨酶、谷草转氨酶及血清总胆红素两组间比较差异无统计学意义(P>0.05);在HAART 6个月后,动脉硬化组CD8^(+)T淋巴细胞计数、甘油三酯、空腹血糖值显著高于正常组,两者比较差异有统计学意义(P<0.05);在HAART 6个月后CD4^(+)、CD8^(+)淋巴细胞计数分层比较中,动脉硬化组CD4^(+)淋巴细胞计数(CD4^(+))<200个/μL患者比例显著高于正常组患者,CD4^(+)淋巴细胞计数CD4^(+)≥500个/μL患者比例显著低于正常组患者;而CD8^(+)淋巴细胞计数CD8^(+)≥800个/μL患者比例显著大于正常组(P均<0.05)。二元Logistic回归分析结果显示,机会性感染、HIV病程、HAART后CD4^(+)T、CD8^(+)T淋巴细胞计数及三酰甘油是影响HIV/AIDS患者发生眼底动脉硬化独立危险因素(P<0.05)。结论HIV/AIDS患者眼底动脉硬化发生率高,>4年HIV病程、合并机会性感染、HAART 6个月后较低的CD4^(+)T淋巴细胞计数,较高的CD8^(+)T淋巴细胞计数和三酰甘油值是患者发生眼底动脉硬化的独立危险因素。应对此类人群在HAART前后均需进行眼底筛查,针对心血管疾病风险,制定HAART方案,并在治疗过程中加强心血管疾病风险管理改善患者结局。  相似文献   

5.
艾滋病是由人免疫缺陷病毒(human immunodeficiency virus,HIV)引起的慢性传染病,简称获得性免疫缺陷综合征(acquired immune deficiency syndrome,AIDS)。本病主要经性接触、血液及母婴传播。HIV感染宿主免疫细胞后直接使CD4+T细胞破坏。从初始感染HIV到终末期,往往经历较为漫长的过程,当出现严重的机会性感染或机会性肿瘤阶段即进入AIDS发病期。机会性感染包括了细菌、真菌、病毒、原体等多种病原体,波及全身多个系统。外周血CD4+T淋巴细胞的水平可反应患者机体的细胞免疫状况,CD4+T细胞计数越低,表明机体免疫水平越低,发生机会性感染的可能性越大。当前最有效的预防机会性感染发生的方法仍是高效抗反转录病毒治疗(highly active antiretroviral therapy,HAART)。  相似文献   

6.
目的 分析人类免疫缺陷病毒(human immunodeficiency virus,HIV)/获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者视网膜炎发生的临床特征及治疗后反应.方法 收集2015-2017年在重庆市公共卫生医疗救治中心住院的193例HIV/AIDS合并视网膜炎的患者,男性156例,女性37例,年龄(43.9±11.9)岁;分为巨细胞病毒视网膜炎(cytomegalovirus retinitis,CMV R)组和HIV微血管病(HIV microangiopathy,HIV M)组,对其临床资料、检测指标、眼科检查结果及抗病毒治疗效果进行回顾性分析.结果 HIV/AIDS合并有视网膜炎的患者,CD4+T细胞计数明显低于非视网膜患者,而HIV RNA显著高于非视网膜患者(t=5.6、-2.3,P<0.05).HIV M和CMV R无眼科症状的患者分别占44.4%、41.7%;CMV R以双眼病变为主,占77.4%;视网膜炎的总发生率为45.7%,并随着CD4+T细胞的降低逐渐增高,CD4+T细胞<200个/μL时视网膜炎的发生率为30%,CD4+T细胞< 50个/μL时视网膜炎发生率最高,达58.6%.人巨细胞病毒DNA(human cytomegalovirus DNA,HCMV DNA)阳性的视网膜炎患者给予抗巨细胞病毒治疗后HCMV DNA转阴率在70%以上;CMV R视力恢复及病灶吸收率明显高于HIV M患者(x2=9.526、24.206,P<0.05).结论 HIV/AIDS患者发生视网膜炎的风险与CD4+T细胞水平密切相关,呈负相关性;对于CD4+T细胞<200个/μL的患者推荐行眼科相关检查,对于CD4+T细胞<50个/μL的患者建议常规开展眼科相关检查;全身抗巨细胞病毒治疗可有效控制病毒,改善眼部症状,提高生活质量.  相似文献   

7.
目的 通过分析HIV/AIDS患者皮肤黏膜表现的种类、严重程度及其与CD4 +T淋巴细胞计数的关系,评估皮肤黏膜病变预测、评价患者免疫状态的可行性. 方法 对345 例首诊确诊HIV/AIDS患者的临床资料进行回顾性研究,其中192例患者出现皮肤黏膜表现,153例无皮肤黏膜表现. 记录患者的CD4 +T淋巴细胞计数,观察HIV感染人群中各种皮肤病的发生率并分析皮肤病的种类、严重程度与患者免疫功能的相关性. 结果 HIV 阳性患者的皮肤病发生率为55.65%(192/345),皮肤黏膜损害的原因复杂,以真菌、病毒感染为主,分别为43.77%(151/345)、11.59%(40/345),其中以口腔念珠菌病发生率最高,达36.23%(125/345) ,其他包括马尔尼菲霉病、梅毒、单纯疱疹、颈部淋巴结核等都有较高的发生率. 无皮肤黏膜表现、出现1种和2种以上皮肤黏膜改变的CD4 +T淋巴细胞计数分别为(247 ±119)个/μl、(84 ±59)个/μl、(36 ±23)个/μl,差异均有统计学意义( P<0.05). 结论 HIV/AIDS患者皮肤黏膜表现多样,感染者免疫功能越差,越易并发皮肤黏膜疾病,某些皮肤黏膜表现可作为预测和评估HIV感染者免疫状态的临床指标.  相似文献   

8.
人类免疫缺陷病毒(HIV)感染合并结核病41例临床分析   总被引:1,自引:0,他引:1  
目的 探讨人类免疫缺陷病毒(HIV)感染合并结核病的临床表现.方法对41例人类免疫缺陷病毒(HIV)感染合并结核病的患者进行分析.结果 静脉吸毒和性乱是HIV的主要感染途径.发热、诮瘦是HIV/MDS合并结核病最常见的临床表现.HIV/AIDS合并结核病患者的临床特点有:易合并除结核感染外的其它机会性感染,PPD试验阳性率低,CD 4细胞计数低,病死率南.HIV/AIDS合并肺结核患者的痰菌阳性率低,X线胸片病灶不典型.结论 临床医师应高度重视HIV感粢在我国流行的现况,对结核病患者应检测HIV抗体.  相似文献   

9.
艾滋病又称获得性免疫缺陷综合征(AIDS),是由人类免疫缺陷病毒(HIV)引起,以侵犯CD4+T淋巴细胞为主要特征的疾病。结核病(TB)是AIDS患者最常见的机会性感染,而我国又是结核病高疫情国家,随着HIV/AIDS患者的病情进展,AIDS合并TB已明显影响了患者的生活质量,所以对其治疗更是不容忽视。  相似文献   

10.
目的调查HIV/AIDS患者巨细胞病毒(CMV)感染情况,比较不同标本(血液、尿液)在HIV合并CMV感染早期筛查的应用价值,分析HIV合并CMV感染的影响因素。方法收集2018年1月—2020年12月南宁市第四人民医院诊治的848例HIV/AIDS患者的性别、年龄、CD4^(^(+))T细胞计数、抗逆转录病毒治疗(ART)等资料信息,采用荧光PCR(FQ-PCR)检测血液/尿液CMV-DNA载量。采用卡方检验、Fisher确切概率法分析感染的差异,以二项Logistic回归分析HIV合并CMV感染的危险因素。结果848例HIV/AIDS患者中,有205例(24.17%)CMV-DNA阳性。尿液CMV-DNA检出率20.03%(142/709)高于血液CMV-DNA检出率12.04%(102/847)。多因素二项Logistic回归分析显示男性合并CMV感染的危险是女性2.30倍(95%CI:1.43~3.71),年龄30~<50岁和≥50岁合并CMV感染危险是年龄<30岁的2.43和2.32倍(95%CI分别为:1.20~4.91,1.15~4.65)、CD4^(+)T<50个/μL合并CMV感染的危险是CD4^(+)T≥100个/μL的3.88倍(95%CI:2.50~6.03),ART治疗患者合并CMV感染的危险比非ART治疗下降89%(OR=0.11,95%CI:0.05~0.24)。结论尿液在CMV感染的早期筛查比血液准确度更高,应重视CD4^(+)T计数较低、中年以上男性,加强其CMV感染的早期筛查和抗病毒治疗。  相似文献   

11.
卢祥婵 《广西医学》2012,34(1):20-23
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的临床特点及其与CD4+T细胞计数关系.方法 对449例HIV/AIDS病人进行间接检眼镜检查,并对其中合并巨细胞病毒性视网膜炎73例患者的临床表现、眼底改变及CD4+T细胞计数进行分析.结果 449例HIV/AIDS病人中检出巨细胞病毒性视网膜炎73例,检出率为16.26%,其中单眼受累28例,双眼受累45例;有视力改变61例,占83.56%.眼底表现为沿血管分布的黄白色病理改变,伴有片状出血,很少累及玻璃体.449例患者中CD4+T细胞计数≤50个/μl的患者巨细胞病毒性视网膜炎检出率为19.74%(45/228),明显高于CD4+T细胞计数>50个/μl患者的12.67%(28/221)(P<0.05).结论 巨细胞病毒性视网膜炎多发生于AIDS晚期患者,多数患者视力未发生改变时,其眼底早就发生病变,对CD4+T细胞低下而眼部无症状的AIDS患者应常规行眼底镜检查,对于改善巨细胞病毒性视网膜炎的预后有重要意义.  相似文献   

12.

目的  探讨抗巨细胞病毒(CMV)治疗对获得性免疫缺陷综合征(简称艾滋病)合并CMV血症患者的外周血凋亡相关因子水平的影响。方法  选取2014年1月1日~12月31日中国医科大学附属第一医院确诊住院的外周血CMVIgG阳性的男性艾滋病患者(CD4+ T<200个/μl)共34例(排除合并CMV视网膜炎者)。非随机对照分为3组,阴性CMV血症组(n =11)、阳性CMV血症非抗CMV组(n =11)、阳性CMV血症抗CMV组(n =12)。同时设立性别、年龄匹配的12例健康人做对照。同时全部入组患者于第3周末接受高效抗逆转录病毒治疗。在随访12月末时,评价各组CD4+T细胞计数、CMV视网膜炎的发生率;评价外周血凋亡相关因子浓度的变化及组间差异。结果  与健康对照比较,艾滋病患者Fas、FasL、TRAIL、TNF-α水平升高(t =-3.369、-2.683、-4.321和-5.321,P =0.012、0.033、0.009和0.003),而Bcl-2水平降低(t =-4.321,P =0.001)。基线时3组年龄、HIVRNA载量、CD4+T细胞计数、WHO临床分期差异无统计学意义;非抗CMV组与抗CMV组CMVDNA载量差异无统计学意义。与非抗CMV组比较,抗CMV组与阴性CMV血症组12个月时CD4+T细胞计数升高(F =4.260,P =0.013和0.020);外周血Bcl-2(F =3.621,P =0.009和0.006)、FasL(F =2.891,P = 0.024和0.002)、TNF-α浓度降低(F =4.912,P =0.003和0.001);而抗CMV组与阴性CMV血症组组间未见差异。与基线水平比较,艾滋病患者随访12个月时Fas、FasL和TRAIL水平下降(t =2.579、2.194和2.274,P =0.015、0.035和0.030)。观察期内无CMV视网膜炎发生,无死亡病例,无HIV病毒学反弹发生。结论  抗CMV治疗促进艾滋病合并CMV血症患者的CD4+T细胞计数增长,这可能与外周血Bcl-2、FasL和TNF-α浓度降低有关。此外,高效抗逆转录病毒治疗本身也可以降低Fas、FasL和TRAIL水平。

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13.
目的:探讨HIV/AIDS患者机体氧化还原态与CD4细胞计数的相关性。方法:采用流式细胞仪检测CD4+和CD8+计数,计算CD4+/CD8+比值。将患者分为AIDS组(54例)和HIV感染组(26例),正常体检者为对照组(30例)。取静脉血,测血还原型谷胱甘肽(GSH)与氧化型谷胱甘肽(GSSG),NADPH与NADP+,以GSH/GSSG、NADPH/NADP+比值表示患者机体氧化还原态,分析氧化还原态与CD4细胞计数的相关性。结果:HIV/AIDS患者血CD4细胞计数及CD4+/CD8+比值均随机体氧化还原态向氧化方向偏移而减少。结论:AIDS/HIV患者机体氧化还原态越向氧化方向偏移,标志着AIDS患者病情进展。  相似文献   

14.
Background  Cytomegalovirus (CMV) retinitis is the most severe intraocular complication that results in total retinal destruction and loss of visual acuity in patients with acquired immunodeficiency syndrome (AIDS). This study aimed to investigate the fundus characteristics, systemic manifestations and therapeutic outcomes of CMV retinitis associated with AIDS.
Methods  It was a retrospective case series. CMV retinitis was present in 39 eyes (25 patients). Best corrected visual acuities, anterior segment, fundus features, fundus fluorescence angiography (FFA) and CD4+ T-lymphocyte counts of the patients with CMV retinitis associated with AIDS were analyzed. Intravitreal injections of ganciclovir (400 µg) were performed in 4 eyes (2 patients).
Results  Retinal vasculitis, dense, full-thickness, yellow-white lesions along vascular distribution with irregular granules at the border, and hemorrhage on the retinal surface were present in 28 eyes. The vitreous was clear or mildly opaque. Late stage of the retinopathy was demonstrated in 8 eyes characterized as atrophic retina, sclerotic and attenuated vessels, retinal pigment epithelium (RPE) atrophy, and optic nerve atrophy. Retinal detachment was found in 3 eyes. The average CD4+ T-lymphocyte count in peripheral blood of the patients with CMV retinitis was (30.6±25.3) ×106/L (range, (0–85) ×106/L). After intravitreal injections of ganciclovir, visual acuity was improved and fundus lesions regressed.
Conclusions  CMV retinitis is the most severe and the most common intraocular complication in patients with AIDS. For the patients with yellow-white retinal lesions, hemorrhage and retinal vasculitis without clear cause, human immunodeficiency virus (HIV) serology should be performed. Routine eye examination is also indicated in HIV positive patients.
  相似文献   

15.
Background Elevated levels of interleukin-7 (IL-7) have been correlated with CD4(+) T cell depletion and the emergence of syncytium-inducing (SI) variants in human immunodeficiency virus type-1 (HIV-1) infection, and suggested as an indicator of acquired immunodeficiency syndrome (AIDS) disease progression. Therefore, we investigated the effects of IL-7 on disease progression and virus phenotype in Chinese HIV/AIDS patients. Methods In a cross-sectional study of 71 untreated HIV-1 seropositive individuals and 12 healthy donors, plasma IL-7 levels were determined by an ultra sensitive enzyme-linked immunosorbent assay (ELISA), and its relations to CD4(+) T cells, CD8(+) T cells, plasma viral loads and HIV phenotypes were analyzed. Results Significant higher IL-7 levels were found in Chinese HIV/AIDS patients [(3.33 ± 3.60) pg/ml] than those of health controls [(1.2 ± 0.81) pg/ml] ( P &lt;0.05), and IL-7 levels were inversely associated with CD4(+) T cell counts ( r = - 0.497, P &lt;0.01). Furthermore, IL-7 levels were significant higher in patients with SI variants [(9.12 ± 4.55) pg/ml] than those with non-syncytium-inducing variants [(1.50 ± 2.69) pg/ml] ( P &lt;0.01). Conclusions Increased IL-7 levels were found in Chinese HIV/AIDS patients and significantly associated with disease progression, thus increased IL-7 plasma levels may indicate disease progression.  相似文献   

16.
A Kovacs  T Frederick  J Church  A Eller  M Oxtoby  L Mascola 《JAMA》1991,265(13):1698-1703
The relationship between CD4 T-lymphocyte counts and infection with the human immunodeficiency virus (HIV) is retrospectively investigated for 266 HIV-infected and uninfected children who were born to infected women, including 39 with Pneumocystis carinii pneumonia (PCP), in a population-based surveillance study. Of 21 perinatally HIV-infected children with PCP only 10 (48%) had CD4 T-lymphocyte counts that were less than 500 x 10(6) cells/L (500 cells/mm3), compared with all 18 who were infected via blood transfusions or clotting factors. Among 68 children who were 1 year or younger, 18 (90%) of 20 PCP cases had CD4 T-lymphocyte counts that were less than 1500 x 10(6) cells/L (1500 cells/mm3) compared with only five (10%) of 48 children who did not have the acquired immunodeficiency syndrome (odds ratio, 77.4; 95% confidence interval, 19.7 to 313.4). The mean CD4 T-lymphocyte count was lower for the 39 PCP cases when compared with the 188 children who were at different stages of HIV infection and did not have the acquired immunodeficiency syndrome (AIDS) independent of age. The majority of perinatally HIV-infected children with PCP were 6 months or younger and 50% were previously unknown to be infected. Thus, HIV-positive children should be identified early and followed closely. CD4 T-lymphocyte counts may be useful in monitoring HIV-positive children and determining when to begin PCP prophylaxis.  相似文献   

17.

Background

Most studies on the ocular manifestations of human immunodeficiency virus (HIV) infection are on cases of acquired immunodeficiency syndrome (AIDS), not including asymptomatic carriers of HIV. With this background, we proceeded to study all the HIV-infected individuals attending our centre, with the aim:a. To study the ocular manifestations of HIV.b. To correlate those manifestations with the CD4+ T-lymphocyte counts.c. To compare our findings with other studies.

Method

A cross-sectional study involving a detailed ocular examination of 321 cases of HIV/AIDS was done. Automated perimetry, digital fundus photography and fundus fluorescein angiography were done for relevant cases. The last 125 cases were subjected to Schirmer's test and tear film break-up time.

Results

We studied 321 male HIV cases (642 eyes), with a mean age of 36.78 years, mean CD4+ count of 276.54 cells/μL, 78.82% of them being on anti-retroviral therapy. Ocular manifestations were seen in 87 out of 321 cases, 72.41% of them being asymptomatic carriers of HIV. The ocular findings seen were conjunctival microvasculopathy, molluscum contagio-sum, dry eye, neuro-ophthalmic manifestations, anterior uveitis, posterior uveitis, and HIV retinopathy, only the last three of which had a significant association with CD4+ counts. The overall prevalence of ocular lesions also had a significant association with CD4+ counts.

Conclusion

Ocular manifestations are common in asymptomatic carriers of HIV. Anterior uveitis, posterior uveitis and HIV retinopathy have a significant association with CD4+ counts and are reliable indicators of low CD4+ count.  相似文献   

18.
Chinese medicine(CM) has been used in the treatment of human immunodeficiency virus(HIV) infection and acquired immunodeficiency syndrome (AIDS) for 30 years and the demonstrated therapeutic effects of CM,such as reducing plasma HIV viral load,increasing CD4~+T cell counts,promoting immunity reconstitution,ameliorating symptoms and signs,improving the health related quality of life(HRQOL) and counteracting against the effects of anti-retroviral drugs,were summarized and reviewed in this article.The authors point out that it had been a good opportunity to use CM for the treatment of HIV infection and AIDS in the past and also there are huge challenges ahead for CM research and clinicians to discover more effective CM and its underlying mechanisms for treatment of AIDS.  相似文献   

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