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/μL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）

Clinical analysis of 32 cases of cytomegalovirus retinitis with AIDS

Objective To investigate characteristics of cytomegalovirus retinitis and immune recovery uveitis in AIDS patients. Design Retrospective cases series. Participants 32 patients with active cytomegalovirus retinitis in Department of Ophthalmology, Beijing You＇an Hospital. Methods All 32 patients were evaluated with general and ophthalmic examinations and the clinical characteristics were analyzed. 32 patients underwent ophthalmologic examinations that included visual acuity, anterior segment, fundus examinations, fundus fluoreseein angiography （FFA） and immunology related examinations. Main Outcome Measures Vision acuity, intraocular pressure （IOP）, fundus examinations and CD4＋T cell counts. Results In all 32 patients with cytomegalovirus retinitis, visual acuity varied from light perception to 1.0; and their IOP varied from 8 to 16 mm Hg. Eight patients had anterior uveitis. All of the patients had typical cytomegalovirus retinitis. 8（25%） patients whose CD4＋T cell counts〈10 per/μL had visual acuity varying from light perception to 0.8,3 of whom had immune recovery uveitis. One of them had retinal detachment. 15 （46.88%） patients whose CD4＋T cell counts were 10-50 per/μL. Their visual acuity varied from finger counting to 0.8. One of them had immune recovery uveitis. One of them had retinal detachment. 9 （28.12%） patients had CD4＋T cell counts〉50 per/μL, none of them had retinal detachment or immune recovery uveitis. 19 patients （including 4 paients with immmune recovery uveitis） had complicated with other opportunistic infections. Conclusion The patients whose CD4＋T cell were no more than 50 per/μL were easy to have eytomegalovirus retinitis. The patients whose CD4＋T cell counts〈10 per/μL were liable to have immune recovery uveitis and other opportunistic infections.