摘要:
目的 探讨人类免疫缺陷病毒感染(HIV)和获得性免疫缺陷综合征(AIDS)患者眼部并发症的临床类型,分析视力损害的主要原因,为防治视力损伤提供依据.方法 回顾性分析247例HIV/AIDS患者眼部并发症的临床特点和致盲原因;所有患者常规进行视力、眼压、裂隙灯检查、散瞳眼底检查,眼底病患者行眼底照相或眼底荧光血管造影(FFA);实验室检测外周血CD4+T淋巴细胞计数,<200/mm3者行血/尿液巨细胞病毒载量(CMV-DNA)检测.结果 247例HIV/AIDS患者中,有眼部并发症者200例(81.0%),共310眼,其中巨细胞病毒性视网膜炎(CMVR)的发病率最高[35%(70/200)],其次是角膜炎[12%(24/200)]、干眼[10.5%(21/200)]等.有13.2%(41/310)眼为盲眼,主要由CMVR引起;绝大多数CMVR患者(65例,92.9%)CD4+T淋巴细胞计数<100/mm3,病情在CD4+T淋巴细胞计数<50/mm3时高发[77.1%(54/70)].结论 充分认识HIV/AIDS眼部并发症的临床特点可提高诊断率;CMVR是AIDS晚期导致视力丧失的主要原因,建议加快建立健全CMVR筛查机制,早发现,早治疗,降低致盲率,提高患者生存质量.%Objective To investigate the clinical types of ocular complications in patients with human immunodeficiency virus infection (HIV)and acquired immunodeficiency syndrome (AIDS),and analyze the main causes of visual impairment,so as to provide evidence for prevention and treatment of visual impairment. Methods The clinical characteristics and causes of blindness in 247 patients with HIV/ AIDS were retrospectively analyzed. Routine examinations on visual acuity,intraocular pressure, slit lamp examination and mydriasis fundus were performed in all patients. Fundus photography or fundus fluorescein angiography (FFA)were performed in patients with fundus disease. The peripheral blood CD4 + T lymphocyte count was detected in laboratory,and blood / urine cytomegalovirus load (CMV-DNA ) detection were carried out on patients with CD4 + T lymphocyte count < 200 / mm3 . Results Among 247 patients with HIV/ AIDS,200 patients (310 eyes,81%)had ocular complica-tions. The incidence of cytomegalovirus retinitis (CMVR)was the highest [35% (70 / 200)],followed by keratitis [12% (24 / 200)]and dry eye [10. 5% (21 / 200)]. And 13. 2% (41 / 310)eyes were blind,which were mainly caused by CMVR [58. 5% (24 / 41)]. In most of CMVR patients (65 cases, 92. 9%),CD4 + T lymphocyte counts were lower than 100 / mm3 ,and the disease get high incidence [77. 1% (54 / 70]when CD4 + T lymphocyte count < 50 / mm3 . Conclusions Sufficient understanding of complications of HIV/ AIDS will lead to better treatment. CMVR is the main reason of blindness for pa-tient with advanced AIDS. Therefore,it is suggested to complete CMVR test and complement treatment in early stage to avoid blindness and improve living quality for patients.