193例HIV/AIDS合并视网膜炎的临床特征分析

谭顺; 姜学松; 黄正谷; 苏世芳

doi:10.16016/j.1000-5404.201710030

您当前的位置：

首页 >

文章列表页 >

193例HIV/AIDS合并视网膜炎的临床特征分析

临床医学 | 更新时间：2026-01-09

- 193例HIV/AIDS合并视网膜炎的临床特征分析
- Clinical characteristics of HIV/AIDS coinfection with retinitis: repot of 193 cases
- 第三军医大学学报 2018年40卷第6期页码：513-518
- 作者机构：
  
  400036 重庆，重庆市公共卫生医疗救治中心
- 作者简介：
  
  [ 苏世芳，E-mail：243370143@qq.com SU Shifang, E-mail:243370143@qq.com
- 基金信息：
  
  重庆市卫计委医学科研计划项目(20143009)
- DOI：10.16016/j.1000-5404.201710030
  中图分类号： R195.4; R512.91; R774.11
- 收稿：2017-10-10，
  
  修回：2017-12-20，
  
  纸质出版：2018-03-30
- 稿件说明：
移动端阅览
谭顺, 姜学松, 黄正谷, 等. 193例HIV/AIDS合并视网膜炎的临床特征分析[J]. 第三军医大学学报, 2018,40(6):513-518.

Shun TAN, Xuesong JIANG, Zhenggu HUANG, et al. Clinical characteristics of HIV/AIDS coinfection with retinitis: repot of 193 cases[J]. Journal of Third Military Medical University, 2018, 40(6): 513-518.
谭顺, 姜学松, 黄正谷, 等. 193例HIV/AIDS合并视网膜炎的临床特征分析[J]. 第三军医大学学报, 2018,40(6):513-518. DOI： 10.16016/j.1000-5404.201710030.

Shun TAN, Xuesong JIANG, Zhenggu HUANG, et al. Clinical characteristics of HIV/AIDS coinfection with retinitis: repot of 193 cases[J]. Journal of Third Military Medical University, 2018, 40(6): 513-518. DOI： 10.16016/j.1000-5404.201710030.

摘要

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(

=5.6、-2.3，

＜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(χ

=9.526、24.206，

＜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。

Abstract

Objective

To investigate the clinical characteristics of retinitis in hospitalized HIV/AIDS patients and explore their therapeutic reactions.

Methods

Totally 193 retinitis patients who suffered from human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and were admitted in our center from 2015 to 2017 were subjected in this study. They were 156 males and 37 females

at an average age of 43.9±11.9 years. They were divided into cytomegalovirus retinitis group and HIV microangiopathy group. Their clinical data

laboratory indexes

results of ophthalmological examination and efficacies of antiviral treatment were retrospectively collected and analyzed.

Results

The CD4

T cell counts in the HIV/AIDS patients with retinitis were significantly lower than those without retinitis

but the former patients had significantly higher HIV RNA level than the latter (

=5.6

-2.3

＜0.05). There were 44.4% and 41.7% patients having no eye problem

respectively in the HIV microangiopathy and cytomegalovirus retinitis groups. While

those with cytomegalovirus retinitis mainly represented as impairment of both eyes

accounting for 77.4%. The total incidence of retinitis was 45.7% and elevated with the decrease of CD4

T cell count. The peak incidence was 58.6% when the CD4

T cell count was＜50/μL. Over 70% retinitis patients positive to human cytomegalovirus-DNA turned into negative after antiviral therapy. The patients with cytomegalovirus retinitis obtained better visual recovery and absorption than those of HIV microangiopathy (

Chi

-square=9.526

24.206

＜0.05).

Conclusion

The risk of retinitis in HIV/AIDS hospitalized patients is closely associated with CD4

T cells

in A negative correlation. For those with CD4

T cell count＜200/μL

ophthalmic examinations are needed

while those＜50/μL

regular examination are recommended. Systematic antiviral therapy is effective in controlling virus infection

improving ophthalmic symptoms

and promoting quality of life.

关键词

Keywords

references

中华医学会感染病学分会艾滋病学组, Association Chinese Medical.艾滋病诊疗指南第三版(2015版)[J].中华临床感染病杂志, 2015, 8(5): 385-401. DOI: 10.3760/cma.j.issn. 1674-2397.2015.05.001.

AIDS Group of Society of Infectious Diseases, Chinese Medical Association.Third edition of the guidelines for diagnosis and treatment of HIV/AIDS (2015)[J]. Chin J Clin Infect Dis, 2015, 8(5): 385-401. DOI: 10.3760/cma.j.issn. 1674-2397.2015.05.001.

李凤鸣, 谢立信.中华眼科学(眼科全书)[M]. 3版.北京:人民卫生出版社, 2014: 2197-2408.

LI F M, XIE L X.Chinese Ophthalmology (Ophthalmology)[M]. 3rd ed, Beijing: People's Medical Publishing House, 2014: 2197-2408.

HEIDEN D, SARANCHUK P, TUN N, et al . We urge WHO to act on cytomegalovirus retinitis[J ] . Lancet Glob Health, 2014, 2(2): e76-e77. DOI: 10.1016/S2214-109X(13)70174-8.

叶俊杰, 李海燕, 孙鼎, 等.获得性免疫缺陷综合征并发巨细胞病毒性视网膜炎的临床分析[J].中华眼科杂志, 2005, 41(9): 803-806. DOI: 10.3760/j:issn: 0412-4081.2005.09.008.

YE J J, LI H Y, SUN D, et al . Cytomegalovirus retinitis associated with acquired immunodeficiency syndrome[J ] . Chin J Ophthalmol, 2005, 41(9): 803-806. DOI: 10.3760/j:issn:0412-4081.2005.09.008.

谭顺, 刘奉凤, 刘敏, 等.重庆市1978例初始接受抗逆转录病毒治疗HIV感染者的回顾性分析[J].第三军医大学学报, 2016, 38(19): 2190-2194. DOI: 10.16016/j.1000-5404.201602108.

TAN S, LIU F F, LIU M, et al . A retrospective analysis of hiv-infected patients receiving initial antiretroviral therapy: Report of 1 978 cases from Chongqing region[J ] . J Third Mil Med Univ, 2016, 38(19): 2190-2194. DOI: 10.16016/j.1000-5404.201602108.

肖江, 何宏宇, 韩宁, 等.艾滋病患者眼科临床特点分析[J].北京医学, 2011, 33(6): 470-473.

XIAO J, HE H Y, HAN N, et al . The clinical features of ocular manifestations in hiv/aids[J ] . Beijing Med J, 2011, 33(6): 470-473.

黄齐.艾滋病合并巨细胞病毒性视网膜炎的护理干预[J].临床医学工程, 2016, 23(4): 533-534. DOI: 10.3969/j.issn. 1674-4659.2016.04.0533.

HUANG Q. Nursing intervention for aids patients complicating cytomegalovirus retinitis[J]. Clinl Med Engin, 2016, 23(4): 533-534. DOI: 10.3969/j.issn. 1674-4659.2016.04.0533.

耿爽, 叶俊杰, 刘丽秋, 等.人类免疫缺陷病毒感染及获得性免疫缺陷综合征患者眼部病变的诊断与治疗[J].中华眼科杂志, 2009, 45(12) : 1093-1098. DOI: 10.3760/cma.j.issn.0412-4081.2009.12.009.

GENG S, YE J J, LIU L Q, et al .Diagnosis and treatment of eye diseases associated with HIV infection and AIDS[J ] . Chin J Ophthalmol, 2009, 45(12): 1093-1098. DOI: 10.3760/cma.j.issn.0412-4081.2009.12.009.

陆慧红, 卢洪洲, 范先群.艾滋病患者机会性感染巨细胞病毒视网膜炎研究进展[J].中国实用眼科杂志, 2012, 30(6): 646-650. DOI: 10.3760/cma.j.issn.1006-4443.2012.06. 003.

LU H H, LU H Z, FAN X Q. Progress in the study of opportunistic cytomegalovirus retinopathy in AIDS patients[J]. Chin J Pract Ophthalmol, 2012, 30(6): 646-650. DOI: 10.3760/cma.j.issn.1006-4443.2012.06. 003.

BOWEN E F, SABIN C A, WILSON P, et al . Cytomegalovirus (CMV) viraemia detected by polymerase chain reaction identifies a group of HIV-positive patients at high risk of CMV disease[J ] . AIDS, 1997, 11(7): 889-893. DOI: 10.1097/00002030-199707000-00008.

杨娅玲, 江睿, 何太雯, 等.获得性免疫缺陷综合征合并巨细胞病毒视网膜炎80例患者的临床特点[J].中华眼科杂志, 2014, 50(3): 197-202. DOI: 10.3760/cma.j.issn.0412-4081.2014.03.009.

YANG Y L, JIANG R, HE T W, et al . Clinical characteristic and treatment of cytomegalovirus retinitis in 80 patients with acquired immunodeficiency syndrome[J ] . Chin J Ophthalmol, 2014, 50(3): 197-202. DOI: 10.3760/cma.j.issn.0412-4081.2014.03.009.

孙挥宇, 毛菲菲, 李丹, 等.艾滋病合并巨细胞病毒性视网膜炎19例[J].眼科,2010, 19(6): 376-379.

SUN H Y, MAO F F, LI D, et al . The clinical characteristics of cytomegaloviral retinitis in 19 cases with AIDS[J ] . Ophthalmol China, 2010, 19(6): 376-379.

DUJIĆ M, JEVTOVIĆ D J, SALEMOVIĆ D, et al . The prognosis of CMV retinitis among patients with AIDS in Serbia[J ] . Biomed Pharmacother, 2008, 62(7): 443-447. DOI: 10.1016/j.biopha.2007.12.011.

KEMPEN J H, JABS D A, WILSON L A, et al . Incidence of cytomegalovirus (CMV) retinitis in second eyes of patients with the acquired immune deficiency syndrome and unilateral CMV retinitis[J ] . Am J Ophthalmol, 2005, 139(6): 1028-1034. DOI: 10.1016/j.a jo.2005.01.005.

JIANG H, XIE N, CAO B, et al . Determinants of progression to AIDS and death following HIV diagnosis: a retrospective cohort study in Wuhan, China[J ] . PLoS ONE, 2013, 8(12): e83078. DOI: 10.1371/journal.pone.0083078.

Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord, LEWDEN C, BOUTELOUP V, et al . All-cause mortality in treated HIV-infected adults with CD4 ≥500/mm 3 compared with the general population: evidence from a largeEuropean observational cohort collaboration[J ] . Int J Epidemiol, 2012, 41(2): 433-445. DOI: 10.1093/ije/dyr164..

MONGE S, JARRíN I, PéREZ-HOYOS S, et al . Educational level and HIV disease progression before and after the introduction of HAART: a cohort study in 989 HIV seroconverters in Spain[J ] . Sex Transm Infect, 2011, 87(7): 571-576. DOI: 10.1136/sextrans-2011-050125.

ZHANG F, DOU Z, YU L, et al . The effect of highly active antiretroviral therapy on mortality among HIV-infected former plasma donors in China[J ] . Clin Infect Dis, 2008, 47(6): 825-833. DOI: 10.1086/590945.

李丹, 孙挥宇, 毛菲菲, 等.获得性免疫缺陷综合征患者巨细胞病毒性视网膜炎相关免疫重建炎症综合征的临床观察[J].中华实验和临床感染病杂志(电子版), 2014, 8(3): 363-367. DOI: 10.3877/cma.j.issn.1674-1358.2014.03.015.

LI D, SUN H Y, MAO F F, et al . Clinical observation of immune reconstitution inlfammatory syndrome associated with cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome[J ] . Chin J Exp Clin Infect Dis(Electr Version), 2014, 8(3): 363-367. DOI: 10.3877/cma.j.issn.1674-1358.2014.03.015.

梁均和, 陈安妮, 关毅荣, 等. HIV/AIDS患者外周血CD4 + T淋巴细胞水平与巨细胞病毒感染相关性分析[J ] .皮肤性病诊疗学杂志, 2015, 22(1): 18-20. DOI: 10.3969/j.issn.1674-8468.2015.01.006.

LIANG J H, CHEN A N, GUAN Y R, et al . The correlation analysis of CD4 + T lymphocyte level and cytomegalovirus infection in the peripheral blood cells of AIDS patients[J ] . J Diag Therap Dermato-venereol, 2015, 22(1): 18-20. DOI: 10.3969/j.issn.1674-8468.2015.01.006..

何清, 孔双艳, 许诚, 等.膦甲酸钠与更昔洛韦比较治疗艾滋病相关巨细胞病毒视网膜炎疗效与安全性的系统评价[J].中国循证医学杂志, 2006, 6(7): 507-513. DOI: 10. 3969/j.issn.1672-2531.2006.07.008.

HE Q, KONG S Y, XU C, et al . The efficacy and safety of foscarnet versus ganciclovir for cytomegalovirus retinitis associated with aids[J ] . Chin J Evid-Based Med, 2006, 6(7): 507-513. DOI: 10. 3969/j.issn.1672-2531.2006.07.008.

蒋瑶祁, 徐宁, 王晓黎, 等.艾滋病合并巨细胞病毒性视网膜炎的临床研究[J].临床医学工程, 2013, 20(12): 1496-1497. DOI: 10.3969/j.issn.1674-4659.2013.12.1496.

JIANG Y Q, XU N, WANG X L, et al . Clinical research on aids patients complicated with cytomegalovirus retinitis[J ] . Clin Med Engin, 2013, 20(12): 1496-1497. DOI: 10.3969/j.issn.1674-4659.2013.12.1496.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

暂无数据