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人类免疫缺陷病毒感染者和获得性免疫缺陷综合征患者眼部病变相关的基础与临床研究

刘小伟,  叶俊杰,  耿爽,  徐海燕,  赵家良,  闵寒毅,  马楠,  韩阳,  李太生

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文章导航 > 协和医学杂志  > 2016 >  7(1): 8-12
刘小伟, 叶俊杰, 耿爽, 徐海燕, 赵家良, 闵寒毅, 马楠, 韩阳, 李太生. 人类免疫缺陷病毒感染者和获得性免疫缺陷综合征患者眼部病变相关的基础与临床研究[J]. 协和医学杂志, 2016, 7(1): 8-12. doi: 10.3969/j.issn.1674-9081.2016.01.002
引用本文: 刘小伟, 叶俊杰, 耿爽, 徐海燕, 赵家良, 闵寒毅, 马楠, 韩阳, 李太生. 人类免疫缺陷病毒感染者和获得性免疫缺陷综合征患者眼部病变相关的基础与临床研究[J]. 协和医学杂志, 2016, 7(1): 8-12. doi: 10.3969/j.issn.1674-9081.2016.01.002
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Xiao-wei LIU, Jun-jie YE, Shuang GENG, Hai-yan XU, Jia-liang ZHAO, Han-yi MIN, Nan MA, Yang HAN, Tai-sheng LI. Basic and Clinical Research Related to Ocular Complications in Human Immunodeficiency Virus Infection/Acquired Immunodeficiency Syndrome Patients[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(1): 8-12. doi: 10.3969/j.issn.1674-9081.2016.01.002
Citation: Xiao-wei LIU, Jun-jie YE, Shuang GENG, Hai-yan XU, Jia-liang ZHAO, Han-yi MIN, Nan MA, Yang HAN, Tai-sheng LI. Basic and Clinical Research Related to Ocular Complications in Human Immunodeficiency Virus Infection/Acquired Immunodeficiency Syndrome Patients[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(1): 8-12. doi: 10.3969/j.issn.1674-9081.2016.01.002
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人类免疫缺陷病毒感染者和获得性免疫缺陷综合征患者眼部病变相关的基础与临床研究

doi: 10.3969/j.issn.1674-9081.2016.01.002
  • 1.

    中国医学科学院 北京协和医学院 北京协和医院 眼科, 北京 100730

  • 2.

    中国医学科学院 北京协和医学院 北京协和医院 感染内科, 北京 100730

详细信息
    通讯作者:

    叶俊杰 电话:010-69152731, E-mail:yejunjie@hotmail.com

  • 中图分类号: R771.3;R512.91

Basic and Clinical Research Related to Ocular Complications in Human Immunodeficiency Virus Infection/Acquired Immunodeficiency Syndrome Patients

  • 1.

    Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 2.

    Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

More Information

    摘要
  • 摘要:   目的  总结北京协和医院眼科诊治的人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染者和获得性免疫缺陷综合征(acquired immunodeficiency syndrome, AIDS)患者眼部病变的发病率及其临床特征、治疗效果和房水、泪液病毒学检测结果。  方法  回顾性分析2001年1月至2015年12月在北京协和医院眼科诊治的223例HIV/AIDS患者的眼部并发症的临床特征和治疗效果。其中男性157例, 女性66例; 平均年龄(39.2±9.7)岁(8.0~78.0岁)。对所有患者的感染方式、眼部并发症的临床表现、检查、治疗等进行回顾性分析。  结果  223例HIV/AIDS患者中, 有眼部并发症者99例(44.4%), 共156只眼, 其中并发巨细胞病毒(cytomegalovirus, CMV)视网膜炎64只眼(40例), HIV视网膜病变54只眼(35例), HIV/梅毒双重感染合并眼底病变20只眼(13例), 免疫重建炎症综合征(immune reconstitution inflammatory syndrome, IRIS)16只眼(10例), 慢性泪腺炎2只眼(1例)。CD4+T淋巴细胞计数小于50/mm3的HIV/AIDS患者泪液分泌低于正常人(P=0.008)。在行高效抗逆转录酶病毒疗法(highly active antiretroviral therapy, HAART)治疗有效且血浆HIV检测为阴性的16例HIV/AIDS患者的泪液中发现HIV-1病毒, 中位病毒载量为2291(519, 6667)拷贝/ml。  结论  在HIV/AIDS患者眼部病变中, CMV视网膜炎是AIDS晚期最常见的机会性感染, 早期发现和及时给予全身及眼部治疗, 可改善患者的视力预后。患者血液HIV检测阴性时, 房水和泪液HIV仍持续阳性, 提示防止HIV病毒播散, 采取有效的预防措施至关重要。
    Abstract:   Objective  To review the clinical features, treatment effectiveness, and aqueous humor and tear virus load results of the ocular complications in human immunodeficiency virus infection/acquired immuno-deficiency syndrome (HIV/AIDS) patients diagnosed and treated in Department of Ophthalmology in Peking Union Medical College Hospital.  Methods  We retrospectively reviewed the clinical features and treatment effectiveness of ocular complications in 223 HIV/AIDS patients in the period from January 2001 to December 2015, including 157 males and 66 females. The mean age was (39.2±9.7) (8.0-78.0) years. Their HIV exposure, clinical manifestations of ocular complications, diagnostic examinations, and treatment were reviewed.  Results  Ocular manifestations were found in 99 (44.4%, 156 eyes) of the 223 patients, including cytomegalovirus retinitis (CMVR) in 64 eyes (40 patients), HIV retinopathy in 54 eyes (35 patients), HIV and syphilis double infection with fundus disease in 20 eyes (13 patients), immune reconstitution inflammatory syndrome (IRIS) in 16 eyes (10 patients), and chronic dacryoadenitis in 2 eyes (1 patient). Tear secretion was lower in HIV/AIDS patients with CD4+T cell less than 50/mm3 than in normal people (P=0.008). HIV-1 virus was found in the aqueous humor and tears of 16 HIV/AIDS patients responding to highly active antiretroviral therapy (HAART) and with undetectable plasma viral load, with the median viral load being 2291 (519, 6667) copies/ml.  Conclusions  CMVR is the most common opportunistic infection among the ocular complications of late-stage HIV/AIDS patients. Early diagnosis and systematic/topical treatment may save the vision of most patients. Detectable viral load may still be present in aqueous humor and tears even in patients with undetectable viral load in the blood, suggesting that precautions should be taken to prevent transmission of HIV virus.
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  • 图  1  AIDS患者彩色眼底像

    可见视盘周围和沿视网膜血管分布的浓厚黄白色病损区，其上片状出血，边缘黄白色颗粒，类似“奶酪加番茄酱”样改变

    下载: 全尺寸图片 幻灯片

    图  2  免疫重建炎症综合征患者眼前节(A)与彩色眼底像(B)

    A.可见角膜后较多灰白色角膜后沉淀物, 房水闪光阳性；B.玻璃体腔炎症性混浊，眼底模糊

    下载: 全尺寸图片 幻灯片

    表  1  223例HIV/AIDS患者眼部并发症患病情况

    眼部并发症 眼数(只) 例数(%)
    CMV视网膜炎 64 40(40.4)
    HIV视网膜病变 54 35(35.4)
    HIV/梅毒双重感染 20 13(13.1)
    免疫重建炎症综合征 16 10(10.1)
    视神经病变* 6 6(6.1)
    并发性白内障* 7 7(7.1)
    慢性泪腺炎 2 1(1.0)
    总计 156 99(100)
    HIV:人类免疫缺陷病毒; AIDS:获得性免疫缺陷综合征; CMV:巨细胞病毒；*该并发症与其他并发症同时存在，故统计总人数时未重复计算
    下载: 导出CSV

    表  2  HIV/AIDS患者和正常人干眼和泪液指标的比较

    组别 例数 干眼主诉[例(%)] 角膜荧光素染色[例(%)] 泪膜破裂时间(x±s，s) 泪液分泌试验(x±s，mm)
    对照组 40 16(40.0%) 6(15.0%) 10.07±7.44 10.65±8.62
    病例组 34 5(14.7%)* 5(14.7%) 9.58±7.24 10.75±7.80
    A组 10 1(10.0%) 1(10.0%) 11.22±7.84 12.20±8.23
    B组 11 2(18.2%) 0 9.91±6.60 13.27±10.30
    C组 13 2(15.4%) 4(30.8%) 7.62±7.30 6.77±4.90**
    A组:CD4+T淋巴细胞计数≥200/mm3；B组：CD4+T淋巴细胞计数(50~199) /mm3；C组:CD4+T淋巴细胞计数＜50/mm3；与对照组比较，* P＜0.05, * * P＜0.01
    下载: 导出CSV
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  • 收稿日期:  2015-09-24
  • 刊出日期:  2016-01-30

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