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目的 探讨巨细胞病毒性视网膜炎与获得性免疫缺陷综合征的关系、临床表现及诊断、治疗。 方法 观察分析 5 6例巨细胞病毒 (cytomeglovirus,CMV)性视网膜炎合并获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者 95只眼 ,对其眼底、视力、T辅助细胞的细胞受体 4(CD4 + )计数及预后进行观察随访 2周～ 18个月。 结果 5 6例患者在诊断为巨细胞病毒性视网膜炎之前 AIDS病程为 4～ 2 6个月。 95只眼 5 6例患者中 ,眼底病灶表现为颗粒型者 5 5只眼 ,其中 4 6只眼位于周边部 ;爆发型者 2 5只眼 ,均位于后极部 ,视网膜坏死灶致密伴斑片状出血和血管炎 ;颗粒型与爆发型病灶混合存在者 15只眼 ;其中 7只眼合并有视神经乳头炎 ;患者就诊时视力为眼前数指至 0 .5 ,病变广泛者及病变位于后极部者视力下降尤为严重。 30例患者 CD4 + 细胞计数为 0～ 30个 /μl,平均 (15± 9)个 /μl。患者存活时间为 3～ 18个月。接受更昔洛韦 (ganciclovir)治疗组患者视力多数提高 ,CD4 + T细胞计数明显升高 ,未治疗组患者 92 %病变呈进行性发展 ,视力显著下降。 结论 CMV性视网膜炎是 AIDS病的主要眼部并发症 ,临床上以坏死性视网膜炎伴出血及血管炎为特征 ,目前治疗主要用更昔洛韦。
Objective To investigate the relationship between cytomegalovirus retinitis and acquired immunodeficiency syndrome, clinical manifestations, diagnosis and treatment. Methods Ninety-five eyes of 56 patients with cytomeglovirus (CMV) retinitis and acquired immunodeficiency syndrome (AIDS) were observed and analyzed. Their fundus, visual acuity, T helper cell receptor 4 (CD4 +) count and prognosis were followed up for 2 weeks to 18 months. Results 56 cases of patients before the diagnosis of cytomegalovirus retinitis AIDS course of 4 ~ 26 months. Of the 95 eyes (56 eyes), fundus lesions showed 55 eyes of the granular type, of which 46 eyes were located in the peripheral part; 25 eyes were in the posterior pole of the explosive type, dense macular degeneration Flaky hemorrhage and vasculitis; granular and explosive-type lesions were mixed in 15 eyes; of which 7 eyes with optic neuritis; patients with visual acuity before the treatment refers to the number of fingers to 0.5, lesions and lesions located in the post Decreased visual acuity in the extreme is particularly serious. The counts of CD4 + cells in 30 patients ranged from 0 to 30 / μl with an average of (15 ± 9) / μl. Patients survival time of 3 to 18 months. Patients receiving ganciclovir had a higher visual acuity and a higher CD4 + T cell count, 92% of the patients in the untreated group developed progressive visual acuity, and visual acuity was significantly decreased. Conclusion CMV retinitis is the main ocular complication of AIDS. It is characterized by necrotizing retinitis with hemorrhage and vasculitis. Currently, it is mainly used to treat ganciclovir.