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目的分析艾滋病合并巨细胞病毒性视网膜炎的误诊病例,以减少误诊。设计回顾性病例系列。研究对象具有误诊史的艾滋病合并巨细胞病毒性视网膜炎的患者9例。方法回顾性分析在北京地坛医院确诊的具有误诊史的艾滋病合并巨细胞病毒性视网膜炎患者的眼部和全身情况。主要指标误诊眼疾病,误诊时间,合并全身疾病。结果艾滋病患者巨细胞病毒性视网膜炎误诊为其他眼病的患者9例(12眼),其中误诊为Coats病者1例,视网膜中央静脉阻塞者1例,Eales病者1例,孔源性视网膜脱离者1例,视盘血管炎者2例(3眼),葡萄膜炎者2例(4眼),曾先后误诊为急性视网膜坏死、葡萄膜炎和玻璃体混浊者1例。发病一周内误诊者3例,1周~3个月内误诊者2例,3个月以上病程者误诊4例。9例误诊患者中5例不曾进行高效抗逆转录病毒治疗(HAART)的患者CMV-IgM检测阳性;5例患者合并有贫血,5例患者合并其他部位的感染,4例患者合并肝肾功能异常,9例患者的CD4均<200个/μL,其中6例患者的CD4<50个/μL。结论艾滋病合并巨细胞病毒性视网膜炎受到病程、艾滋病抗病毒治疗和我们对疾病的认识等多种因素的影响易出现误诊。对于临床诊断有困难的疾病应考虑到这种疾病的可能,其正确的诊断需要结合全身情况综合判断。
Objective To analyze the misdiagnosis cases of AIDS complicated with cytomegalovirus retinitis to reduce misdiagnosis. Design retrospective case series. Nine misdiagnosed HIV-infected patients with cytomegalovirus retinitis were included in the study. Methods A retrospective analysis was conducted on the ocular and systemic conditions of patients with AIDS with cytomegalovirus retinitis who have been misdiagnosed in Beijing Ditan Hospital. Misdiagnosis of major indicators of eye disease, misdiagnosis time, combined systemic disease. Results Nine patients (12 eyes) were misdiagnosed as other eye disease due to cytomegalovirus retinitis. Among them, 1 patient was diagnosed as Coats misdiagnosis, 1 patient had central retinal vein occlusion, 1 patient had Eales disease and rhegmatogenous retinal detachment 1 case, 2 cases of optic discitis (3 eyes), 2 cases of uveitis (4 eyes), which had been misdiagnosed as acute retinal necrosis, uveitis and vitreous opacity in 1 case. Three cases of misdiagnosis in one week, two cases of misdiagnosis in one week to three months and four cases of misdiagnosis in more than three months. CMV-IgM was detected in 5 of 9 misdiagnosed patients who did not undergo HAART; 5 patients had anemia, 5 had other sites of infection, 4 had liver and kidney dysfunction , And all 9 patients had CD4 <200 / μL, of which 6 patients had CD4 <50 cells / μL. Conclusions The influence of many factors such as the course of AIDS complicated with cytomegalovirus retinitis, AIDS antiviral therapy and our understanding of the disease is prone to misdiagnosis. For clinical diagnosis of difficult diseases should take into account the possibility of this disease, the correct diagnosis needs to be combined with the overall situation to judge.