摘要
探讨免疫功能低下患者中巨细胞病毒性视网膜炎的临床表现、诊断及治疗。方法 :观察分析 6 1例巨细胞病毒 (cytomeglovirus ,CMV)性视网膜炎患者 10 4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 :6 1例CMV视网膜炎中 ,5 6例为获得性免疫缺陷综合征 (acquiredimmunodeficiencysyndrome ,AIDS)患者 ,1例为应用免疫抑制剂的肾移植患者 ,1例为接受化疗的急性淋巴细胞性白血病患者 ,3例为白血病同时合并AIDS患者。 10 4眼 6 1例患者中 ,眼底病灶表现为颗粒型者 5 8眼 ,其中 46眼位于周边部 ;爆发型者 2 8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 18眼 ;其中 7眼合并有视神经乳头炎 ;患者就诊时视力为眼前指数至 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。接受更喜洛韦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 93 %病变呈进行性发展 ,视力显著下降。结论 :CMV视网膜炎是免疫功能严重低下患者 ,尤其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 ,治疗目前主要用更昔洛韦。
Objective:To evaluate the clinical processes of cytomegalovirus (CMV) retinitis in immunosupressed hosts. Methods:A total of 104 eyes of 61 patients with cytomegalovirus retinitis were studied.The fundus features,visual acuity and CD4 + T-lymphocyte counts were analyzed and the follow-up ranged from 2 weeks to 18 months. Results:The underlying causes of immunity disturbances in the 61 cases were acquired immunodeficiency syndrome (AIDS) (n=56),immunosuppressive therapy after renal transplantation (n=1),chemotherapy for acute lymphocytic leukemia (n=1),and leukemia with AIDS (n=3).In the initial examination,the granular form of CMV retinal lesion was noted in 58 eyes (55.7%),in which retinal lesion of 46 eyes was peripheral.The fulminant form of CMV retinitis was found in28 eyes (26.9%) at the posterior pole and consisted of dense opaque retinal lesions with blotchy hemorrhage and vasculitis.The overlap between these two presentations was noted in 18 eyes,in which papillitis was complicated in 7 eyes.The vision ranged from finger counting to 0.5.The CD4 + T-lymphocyte counts of 30 patients was 0～30 (mean,15±9/ul).In the group treated with ganciclorvir the vision was improved and CD4\++ T-lymphocyte counts was significantly higher.The condition of CMV retinitis,however,was worse and the vision decreased in the control group. Conclusions:Diagnosis of CMV retinitis is based on the characteristic of necrotizing retinitis that was typically associated with retinal hemorrhage and vasculitis.Ganciclorvir is usually used for the treatment of CMV retinitis.
出处
《中国实用眼科杂志》
CSCD
北大核心
2002年第7期511-513,共3页
Chinese Journal of Practical Ophthalmology
