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目的探讨获得性免疫缺陷综合征(AIDS)合并巨细胞病毒性视网膜炎(CMVR)患者的临床特点以及视力下降可能的危险因素。设计回顾性病例系列。研究对象 2009年8月至2014年8月就诊于北京地坛医院的AIDS合并CMVR患者71例。方法对71例AIDS合并CMVR患者进行与艾滋病相关的免疫性检测(人类免疫缺陷病毒抗体,CD4+T淋巴细胞计数);所有患者进行视力、眼压、裂隙灯以及眼底照相等眼科检查,并观察其临床特征。主要指标视力、眼底、CD4+T细胞计数。结果 71例患者中54例(76%)CD4+T细胞≤50个/μl,7例(10%)CD4+T细胞>50~100个/μl,10例(14%)CD4+T细胞>100个/μl。视力≤0.3的49眼中,34眼(70%)视网膜病变以后极部为主,24眼(24%)最终视力<0.05,其中8眼(33%)视网膜脱离,12眼(50%)后极部视网膜坏死严重累及黄斑(包括9眼视神经萎缩),6眼(25%)并发性白内障,其中4眼为全葡萄膜炎合并白内障,2眼为视网膜脱离合并白内障。结论 CD4+T淋巴细胞计数较低是CMVR危险因素。后极部视网膜坏死是AIDS视力损害的主要原因。
Objective To investigate the clinical features of acquired immunodeficiency syndrome (AIDS) combined with cytomegalovirus retinitis (CMVR) and the possible risk factors of vision loss. Design retrospective case series. Participants Between August 2009 and August 2014, 71 patients with AIDS complicated with CMVR were treated in Beijing Ditan Hospital. Methods A total of 71 AIDS-related CMVR patients were tested for immune-related immunity (human immunodeficiency virus antibody, CD4 + T lymphocyte count). All patients underwent ophthalmological examinations such as visual acuity, intraocular pressure, slit lamp and fundus photography, and observed Its clinical features. Main indicators of vision, fundus, CD4 + T cell count. Results Of the 71 patients, 54 (76%) had CD4 + T cells ≤ 50 / μl, 7 (10%) CD4 + T cells> 50-100 cells / μl and 10 (14%) CD4 + T cells> 100 / μl. Among 49 eyes with visual acuities ≤0.3, 34 eyes (70%) were predominantly retinopathy, 24 eyes (24%) had final visual acuity <0.05, of which 8 eyes (33%) had retinal detachment and 12 eyes (50% Severe retinal necrosis involving the macula (including 9 optic atrophy), 6 (25%) complicated cataract, of which 4 cases of total uveitis with cataract and 2 eyes with retinal detachment associated with cataract. Conclusion The low CD4 + T lymphocyte count is a risk factor for CMVR. Posterior pole retinal necrosis is the main cause of AIDS vision damage.