【摘要】 目的对比分析获得性免疫缺陷综合征（AIDS）合并巨细胞病毒视网膜炎（CMVR）患者行玻璃体腔注射更昔洛韦联合全身抗病毒治疗注药前后血液、房水、玻璃体液巨细胞病毒（CMV）-DNA载量及血液CD4⁺T淋巴细胞计数变化情况。方法选取2016年1月至2018年1月广西医科大学第一附属医院收治的AIDS合并CMVR患者7例（13眼）。予以全身更昔洛韦和膦甲酸钠抗病毒治疗联合玻璃体腔注射更昔洛韦（800μg/0.08mL,每周1次,共2～5次）。收集患者注药前后血液、房水、玻璃体液CMV-DNA载量,以及血液CD4⁺T淋巴细胞计数及多次注药前后观察视力、眼底改变等。结果 7例（13眼）患者注药前平均LogMAR最佳矫正视力（1.07±0.83）与末次注药后（0.71±0.83）比较,差异有统计学意义（t=4.287,P=0.001）;眼底均表现为中央型CMVR,眼底病变损伤范围较治疗前缩小6例,差异有统计学意义（H=6.072,P=0.013）。注药前后血液CMV-DNA载量比较,差异无统计学意义（Z=-1.461,P=0.281）;注药前玻璃体液CMV-DNA载量为7.00×106 copy/mL,末次注药后为9.25×105 copy/mL,较注药前降低,差异有统计学意义（Z=-2.589,P=0.027）;注药前房水CMV-DNA载量为4.20×105 copy/mL,末次注药后为1.94×104copy/mL,较注药前降低,差异有统计学意义（Z=-2.312,P=0.031）。注药前CD4⁺T淋巴细胞计数小于50μL^-1 5例（9眼）,占71.43%;末次注药后CD4⁺T淋巴细胞计数大于50μL^-1 4例（8眼）,占57.14%。7例（13眼）患者中随注药次数增加双眼玻璃体液、房水CMV-DNA载量未下降反而增加1例,注药前表现为血液、玻璃体液、房水CMV-DNA载量一致性增高3例（5眼）,注药前血液CMV-DNA载量为阴性,而玻璃体液/房水CMV-DNA载量呈阳性（9.30×103～4.30×108 copy/mL）且明显高于正常水平4例（6眼）。结论临床上可通过房水、玻璃体液检查辅助诊断、预测CMVR发生和发展,经采用高效抗逆转录病毒疗法治疗后血液CMVDNA载量为阴性,部分患者房水/玻璃体液仍存在高浓度CMV-DNA,CMVR首发的AIDS患者血液、房水、玻璃体液CMV-DNA载量存在更高的一致性。更多还原

【Abstract】 Objective To compare and analyze the changes of cytomegalovirus（CMV）-DNA load and CD4⁺T lymphocyte count in blood,aqueous humor and vitreous humor of patients with acquired immunodeficiency syndrome（AIDS）complicated with cytomegalovirus retinitis（CMVR）before and after intravitreal injection of ganciclovir combined with systemic antiviral therapy.Methods Seven patients（thirteen eyes）with AIDS complicated with CMVR admitted to the First Affiliated Hospital of Guangxi Medical University from January 2016 to January 2018 were selected.All patients were given systemic ganciclovir and foscarnet sodium antiviral therapy combined with intra-ball injection of ganciclovir（800μg/0.08 mL,once a week,2-5 times in total）.The CMV-DNA load in blood,aqueous humor and vitreous humor,CD4⁺T lymphocyte count in blood,visual acuity and fundus changes multiple times before and after the injections were collected.Results The mean LogMAR best corrected visual acuity of seven patients（thirteen eyes）before operation was 1.07±0.83 and that of the post-operation was 0.71±0.83.The difference was statistically significant（t=4.287,P=0.001）.The fundus of all patients showed central CMVR.The number of cases with damage of fundus lesions were reduced to six patients compared with that of pretherapy,and the difference was statistically significant（H=6.072,P=0.013）.There was no significant difference in blood CMV-DNA load before and after the injection（Z=-1.461,P=0.281）.The CMV-DNA load in the vitreous humor before the injection was7.00×106 copy/mL and that of the last post-injection was 9.25×105 copy/mL.The CMV-DNA load in vitreous humor after the last injection was lower than that of the pre-injection,and the difference was statistically significant（Z=-2.589,P=0.027）.The CMV-DNA load in the aqueous humor before injection was 4.20×105 copy/mL and that of the last post-injection was 1.94×104 copy/mL.The CMV-DNA load in the aqueous humor after the last injection was lower than that of the pre-injection,the difference was statistically significant（Z=-2.312,P=0.031）.The CD4⁺T lymphocyte count of the five patients（nine eyes）was less than 50μL^-1 before the injection,accounting for 71.43%,while there were four patients（eight eyes）who got the count of more than 50μL^-1 after the last injection,accounting for 57.14%.Among the seven patients（thirteen eyes）,the number of those whose CMV-DNA load of the vitreous fluid and the aqueous humor increase by one patient rather than decrease.Three patients（five eyes）showed a consistent increase of CMV-DNA load in blood,vitreous fluid and aqueous humor before injection.Before injection,the CMV-DNA load in blood of four patients（six eyes）was negative,while the CMV-DNA load in vitreous humor and aqueous humor was positive（9.30×103-4.30×108 copy/mL）,which was significantly higher than that of the normal level.Conclusion The aqueous humor and vitreous fluid examination could be used to diagnose and predict the occurrence and development of CMVR.After the highly effective antiretroviral therapy,some patients still had the high concentration of CMV-DNA in the aqueous humor and vitreous humor even though their blood CMVDNA load was negative.There was a higher consistency of blood-aqueous humor-vitreous fluid CMV-DNA load in the AIDS patients with the first-episode of CMVR.更多还原