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巨细胞病毒视网膜炎在 HIV 感染患者中的临床特征。

Clinical Features of Cytomegalovirus Retinitis in HIV Infected Patients.

机构信息

Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.

出版信息

Front Cell Infect Microbiol. 2020 Apr 7;10:136. doi: 10.3389/fcimb.2020.00136. eCollection 2020.

DOI:10.3389/fcimb.2020.00136
PMID:32318357
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7154068/
Abstract

The purpose of this study was to investigate the clinical features and related laboratory indicators of cytomegalovirus retinitis in HIV infected patients in order to find a suitable laboratory reference guide to aid in the early diagnosis of CMVR, which should improve the prognosis of the severe retinitis. PLHIVs who were admitted to our hospital from January 2010 to December 2016 were included. The diagnosis of AIDS follows the AIDS Treatment Guidelines. Levels of CMV IgG and IgM were measured by ELISA in order to detect the CMV infection status of the patient. CMV-DNA levels were assessed by a quantitative PCR method, and CD4 T lymphocytes were detected by flow cytometry. Logistical regression was used to analyze the risk factors for CMV retinitis in HIV-infected patients. There were 93 patients with HIV that were also diagnosed with CMV retinitis. After ART, the intraocular pressure, visual acuity, cotton plaque incidence, and CD4 T lymphocyte count were significantly improved, and the yellow-white retinal lesions gradually disappeared. In patients with HIV infections, the CD4+ T lymphocyte count, and peripheral blood quantitative CMV-DNA levels were found to be independent risk factors for CMV retinitis ( < 0.05). Patients with HIV infection who had CMV-DNA levels >6,390 copies/mL were associated with more severe ophthalmolgic conditions related to CMV retinitis. Patients with HIV infections with quantitative CMV-DNA levels >6,390 copies/mL have a higher probability of having a diagnosis of CMV retinitis and a worse prognosis than those whose CMV-DNA level is <6,390 copies/mL.

摘要

本研究旨在探讨 HIV 感染患者巨细胞病毒视网膜炎的临床特征及相关实验室指标,以寻找合适的实验室参考指标,辅助 CMVR 的早期诊断,从而改善重度视网膜炎的预后。PLHIV 于 2010 年 1 月至 2016 年 12 月期间入住我院,艾滋病的诊断符合艾滋病治疗指南。采用酶联免疫吸附试验(ELISA)检测 CMV IgG 和 IgM 水平,以检测患者的 CMV 感染状况。采用实时荧光定量 PCR 方法检测 CMV-DNA 水平,采用流式细胞术检测 CD4 T 淋巴细胞。采用逻辑回归分析 HIV 感染患者发生 CMV 视网膜炎的危险因素。93 例 HIV 患者同时诊断为 CMV 视网膜炎。经 ART 治疗后,患者的眼压、视力、棉斑发生率及 CD4 T 淋巴细胞计数均显著改善,黄白色视网膜病变逐渐消失。HIV 感染者 CD4+T 淋巴细胞计数和外周血定量 CMV-DNA 水平是 CMV 视网膜炎的独立危险因素(<0.05)。CMV-DNA 水平>6,390 拷贝/ml 的 HIV 感染者与更严重的 CMV 视网膜炎相关眼科状况有关。定量 CMV-DNA 水平>6,390 拷贝/ml 的 HIV 感染者发生 CMV 视网膜炎的可能性更高,且预后较 CMV-DNA 水平<6,390 拷贝/ml 的患者更差。

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