上海市艾滋病初诊患者眼部并发症及致盲原因调查分析

摘要

Objective To study the eye complication situation of patients initially diagnosed with Acquired Immunodeficiency Syndrome (AIDS); to analyze the main factors that cause damage to eyesight; and to provide a basis for the prevention and control of damage to vision in Shanghai.Methods This was a cross-sectional investigation.A cohort study of patients initially diagnosed with AIDS was conducted in the Shanghai public health clinic center from March 2011 to February 2012.The patients underwent a full and thorough set of ophthalmology examinations.Natural and best corrected distance vision were tested with a Snellen chart.The anterior segment and fundus were examined by slit lamp microscopy and direct ophthalmoscopy.The data were input in compliance with the WHO visual impairment standard classification,and the causes of blindness and low vision damage were analyzed.The data were collected and measured by percentage,and analyzed with a chi-square test.Results Among 358 patients initially diagnosed with AIDS,286 patients (79％)signed an informed consent to allow the eye clinic to examine them.Of the 286 patients,58.4％ had ocular complications.The highest incidence was 36.01％ for dry eyes,the second highest was 19.9％for conjunctivitis and the third was 8.39％ for cytomegalovirus retinitis (CMVR).The leading cause of blindness was 40％ from CMVR and the second leading causes were 30％ from retinal microvascular lesions (HIVM) and glaucoma.The rate of blindness increased with a CD4+T lymphocyte level less than 250 cells/μl.Conclusion The ocular complications in patients initially diagnosed with AIDS in Shanghai are higher than in the United States and other countries.CMVR was the main reason for damage to eyesight.It is recommended to move more quickly to establish a reliable CMVR screening and treatment network to improve the quality of life of AIDS patients.%目的 调查上海市获得性免疫缺陷综合征(艾滋病,AIDS)初诊患者的眼部并发症的发生情况,分析其损害视力的主要因素,为防治视力损伤提供依据.方法 横断面研究.于2011年3月～2012年2月期间对上海市公共卫生临床中心就诊的AIDS初诊患者进行调查,进行一系列完整的眼科及全身检查.采用Snellen视力表检查裸眼远视力和最佳矫正远视力;采用裂隙灯和眼底镜进行眼前段和眼底检查.对录入数据按WHO视力损害标准分级,并分析肓和低视力损害的原因.对数据进行分类计数,求百分比,用卡方检验进行数据分析.结果 358例艾滋病初诊患者中,286名患者知情同意至眼科门诊参加检查,受检率79.9％.眼部并发症患病率58.4％(167/286),其中干眼症的患病率最高36.0％(103/286),其次是结膜炎19.9％(57/286)、巨细胞病毒性视网膜炎(CMVR) 8.39％ (24/286)等.致盲率据首位的是CMVR40.0％ (4/10),其次是均为30.0％(3/10)的视网膜微血管病变(HIVM)和青光眼等.致盲性眼病在CD4+F淋巴细胞水平低于250个/μl时高发.结论 上海市AIDS初诊患者眼部并发症患病率高于美国等国家,CMVR是主要损害视力的原因,建议加快建立健全CMVR的筛查和诊治网络,提高AIDS患者的生存质量.