Longitudinal study of cytomegalovirus retinitis in acquired immune deficiency syndrome.
Longitudinal study of cytomegalovirus retinitis in acquired immune deficiency syndrome.
复制标题
获得性免疫缺陷综合征中巨细胞病毒视网膜炎的纵向研究。
DOI：
10.1016/s0161-6420(90)32552-6
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发表时间：
1990
期刊：
影响因子：
13.7
通讯作者：
Freeman,WR
中科院分区：
文献类型：
--
作者：
Gross,JG;Bozzette,SA;Mathews,WC;Spector,SA;Abramson,IS;McCutchan,JA;Mendez,T;Munguia,D;Freeman,WR
作者前瞻性评估了67例连续33个月的获得性免疫缺陷综合征（AIDS）和巨细胞病毒（CMV）视网膜炎患者，以评估视网膜感染的临床模式、治疗效果、长期生存率以及视网膜炎与免疫功能的关系。6名视乳头周围疾病患者（9%）出现了立即威胁视力的视网膜炎;未观察到原发性中心凹感染。87%的患者接受了更昔洛韦治疗。39例患者（58%）出现单侧疾病，15%的患者在更昔洛韦治疗期间发生对侧感染。在接受更昔洛韦治疗期间视网膜炎进展的21例患者中，33%的患者出现了阴燃（不完全反应）视网膜炎。治疗后视网膜炎的进展与淋巴细胞计数降低相关（P = 0.04）。诊断为CMV视网膜炎后的中位生存期为8个月。这代表了CMV视网膜炎的最大报告的前瞻性研究，并表明（1）CMV很少对表现的视力构成直接威胁，（2）对治疗的反应可能与免疫功能有关，（3）闷烧性视网膜炎应被视为与治疗失败相关的重要临床实体。
The authors prospectively evaluated 67 consecutive patients with the acquired immune deficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis during a 33-month period to assess the clinical patterns of retinal infection, efficacy of treatment, long-term survival, and relationship of retinitis to immune function. Immediately sight-threatening retinitis presented in six patients (9%) with peripapillary disease; primary foveal infection was not observed. Eightyseven percent of patients were treated with ganciclovir. Thirty-nine patients (58%) presented with unilateral disease and contralateral infection developed in 15% of those while on ganciclovir. Smoldering (incompletely responsive) retinitis was seen in 33% of the 21 patients whose retinitis progressed while receiving ganciclovir. Progression of treated retinitis was associated with a lower lymphocyte count (P= 0.04). Median survival after diagnosis of CMV retinitis was 8 months. This represents the largest reported prospective study of CMV retinitis and indicates that (1) CMV infrequently poses an immediate threat to vision on presentation, (2) response to therapy may be related to immune function, and (3) smoldering retinitis should be recognized as an important clinical entity associated with treatment failure.