人类免疫缺陷病毒(HIV)感染者眼表情况与CD4~+T淋巴细胞的相关性分析
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摘要
目的探讨人类免疫缺陷病毒(human immune deficiency virus,HIV)感染者眼表情况、干眼症的发病情况与全身免疫情况是否存在相关性。方法对病例组(15例)和对照组(15例)分别行泪液分泌试验I(Schirmer I test,SIT)、泪膜破裂时间(break-up time,BUT)、角膜荧光素染色(fluorescein staining,FLS)计分、结膜印迹细胞学(conjunctival impression cytology,CIC)检查,以了解正常眼、HIV感染者的眼表情况。病例组中以患者+-1-1CD4T淋巴细胞数-150μL为界分为A(≥50μL)、B(<50μL)两组进行分析。结果 BUT结果 :对照组(10.80±2.48)s,A组(7.00±3.74)s,B组(6.44±4.19)s,总体比较各组间BUT结果差异有统计学意义(F=5.882,P=0.008),A组及B组与对照组差异均有统计学意义(P值分别为0.025、0.004),A组与B组间差异无统计学意义(P=0.753)。SIT结果 :对照组每5 min(11.73±2.46)mm,A组(8.33±2.58)mm,B组(8.67±4.44)mm,各组间总体比较SIT结果差异有统计学意义(F=3.910,P=0.032),A组及B组与对照组差异均有统计学意义(P值分别为0.034、0.028),A组与B组间差异无统计学意义(P=0.845)。各病例组和对照组之间角膜FLS检查总体差异有统计学意义(χ2=10.903,P=0.004),病例组与对照组之间差异有统计学意义(χ2=7.500,P=0.006),A组与B组间差异无统计学意义(χ2=2.269,P=0.132)。各病例组和对照组之间结膜CIC检查总体差异有统计学意义(χ2=15.000,P=0.001),病例组与对照组之间差异有统计学意义(χ2=13.393,P=0.000),A组与B组间差异无统计学意义(χ2=3.462,P=0.063)。HIV感染者易出现BUT变短、SIT减少、角结膜FLS重,印迹细胞学分级有显著的差异,对照组分级主要集中于0级、Ⅰ级,病例组主要集中于Ⅱ级和Ⅲ级。对照组干眼症的患病率为6.7%(1/15),病例组干眼症的患病率为40.0%(6/15)。两组间发病率的差异有统计学意义(χ2=4.658,P=0.031)。结论 HIV感染者易出现眼表异常及眼表细胞的损害,其干眼症发病率明显增高,眼表改变情况、干眼症发病率与CD4+T淋巴细胞数可能存在密切关系。
Objective To study the correlation of the manifestation of ocular surface and dry eye with general immunity in HIV-infected patients. Methods Schirmer I test( SIT),tear film break-up time( BU T) and corneal fluorescein staining( FLS),conjunctival impression cytology( CIC) were performed and the manifestation of the ocular surface was studied in 15 patients and15 normal controls. The 15 patients were divided into group A( C D4+T-cells count ≥ 50μL- 1) and group B( CD4+T-cells count < 50 μL- 1). Results Result of BUT: The mean value of BU Twere( 10. 80 ± 2. 48) seconds,( 7. 00 ± 3. 74) seconds,( 6. 44 ± 4. 19) seconds in control group,group A and group B,respectively. The difference of BU Tammong groups was significant( F = 5. 882,P = 0. 008). The difference of BU Tbetween group A or group B and control group were significant( P = 0. 025,0. 004) and not between group A and B( P = 0.753). R esult of SITI: The mean value of SITwere( 11. 73 ± 2. 46) mm /5 min,( 8. 33 ± 2. 58)mm /5 min,( 8. 33 ± 2. 58) mm /5 min in control group,group A and group B,respectively. The difference of SITamong groups was significant( F = 3. 910,P = 0. 032). The difference of SITbetween group A or group B and control group were significant( P = 0. 034,0. 028),and not between group A and group B( P = 0. 845). The difference of FLS among groups was significant( χ2= 10. 903,P = 0. 004). The difference of FLS between patients and controls was significant( χ2= 7. 500,P = 0. 006),and not between group A and group B( χ2= 2. 269,P = 0. 132). The difference of C IC among groups was significant( χ2= 15. 00,P = 0. 001). The difference of C IC between patients and controls was significant( χ2= 13. 393,P = 0. 000),and not between group A and group B( χ2= 3. 462,P = 0. 063). The HIV infection was prone to result in BU Tand SITmore less,FLS was impression. The difference was significant in the conjunctival impression cytology of each group. The normal controls presented the grade 0 to Ⅰ,the patients presented the grade Ⅱ to Ⅲ. The incidence of dry eye was 6. 7%( 1 /15),40. 0%( 6 /15) in normal controls and patients,respectively. The difference in incidence of dry eye between groups was significant( χ2= 4. 658,P = 0. 031). Conclusion The HIV infection is prone to ocular surface abnormalities and ocular surface cell damage. The incidence of dry eye increase significantly,there may be a close relationship between the manifestation of the ocular surface,the incidence of dry eye with C D4+T-cells count.
Objective To study the correlation of the manifestation of ocular surface and dry eye with general immunity in HIV-infected patients. Methods Schirmer I test( SIT),tear film break-up time( BU T) and corneal fluorescein staining( FLS),conjunctival impression cytology( CIC) were performed and the manifestation of the ocular surface was studied in 15 patients and15 normal controls. The 15 patients were divided into group A( C D4+T-cells count ≥ 50μL- 1) and group B( CD4+T-cells count < 50 μL- 1). Results Result of BUT: The mean value of BU Twere( 10. 80 ± 2. 48) seconds,( 7. 00 ± 3. 74) seconds,( 6. 44 ± 4. 19) seconds in control group,group A and group B,respectively. The difference of BU Tammong groups was significant( F = 5. 882,P = 0. 008). The difference of BU Tbetween group A or group B and control group were significant( P = 0. 025,0. 004) and not between group A and B( P = 0.753). R esult of SITI: The mean value of SITwere( 11. 73 ± 2. 46) mm /5 min,( 8. 33 ± 2. 58)mm /5 min,( 8. 33 ± 2. 58) mm /5 min in control group,group A and group B,respectively. The difference of SITamong groups was significant( F = 3. 910,P = 0. 032). The difference of SITbetween group A or group B and control group were significant( P = 0. 034,0. 028),and not between group A and group B( P = 0. 845). The difference of FLS among groups was significant( χ2= 10. 903,P = 0. 004). The difference of FLS between patients and controls was significant( χ2= 7. 500,P = 0. 006),and not between group A and group B( χ2= 2. 269,P = 0. 132). The difference of C IC among groups was significant( χ2= 15. 00,P = 0. 001). The difference of C IC between patients and controls was significant( χ2= 13. 393,P = 0. 000),and not between group A and group B( χ2= 3. 462,P = 0. 063). The HIV infection was prone to result in BU Tand SITmore less,FLS was impression. The difference was significant in the conjunctival impression cytology of each group. The normal controls presented the grade 0 to Ⅰ,the patients presented the grade Ⅱ to Ⅲ. The incidence of dry eye was 6. 7%( 1 /15),40. 0%( 6 /15) in normal controls and patients,respectively. The difference in incidence of dry eye between groups was significant( χ2= 4. 658,P = 0. 031). Conclusion The HIV infection is prone to ocular surface abnormalities and ocular surface cell damage. The incidence of dry eye increase significantly,there may be a close relationship between the manifestation of the ocular surface,the incidence of dry eye with C D4+T-cells count.
引文
1 Shah SU,Kerkar SP,Pazare AR.Evaluation of ocular manifestations and blindness in HIV/AIDS patients on HAART in a tertiary care hospital in Western India[J].Br J Ophthalmol,2009,93(1):88-90.
2 阎慧,赵少贞,魏瑞华.干眼症症状与体征的相关性研究[J].眼科研究,2010,28(7):670-673.
3 Nelson JD.Impression cytology[J].Cornea,1988,7(1):71-81.
4 Bisw as J,Sudharshan S.Adnexal and anterior segment manifestations of HIV-AID S.Indian[J].O phthalmology,2008,56(5):363-375.
5 Akcakaya AA,Sargin F,Erbil HH,Aybar A,Sadigov F,YaylalSA,et al.HIV-related eye disease in patients presenting to a tertiary care government hospital in turkey[J].O cul Immunol Inflamm,2012,20(3):158-162.
6 李海燕,庞国祥,叶俊杰,郭立斌.人类免疫缺陷病毒感染者泪膜功能的研究[J].眼科研究,2004,22(6):634-637.
7 张宏,安晓,陈雪艺.眼科门诊干眼的流行病学调查及相关危险因素分析[J].眼科新进展,2008,28(3):214-220.
8 肖秀林,韦福邦,韦礼友,许建铮.广西柳州市普通人群干眼症流行病学的调查[J].国际眼科杂志,2009,9(5):947-949.
9 Han Y,W u N,Z hu W,Li Y,Z uo L,Ye J,et al.D etection of HIV-1viruses in tears of patients even under long-term HAAR T[J].A ID S,2011,25(15):1925-1927.
10 Fujihara T,Fujita H,T subota K,Saito K,T suzaka K,Abe T,et al.Preferential localization of C D8+alpha E beta 7+T cells around acinar epithelial cells with apoptosis in patients with sjogren’s syndrome[J].J Immunol,1999,163(4):2226-2235.
11 Paul M E,Shearer W T,Kozinetz C A,Lew is D E.C omparison of CD8+T-cell subsets in HIV-infected rapid progressor children versus non-rapid progressor children[J].A llergy C lin Immunol,2001,108(2):258-264.
12 周立平,尚红,张子宁,王亚男,李革飞,施万英,等.中国部分地区HIV感染者/艾滋病患者外周血单核/巨噬细胞功能与疾病的进展关系[J].中华医学杂志,2007,87(34):2394-2397.
13 Smed-Srensen A,LoréK,Vasudevan J,Louder M K,Andersson J,M ascola JR,et al.Differential susceptibility to human immunodeficiency virus type 1 infection of myeloid and plasmacytoid dendritic cells[J].J Virol,2005,79(14):8861-8869.
14 Geier SA,Libera S,Klauss V,Goebel FD.Sicca syndrome in patients infected with the human immunodeficiency virus[J].Ophthalmology,1995,102(9):1319-1424.
15 Kestelyn P,Lepage P,Karita E,Van de Perre P.O cular manifestations of infection with the human immunodeficiency virus in an African pediatric population[J].O cul Immunol Inflamm,2000,8(4):263-273.
16 Murube J,Rivas L.Impression cytology on conjunctiva and cornea in dry eye patients establishes a correlation between squamous metaplasia and dry eye clinical severity[J].Eur J O phthalmol,2003,13(2):115-127.
17 Burtin T,Guepratte N,Bourges JL,Garcher C,Le Hoang P,Baudouin C.Abnormalities of the ocular surface in patients with AID S[J].J Fr O phtalmol,1998,21(9):637-642.
2 阎慧,赵少贞,魏瑞华.干眼症症状与体征的相关性研究[J].眼科研究,2010,28(7):670-673.
3 Nelson JD.Impression cytology[J].Cornea,1988,7(1):71-81.
4 Bisw as J,Sudharshan S.Adnexal and anterior segment manifestations of HIV-AID S.Indian[J].O phthalmology,2008,56(5):363-375.
5 Akcakaya AA,Sargin F,Erbil HH,Aybar A,Sadigov F,YaylalSA,et al.HIV-related eye disease in patients presenting to a tertiary care government hospital in turkey[J].O cul Immunol Inflamm,2012,20(3):158-162.
6 李海燕,庞国祥,叶俊杰,郭立斌.人类免疫缺陷病毒感染者泪膜功能的研究[J].眼科研究,2004,22(6):634-637.
7 张宏,安晓,陈雪艺.眼科门诊干眼的流行病学调查及相关危险因素分析[J].眼科新进展,2008,28(3):214-220.
8 肖秀林,韦福邦,韦礼友,许建铮.广西柳州市普通人群干眼症流行病学的调查[J].国际眼科杂志,2009,9(5):947-949.
9 Han Y,W u N,Z hu W,Li Y,Z uo L,Ye J,et al.D etection of HIV-1viruses in tears of patients even under long-term HAAR T[J].A ID S,2011,25(15):1925-1927.
10 Fujihara T,Fujita H,T subota K,Saito K,T suzaka K,Abe T,et al.Preferential localization of C D8+alpha E beta 7+T cells around acinar epithelial cells with apoptosis in patients with sjogren’s syndrome[J].J Immunol,1999,163(4):2226-2235.
11 Paul M E,Shearer W T,Kozinetz C A,Lew is D E.C omparison of CD8+T-cell subsets in HIV-infected rapid progressor children versus non-rapid progressor children[J].A llergy C lin Immunol,2001,108(2):258-264.
12 周立平,尚红,张子宁,王亚男,李革飞,施万英,等.中国部分地区HIV感染者/艾滋病患者外周血单核/巨噬细胞功能与疾病的进展关系[J].中华医学杂志,2007,87(34):2394-2397.
13 Smed-Srensen A,LoréK,Vasudevan J,Louder M K,Andersson J,M ascola JR,et al.Differential susceptibility to human immunodeficiency virus type 1 infection of myeloid and plasmacytoid dendritic cells[J].J Virol,2005,79(14):8861-8869.
14 Geier SA,Libera S,Klauss V,Goebel FD.Sicca syndrome in patients infected with the human immunodeficiency virus[J].Ophthalmology,1995,102(9):1319-1424.
15 Kestelyn P,Lepage P,Karita E,Van de Perre P.O cular manifestations of infection with the human immunodeficiency virus in an African pediatric population[J].O cul Immunol Inflamm,2000,8(4):263-273.
16 Murube J,Rivas L.Impression cytology on conjunctiva and cornea in dry eye patients establishes a correlation between squamous metaplasia and dry eye clinical severity[J].Eur J O phthalmol,2003,13(2):115-127.
17 Burtin T,Guepratte N,Bourges JL,Garcher C,Le Hoang P,Baudouin C.Abnormalities of the ocular surface in patients with AID S[J].J Fr O phtalmol,1998,21(9):637-642.