分析获得性免疫缺陷综合征（AIDS）合并巨细胞病毒性视网膜炎患者在行抗逆转录病毒治疗（ART）过程中发生的免疫恢复性葡萄膜炎（IRU）患者的眼底特征以及影响患者视力预后的相关因素。

回顾性分析2014年2月至2019年2月首都医科大学附属北京地坛医院眼科确诊的31例AIDS合并IRU患者的临床资料，包括ART和发生IRU的间隔时间、IRU症状和体征、最佳矫正视力、裂隙灯显微镜检查眼前节、散瞳眼底检查及彩色眼底照相、频域OCT测量黄斑以及ART前、IRU发生时CD4⁺ T淋巴细胞计数。采用Logistic回归分析IRU患者视力改变的影响因素。

入组的31例IRU患者中27例（87.09%）为男性，21例（67.75%）为双眼发病。31眼（59.62%）出现玻璃体混浊，26眼（50.00%）出现前葡萄膜炎，11眼（21.15%）出现白内障，8眼（15.38%）出现黄斑水肿，3眼（5.77%）出现视乳头炎，3眼（5.77%）出现黄斑前膜。启动ART治疗时患者CD4⁺ T淋巴细胞中位数为21个/μl。IRU发生时患者CD4⁺ T淋巴细胞中位数为180个/μl。ART治疗到发生IRU的间隔周期中位数为31周。24眼（44.23%）眼底病灶位于1区，14眼（26.92%）位于2区，15眼（28.85%）位于3区。11眼（21.15%）眼底病灶范围< 25%，25眼（48.08%）眼底病灶范围为25%～50%，16眼（30.77%）眼底病灶范围大于50%。IRU初诊和随访6个月时视力下降者为11眼（21.15%），视力无变化者为15眼（28.85%），视力改善者为26眼（50.00%）。单因素分析显示，不同视力组患者的CD4⁺ T淋巴细胞计数改变量、CMVR眼底病灶分区、CMVR眼底病灶范围，组间差异有统计学意义（P = 0.014、0.007、0.005）。多因素Logistic回归分析显示，CD4⁺ T淋巴细胞计数改变量、CMVR眼底病灶分区为影响IRU患者视力预后的独立因素。CD4⁺ T淋巴细胞计数每增加1个/μl，视力改善的机率为1.03倍（95%CI：1.01～1.05、OR = 1.03、P = 0.004）。CMVR眼底病灶位于3区者视力改善的机率为位于1区者的6.89倍（95%CI：1.38～34.37、OR = 6.89、P = 0.018）。

IRU患者最常见的眼底特征为前葡萄膜炎和玻璃体混浊。CD4⁺ T淋巴细胞计数改变量和CMVR病灶分区为影响视力预后的独立因素。

To investigate the clinical characteristics, risk factors and prognosis of immune recovery uveitis (IRU) of patients with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus retinitis during antiretroviral therapy (ART).

The clinical data of 31 AIDS patients with IRU diagnosed in Ophthalmology Department of Beijing Ditan Hospital, Capital Medical University from February 2014 to February 2019 were analyzed, retrospectively, including the time interval between ART and IRU, symptoms and signs of IRU, best corrected visual acuity, slit lamp microscope examination of anterior segment, mydriatic fundus examination and color fundus photography, frequency domain OCT measurement of macula, CD4⁺ T lymphocyte count before ART and during IRU. Logistic regression analysis was used to analyze the related factors influencing the visual acuity of patients with IRU.

Among the 31 patients, 27 (87.09%) patients were male, 21 (67.75%) patients with bilateral disease, 31 (59.62%) eyes had vitreous opacity, and 26 (50.00%) eyes had anterior uveitis. Eleven (21.15%) eyes had cataract, 8 (15.38%) eyes had macular edema, 3 (5.77%) eyes had optic papillitis, and 3 (5.77%) eyes had epimacular membrane. The median number of CD4⁺ T lymphocytes was 21 cells/μl when ART treatment started. The median number of CD4⁺ T lymphocytes was 180 cells/μl when IRU occurred. The median interval between ATR treatment and IRU was 31 weeks. Twenty-four (44.23%) eyes located in zone 1, 14 (26.92%) eyes located in zone 2 and 15 (28.85%) eyes located in zone 3. The range of fundus lesions was less than 25% in 11 (21.15%) eyes, 25 (48.08%) eyes had fundus lesions ranging from 25% to 50%, and 16 (30.77%) eyes had fundus lesions larger than 50%. The visual acuity of 11 (21.15%) eyes decreased, 15 (28.85%) eyes remained unchanged and 26 (50.00%) eyes improved when followed-up at 6 months. Univariate analysis showed that there were significant differences in the changs of CD4⁺ T lymphocyte count, CMVR fundus lesion area and the zone of CMVR among different vision groups (P = 0.014, 0.007, 0.005). Multivariate Logistic regression analysis showed that the change of CD4⁺ T lymphocyte count and the zone of CMVR were independent factors affecting the improvement of visual acuity. The chance of vision improvement was 1.03 times (95%CI: 1.01-1.05, OR = 1.03, P = 0.004) based on each increase of CD4⁺ T lymphocyte (count/μl). The rate of vision improvement in CMVR patients with fundus lesions in zone 3 was 6.89 times higher than that in zone 1 (95%CI: 1.38-34.37, OR = 6.89, P = 0.018).

The most common clinical features of IRU were anterior uveitis and vitritis. The improvement of visual acuity was correlated with the zone of involvement of CMVR and the absolute change of CD4⁺ T lymphocyte counts at IRU and at ART commencement.