AIDS合并巨细胞病毒视网膜炎患者眼免疫重建炎症反应综合征的临床表现及治疗  

Clinical manifestation and treatment of ocular immune reconstitution inflammatory response syndrome in acquired immunodeficiency syndrome patients with cytomegalovirus retinitis

作　　者：孔文君 魏文斌 谢连永[1] 陈超[1] 杜葵芳 Kong Wenjun;Wei Wenbin;Xie Lianyong;Chen Chao;Du Kuifang(Department of Ophthalmology,Beijing You'an Hospital,Capital Medical University,Beijing Infectious Eye Disease Diagnosis And Treatment Center,Beijing 100069,China;Department of Ophthalmology,Beijing Tongren Hospital,Capital Medical University,Beijing Ophthalmology and Visual Sciences Key Lab,Beijing Infectious Eye Disease Diagnosis And Treatment Center,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京佑安医院眼科,北京市感染性眼病诊疗中心,100069 [2]首都医科大学附属北京同仁医院,北京同仁眼科中心,眼科与视觉科学北京市重点实验室,北京市感染性眼病诊疗中心,100730

出　　处：《中华实验眼科杂志》2021年第7期626-631,共6页Chinese Journal Of Experimental Ophthalmology

基　　金：中国初级卫生保健基金会佑安肝病艾滋病基金项目(YNKT20160038);首都医科大学北京市重点实验室开放性课题项目(2016YKSJ04)。

摘　　要：目的探讨获得性免疫缺陷综合征(AIDS)合并巨细胞病毒视网膜炎(CMVR)的眼免疫重建炎症反应综合征(IRIS)患者眼部特征及治疗预后。方法采用系列病例观察研究方法,纳入2016年2月至2018年12月于首都医科大学附属北京佑安医院确诊为AIDS合并CMVR的IRIS患者15例17眼,患者均为男性,年龄21~43岁,记录患者最佳矫正视力(BCVA),采用非接触眼压计测量眼压,采用裂隙灯显微镜检查眼前节,采用彩色眼底照相和光相干断层扫描(OCT)法观察眼底表现,采用逆转录PCR反应检测发生眼IRIS时房水中巨细胞病毒脱氧核糖核酸(CMV-DNA)含量,采用流式细胞仪检测高效抗逆转录病毒治疗(HAART)前和发生眼IRIS时外周血CD4^(+)T淋巴细胞计数,所有患者随访3~25个月,平均15个月,IRIS眼HAART时间为17~104 d,平均(66.1±27.4)d。对IRIS眼出现眼前节炎症反应患者进行抗炎和扩瞳治疗,严重玻璃体混浊者给予曲安奈德4 mg玻璃体腔注射,黄斑水肿者给予康柏西普0.50 mg玻璃体腔注射。结果17眼中9眼出现眼前节炎症反应,11眼出现不同程度的玻璃体混浊,2眼出现黄斑水肿。15眼房水CMV-DNA测定结果为阴性(<500拷贝/ml)。发生眼IRIS时,外周血CD4^(+)T淋巴细胞计数为67(51,99)个/μl,高于HAART治疗前的17(6,20)个/μl,差异有统计学意义(Z=-4.48,P<0.01)。15例AIDS患者中2例合并肺结核。治疗后患眼平均BCVA为0.50(0.35,0.60),明显高于治疗前的0.30(0.10,0.55),差异有统计学意义(Z=-2.34,P=0.019)。结论AIDS合并CMVR患者的眼IRIS可累及眼前后节,眼部对症治疗效果显著。Objective To investigate the ocular characteristics and treatment prognosis of ocular immune reconstruction inflammatory syndrome(IRIS)in patients with cytomegalovirus retinitis(CMVR)complicated with acquired immunodeficiency syndrome(AIDS).Methods A serial case-observational study was conducted.Seventeen eyes from 15 male 21-to 43-year-old AIDS patients combined with CMVR,who were diagnosed with IRIS at Beijing You'an Hospital,Capital Medical University from February 2016 to December 2018 were included.The best corrected visual acuity(BCVA)of patients was recorded,and the intraocular pressure and anterior segment was measured with a non-contact tonometer and a slit-lamp microscope,respectively.The ocular fundus was observed by fundus photography and optical coherence tomography(OCT).Reverse transcription polymerase chain reaction was used to measure the cytomegalovirus deoxyribonucleic acid(CMV-DNA)content in the aqueous humor during the occurrence of IRIS.The flow cytometry was employed to determine the peripheral blood CD4^(+)T lymphocyte count before highly active antiretroviral therapy(HAART)and during the occurrence of IRIS.All patients were followed for 3 to 25 months,with an average of 15 months.The HAART time of patients was 17 to 104 days,with an average of(66.1±27.4)days.Patients with anterior segment inflammatory reactions were given the anti-inflammatory and mydriatic treatment.Patients with severe vitreous opacity were intravitreally injected with 4 mg of triamcinolone.Patients with macular edema were given 0.5 mg intravitreal injection of conbercept.The study adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Beijing You'an Hospital,Capital Medical University(No.[2017]11).Written informed consent was obtained from each patient prior to any examination.Results Anterior segment inflammation(Tyndall effect,KP,post-iris adhesion)was found in 9 eyes,vitreous opacities to varying degrees in 11 eyes,and macular edema in 2 eyes.The CMV-DNA content was negative(<500 copies/ml

关 键 词：获得性免疫缺陷综合征/治疗 眼免疫重建炎症反应综合征/治疗 临床表现 疗效 

分 类 号：R512.91[医药卫生—内科学] R774.11[医药卫生—临床医学]