大剂量甲基强的松龙冲击疗法对急性视神经炎的疗效及自身免疫抗体的影响

Effect of intravenous high dose methylprednisolon on acute optic neuritis and its influence on autoimmune antibodies

目的 研究大剂量甲基强的松龙冲击疗法对急性视神经炎的治疗效果及对自身免疫抗体的影响.方法 82例急性视神经炎患者,随机分为强的松组（n=41）与对照组（n=41）,所有研究对象于治疗前和治疗后检测ANAs和AQP4-Ab.强的松组患者在常规治疗基础上静滴甲基强的松龙,将1 000 mg甲基强的松龙溶于500 mL 5%葡萄糖溶液中,1次/d,连用3～5 d后停药改口服,60 mg/次,1次/d,5 d后逐渐减量口服至停药,总疗程20 d.对照组常规治疗基础上静滴含10 mg地塞米松的5%葡萄糖溶液500 mL,1次/d,5～7 d后减少地塞米松到5 mg/次,连用5 d后停药改口服并逐渐减量.治疗前后均接受视力、裂隙灯、眼底、P-VEP、电脑视野检查.结果 强的松组有效率（95.12%）显著高于对照组（65%,χ2=12.54,P〈0.05）;强的松组AQP4-Ab阳性率（9.76%）显著低于对照组（31.71%,χ2=6.01,P〈0.05）;强的松组ANAs阳性率（4.88%）显著低于对照组（21.95%,χ2=5.15,P〈0.05）;强的松组不良反应发生率（4.88%）显著低于对照组（26.83%,χ2=7.41,P〈0.05）.结论 大剂量甲基强的松龙冲击疗法可有效治疗急性视神经炎,不良反应少,值得临床进一步研究并推广应用.

Objective To study the efficacy of high-dose methylprednisolone therapy on the treatment of acute optic neuritis and the impact on autoimmune antibodies. Methods Totally 82 patients with acute optic neuritis were randomly divided into the methylprednisolon group （n=41） and control group （n=41）. ANAs and AQP47Ab were detected in all of the subjects before and after treatment. Methylprednisolon group received intravenous methylprednisolon（1000 mg dissolved in 500 mL 5% glucose solution, 1 time/day, once every 3 - 5d） based on the conventional treatment. After the withdrawal oral prednisone was given （60 rag/times, 1 times/d, subsequent to the withdrawal by 5 mg per week）, with a total course of 20d or not. The control group received intravenous dexamethasone （10 mg of 5% glucose soiution 500 mL, 1 time/d, 5 - 7d after dexamethasone reduced to 5 mg/times, once after the withdrawal 5d change of oral）, based on the conventional treatment. Before and after treatment visual acuity, slit lamp, fundus, P-VEP, computer vision （vision allows patients to be OK this check） were checked. Results The two groups were given appropriate treatment, and the effective rate of methylprednisolone group （95. 12%） was significantly higher than that of the control group （65%, X2 = 12.54, P〈0.05）; Positive rate of AQP4-Ab in methylprednisolone group （9.76 %） was significantly lower than that in the control group （31.71%,X2=6.01, P〈0.05）; the positive rate of ANAs in methylprednisolone group （4. 88%） was significantly lower than that in the control group （21.95%, X2 = 5.15, P〈0.05） ; Rate of adverse reactions in methylprednisolone group （4.88%） was significantly lower than that in the control group（26.83% ,X2 =7.41, P〈0.05）. Conclusion High-dose methylprednisolone therapy can be efficacious on treating acute optic neuritis without less adverse reactions, and it is worth of further research and clinical application.