肿瘤坏死因子α抑制剂相关视神经炎文献病例分析

Literature case analysis of optic neuritis caused by tumor necrosis factor‑αinhibitors

目的探讨肿瘤坏死因子α(TNF‑α)抑制剂相关视神经炎的临床特征。方法检索国内外相关数据库(截至2022年11月),收集接受TNF‑α抑制剂治疗后发生视神经炎患者的文献资料,提取患者的性别、年龄、TNF‑α抑制剂使用情况、联合用药情况、视神经炎发生时间、临床表现、辅助检查、治疗及转归等,进行描述性统计分析。结果纳入分析的患者共37例,男性16例,女性21例,平均年龄44岁;接受阿达木单抗治疗11例,英夫利昔单抗治疗16例,依那西普治疗8例,戈利木单抗和培塞利珠单抗治疗各1例;其中5例患者曾接受过其他TNF‑α抑制剂治疗。原发病为类风湿关节炎者15例,克罗恩病和溃疡性结肠炎8例,银屑病关节炎3例,前葡萄炎2例,其他风湿性和炎症性疾病9例;其中4例合并其他疾病。患者从接受TNF‑α抑制剂至视神经炎发生的中位时间为4.5个月(3 d~2年),临床表现以视力下降、伴眼球运动疼痛多见。37例患者中,8例进行了脑脊液检查,其中6例存在脑脊液异常;7例进行了脑脊液寡克隆区带检测,其中4例阳性。32例患者行脑或眼眶磁共振成像(MRI)检查,11例表现为视神经增强,14例有脑部病变,5例有颈椎或脊髓病变。30例患者进行了视力检查,29例视力下降。24例停药并同时给予糖皮质激素(GC)治疗;6例仅停药未给予GC;7例未描述是否停药,其中5例给予GC。30例经停药和/或GC治疗后,视力部分或完全恢复,6例无明显改善,1例恶化。结论TNF‑α抑制剂相关视神经炎多发生于接受TNF‑α抑制剂治疗6个月内,临床表现以视力下降多见,伴或不伴脑部MRI病变,及早发现并给予干预,通常预后较好。

Objective To explore the clinical characteristics of tumor necrosis factor‑α(TNF‑α)inhibitors‑related optic neuritis.Methods The database at home and abroad(as of November 2022)were searched and the case reports on optic neuritis induced by TNF‑αinhibitors were collected.Clinical data including gender,age,use of TNF‑αinhibitors,combination drugs,time to onset of optic neuritis,clinical manifestations,results of ancillary examinations,treatment and outcome were extracted and analyzed descriptively.Results A total of 37 patients were enrolled in the study,including 16 males and 21 females,with an average age of 44 years;11 patients were treated with adalimumab,16 with infliximab,8 with etanercept,1 with golimumab,and 1 with peselizumab.Among them,5 patients had previously been treated with other TNF‑αinhibitors.The primary disease was rheumatoid arthritis in 15 patients,Crohn′s disease and ulcerative colitis disease in 8 patients,psoriatic arthritis in 3 patients,anterior uveitis in 2 aptients,and other rheumatic and inflammatory diseases in 9 patients.Of them,4 patients were complicated with other diseases.The median time from TNF‑αinhibitors use to optic neuritis occurrence was 4.5 months(3 days to 2 years).The most common clinical manifestations were decreased vision and ocular movement pain.Of the 37 patients,cerebrospinal fluid(CSF)analysis was performed in 8 patients,and 6 were abnormal.CSF oligoclonal bands were detected in 7 patients,and 4 were positive.Magnetic resonance imaging of the brain or orbit was performed in 32 patients,11 patients showed optic nerve enhancement,14 patients had brain lesions,and 5 patients had cervical or spinal cord lesions.Visual acuity was examined in 30 patients,29 of which showed decreased vision.Of the 37 patients,24 patients stopped the suspected drugs and were treated with glucocorticoid(GC),6 patients only stopped medication but not treated with GC,and it was not described in 7 patients,5 of whom were treated with GC.Of the 37 patients,30 patients recovered partially or completely after discontinuation of the drugs and/or treated with GC,6 patients were not improved and 1 patient was deteriorated.Conclusions TNF‑αinhibitors‑related optic neuritis mostly occurs within the first 6 months of treatment,and more common clinical manifestation is visual acuity loss,with or without brain MRI lesions.Early detection and intervention usually lead to a better prognosis.