弥可保治疗视神经挫伤的临床观察

Clinical observation of methylcobalamin for the treatment of optic nerve contusion

目的对照观察弥可保和普通VitB12治疗视神经挫伤的临床疗效,评估弥可保的治疗有效性和优越性。方法33例视神经挫伤患者随机分成弥可保组(Ⅰ组)19例和VitB12组(Ⅱ组)14例,以相同剂量500μg联合VitB1100mg,1次·d-1肌肉注射20～30d;随后改口服500μg联合VitB110mg,3次·d-1。随诊(5.58±1.90)个月,期间及末次复查视力、眼底、对比敏感度和视野。结果治疗后患者的视力较治疗前提高,Ⅰ组治疗前后平均视力差异有非常显著性(P<0.001)。Ⅱ组差异无显著性(P>0.05)。视力提高≥2行者,Ⅰ组中为78.95%,Ⅱ组为64.29%,组间比较差异无显著性(P>0.05)。能识辨对比敏感度检查图者在治疗前为10例,治疗后增加至23例,差异有非常显著性(P<0.01)。治疗后平均对比度值较治疗前提高,差异有非常显著性(P<0.01)。检查图阳性识辨率Ⅰ组由治疗前的6例增加至治疗后的12例,差异有显著性(P<0.05);Ⅱ组由治疗前的4例增加至治疗后的7例(P>0.05),差异无显著性(P>0.05)。治疗前2组间的对比度值差异无显著性(P>0.05),治疗后Ⅰ组的对比度值改善较Ⅱ组更为显著,差异无显著性(P>0.05)。治疗后Ⅰ组中81.82%(9/11)的视野较前改善,Ⅱ组40.0%(2/5)的患者视野有改善。眼底随诊过程中所有患者最终出现程度不等的视神经萎缩。结论弥可保对视神经挫伤的治疗有明显的临床效果,其视功能的恢复状况优于普通VitB12。

Objective To compare the effect and superiority of methylcobalamin for the treatment of optic nerve contusion with vitamin B12. Methods Thirty-three patients randomly received either methylcobalamtn treatment（ 19 eases） or vitamin B12 treatment （14 eases）. Firstly 500 μg of methylcobgalamin or vitamin B12 combined with 100μg vitamin B1 rospectively was injected intramuscularly once a day for twenty to thirty days, and then kept the same dosage of methylcobalamtn or Vitamin B12 and 10 mg vitamin B1 orally three times daily. All patients were followed for visual acuity, fundus, contrast sensitivity and visual field. Results The mean visual acuity of methylcobalamtn group after therapy improved with significant difference （P 〈 0.001 ）. The mean visual acuity of vitamin B12 group after therapy improved without static difference （P 〉 0.05 ）. There were 78. 95% patients with methylcobalamin and 64.29% patients with vitamin B12 who got improved in visual acuity more than 2 lines after therapy. There was no statistically significant difference between two groups （P 〉 0.05）. Positive rate of contrast sensitivity in methylcobalamtn group was ten eyes before therapy and twenty-three eyes after therapy. The positive rate and contrast value of contrast sensi- tivity were improved after therapy with significant difference（P 〈 0.01 ）. Positive rate of contrast sensitivity in methylcobalamin group were 6 patient before therapy and 12 patients after therapy, and in vitamin Bl2 group were 4 patients before therapy and 7 patients after therapy. There was no statistically signifieant difference （P 〉 0.05 ）. Patients with methyl cobalamin recovered better in contrast sensitivity than with vitamin B12. But there was no significant difference. Visual field became better in 81.82% （9/11 eyes） with methylcobalamin and 40.0% （2/5 eyes） with vitamin B12. Optic atrophy to different degrees was found in all patients. Conclusion Methylcobalamin in the treatment of optic nerve contusion is more effective than vitamin B12. [Rec Adv Ophthalmol 2006;26（7）：535-537]