皮质类固醇治疗外伤性视神经病变的四天关键时期

A 4-day critical period in corticosteroids treatment for traumatic optic neuropathy

目的：评估静脉注射甲基强的松龙（IVMP）对外伤性视神经病变患者的疗效。 方法：回顾性分析2000-01至2007-06我院收治的16例外伤性视神经病变（TON）患者的临床资料。1g甲基强的松龙分3d静脉应用，然后口服泼尼松龙11d，并逐渐减量。记录从损伤开始到治疗开始的时间。视力变化是本研究结果的主要功能评价指标。在入院时，治疗后1，2，3d；1wk和1mo时，分别记录最佳矫正视力（BCVA）。 结果：共有16例患者纳入本研究，平均年龄为30岁，其中男性14例、女性2例。引起TON的主要原因有摩托车事故（占69％），打架斗殴（占19％）和体育运动（占12％）。所有患者都表现有相对传入性瞳孔障碍。在损伤后4d内开始静脉注射甲基强的松龙，采用Snellen视力表检查视力，绝大部分（56％）患者视力提高超过3行或大于等于0．5（6／12）。在损伤后5d以上才开始用类固醇治疗，视力则没有任何进步。 结论：治疗TON，静脉注射中等到大剂量甲基强的松龙仍将起到重要作用。静脉注射甲基强的松龙治疗TON可能存在伤后4d的关键时期，超过了这个时期，该治疗可能就毫无效果。但还需要有更多的研究来为我们提供有明显统计学意义的数据。

AIM： To evaluate the outcome of intravenous methylprednisolone （IVMP） in patients with traumatic optic neuropathy （TON）. METHODS： Clinical data of 16 patients with TON who were admitted to our hospital from January 2000 to June 2006 were retrospectively analyzed, lg of IVMP in divided doses for 3 days followed by a reducing dose of oral prednisolone for 11 days were given. Timing between the onset of injury and the initiation of treatment was noted. A change in visual acuity is the primary functional outcome measure of this study. Best corrected visual acuity （BCVA） was recorded at admission, on day 1, day 2, day 3, 1 week and 1 month after treatment. RESULTS： Sixteen patients were included in this study with a mean age of 30. Fourteen of them were male and 2 were female. Motor vehicle accident （ 69%）, assaults（19%） and sports （12%） were the major causes of TON, All patients had relative afferent pupillary defect at presentation. Majority of the patients （56%） have significant improvement of ≥3 lines or ≥ 6/12 Snellen chart visual acuity when IVMP was started within 4 days of injury. None showed improvement when steroids were started more than 5 days of injury. CONCLUSION： Moderate to high dose of IVMP still plays an important role in treatment of TON. A 4-day critical time frame may exist for treatment of TON with IVMP beyond which treatment may be ineffective. More studies are needed to provide us with statistically significant data.