儿童视神经炎病因分析

Etiological study on optic neuritis in childhood

目的了解临床初诊为视神经炎（ON）儿童患者的病因分布和临床特点。方法收集158例初诊ON的儿童患者详细的眼科和神经内科检查及实验室、影像学检查资料，参照国际认可的标准重新诊断，并与成人ON病因进行比较。结果104例初诊为ON的儿童患者最后诊断符合ON，占65．8％。其中，80例为特发性脱髓鞘性ON，占76．9％；感染性ON和炎性视神经病各3例，18例病因未明。另54例不符合ON诊断，其中，以Leber遗传性视神经病、非器质性视力下降等较常见。结论初诊为ON的儿童患者病因分布与成人类似，以特发性脱髓鞘性ON最为常见。Leber遗传性视神经病和非器质性视力下降是儿童患者中最常见的与ON混淆的疾病。

Objective To explore underlying causes of presumptive optic neuritis （ON）in children. Methods Retrospective study of continuous cases with presumed diagnosis of optic neuritis in childhood. Results 104 cases（65.8%） met ON criteria in this cohort of children, among which 80 cases （76. 9%） were considered as idiopathic demyelinating optic neuritis （IDON）. Infectious optic neuritis and inflammatory optic neuropathy were found on 3 cases respectively. The cause of 18 cases remains unknown. Leber hereditary optic neuropathy and non-organic visual acuity loss account most of the 54 cases misdiagnosed as optic neuritis. Conclusions As in adult patients, idiopathic demyelinating optic neuritis is the most common pathogeny of optic neuritis in children, while infectious events were more common in children. Leber hereditary optic neuropathy and non-organic visual acuity loss were the most common disease confused with optic neuritis in childhood. Some rare disease in childhood which can cause optic nerve lesion should also be considered.