视神经炎治疗的循证医学研究进展

Progress in evidence-based medicine for the treatment of optic neuritis

视神经炎是常见的视神经病变，典型表现为视力突然丧失。视力改变的严重程度可以不同，数月后有自愈倾向。通过检索CochraneCENTRAL、Medline和Embase等数据库资料，收集了近十几年来有关视神经炎治疗方面最有说服力的8个Ⅰ级、Ⅱ级循证医学（EBM）证据。目前研究结果认为：就视力、视野、对比敏感度而言，还没有令人信服的证据证实静脉滴注糖皮质激素或口服糖皮质激素较对照组有明显的疗效。视神经炎首先应不给予治疗，或者先静脉滴注糖皮质激素治疗后再改为口服。鉴于中国和西方国家因地理环境、种族和遗传背景不同造成视神经炎的病因和临床特点方面的差异，其治疗可能有所区别。因此，应尽快组织实施中国治疗视神经炎多中心大样本的随机临床对照试验（RCT），为视神经炎患者提供较好的治疗。

Optic neuritis is a common optic neuropathy,which typically presents with sudden loss of vision. Visual deficit of optic neuritis varies in severity and generally can be improved spontaneously over several-month duration. The most convincing eight evidences from level Ⅰ and Ⅱ evidence of evidence-based medicine（EBM） about the treatment of all the optic neuritis were collected by searching the Cochrane Controlled Trials Register （CENTRAL） , MEDLINE, EMBASE and reference lists of identified trial reports since the last decade. At present,the latest findings showed that there is no conclusive evidence of benefit in terms of recovery to normal visual acuity, visual field or contrast sensitivity with either intravenous or oral corticosteroids at the doses evaluated in trials included in this review. Either no treatment or intravenous corticosteroid therapy followed by oral corticosteroids is appropriate, and intravenous corticosteroid may benefit the patient in terms of faster recovery to normal vision. There may be of different treatment of optic neuritis in China compared to Western countries due to geographical, racial and genetic background that may cause different etiology and clinical features of optic neuritis. Therefore, in China, it is imperative to carry out a large randomized control trial（RCT） of optic neuritis as soon as possible to get the best evidence for the management of optic neuritis patients.