复发性视神经炎54例临床特点及自身免疫抗体的分布

Distribution of autoimmune antibodies and clinical features in 54 cases with recurrent optic neuritis

目的观察复发性视神经炎的临床特点以及自身免疫抗体（水通道蛋白4抗体和血清抗核抗体）的分布。方法收集2010年10月至2012年4月间在解放军总医院神经眼科住院诊治的复发性视神经炎患者54例的临床资料，回顾分析其一般临床特点，统计其水通道蛋白4抗体（AQP4-Ab）（36例）和血清抗核抗体（ANAs）的阳性率，并与相关文献数据分析比较。结果男女比例1：2．6，发病年龄平均30．3岁；病程50d～20年，发病次数2。8次。病程中最差视力（矫正后）在0．1以下者44例，占81．5％。ANAs阳性率22．2％（12／54），AQP4-Ab阳性率27．8％（10／36）；颅脑和，或脊髓核磁异常者占48．0％（24／50）；脑脊液异常70．0％（16／23）。结论复发性视神经炎多发于青壮年，视力损害较重，自身免疫抗体（AQP4-Ab和ANAs）阳性率较视神经脊髓炎及复发性长节段横贯性脊髓炎略低，中枢神经系统影像检查对其诊治有重要价值。

ObJective To investigate the clinical features and seroprevalence of autoimmune antibodies （aquaporin-4 antibodies, AQP4-Ab and antinucl^ar antibodies, ANAs） in patients with recurrent optic neuritis （RON）. Methods Fifty-four RON patients who were in -hospital in Ophthalmolo- gy Department of PLA from October 2010 to April 2012 were enrolled in the study. The general clinical features and statistic the positive rate of AQP4-Ab and ANAs were analyzed retrospectively, and the relative data in other studies were compared. Results The ratio of male to female was 1： 2.6 and the average age of onset was 30.3 years old. The recurrent attacks of optic neuritis were 2 to 8 times during 50 days to 20 years. There were 44 patients （81.5%） who had ever appeared the lowest visual acuity （corrected） of 〈0.1 in the course of disease. The rate of seropositive ANAs was 22.2% （12/54） while 27.8% （10/36） for AQP4-Ab. The 48.0% （24/50） cases were abnormal in Brain and/or spinal cord MRI and 70.0% （16/23） in CSF. Conclusions RON is more appeared in youth with poor visual acuity. The positive rate of AQP4-Ab and ANAs are lower than neuromyelitis optica （NMO） and recurrent longitudinally extensive transverse myelitis （r-LETM）. The MRI of central nervous system posses important value for diagnosis and treatment of RON.