双眼同时发病的视神经炎患者的临床表现、免疫学指标及转归

Clinical profile,immunological indicators and prognosis of simultaneous bilateral optic neuritis

目的研究双眼同时发病的视神经炎(optic neuritis,ON)患者的基线临床特征、血清免疫学指标及发病后12个月的预后和转归。方法回顾性分析解放军总医院以双眼同时发病为首发的ON患者,从中选择接受相同的激素冲击治疗方案的患者47例94眼。分析患者人口学特征、基线临床表现、免疫学指标、12个月内恢复程度及不良事件发生情况。结果47例患者中男12例,女35例;32例(68.1%)患者发病前半个月有明确诱因,30例(63.8%)患者合并眼球转动痛,73眼(77.7%)发病时视力小于0.1。17例(36.2%)患者血清抗AQP4抗体阳性,21例(44.7%)患者血清风湿免疫指标异常。19例患者12个月内发生不良事件,13例患者进展为中枢神经系统脱髓鞘疾病,以视神经脊髓炎多见。28例单次病程患者12个月后视力恢复较好。结论双眼同时发病的ON患者多存在免疫学指标异常,在发病后12个月内不良事件发生率较高,对于同时存在免疫学指标异常的患者不良事件的发生率更高。

Objective To study the clinical manifestations, abnormal of serum autoantibody, efficacy of steroid therapy and outcome in the following year of simulta- neous bilateral optic neuritis （ON）. Methods Patients with simultaneous bilateral ON as the first attack were retrospectively reviewed. Forty-seven patients （94 eyes） accept ed same treatment of intravenous methylprednisolone pulse therapy. Demographic data, clinical characteristics at baseline, abnormal of serum autoantibody, degree of prognosis in 12 months,and adverse events were analyzed. Results In 47 patients fulfilled the inclusion criteria,12 men and 35 women,32 cases （68.1%） with precipitating factors, 30 cases （63.8%） with pain on eye movement,73 eyes （77.7%） with visual acuity un der 0.1 at first. Seventeen patients （36.2%） manifested positive result of serum aqua porin-4 antibody ,21 cases （44.7%） with positive rheumatoid immune indexes. Nineteen patients had adverse event in the following 12 months, 13 cases had demyelinating dis ease of central nervous system, mainly neuromyelitis optica. Twenty-eight patients with a single course in 12 months had a good recover of visual acuity. Conclusion Simul taneous bilateral ON have more abnormalities of serum immune indices, and more ad verse events occur in following 12 months. For a single patient, more abnormalities of serum immune indices may lead to higher rate of adverse event.