不同年龄段特发性视神经炎的临床特征和转归

Clinical characteristics and turnover of idiopathic demyelinated optic neuritis in patients of different ages

目的 了解不同年龄段特发性脱髓鞘性视神经炎的临床特征及转归.方法 收集2009年5月~2010年12月就诊于解放军总医院确诊为特发性脱髓鞘性视神经炎的137例患者的临床资料,按年龄分为：A组（≤18岁）、B组（19~45岁）和C组（≥46岁）.结果 A组男女比例为1：1,B组和C组男女比例之比分别为1：1.8和1：1.7;B组32.8%患者伴有眼球转动痛或头痛,比例高于其他两组;球后视神经炎和视神经乳头炎的比例3组相近;A组、B组、C组分别为73.1%、56.2%、45%,患者预后视力＞0.5,3组比较差异具有显著性（P＜0.05）.视力预后,3组相比,A组较好,B组稍差,C组最差.B组女性且双眼发病患者中,水通道蛋白-4（AQP-4）阳性率高于其他两组（P＜0.05）.在2年的随访中,A组6例AQP-4阳性中,1例发展视神经脊髓炎（NMO）,1例发展为多发性硬化（MS）;B组13例AQP-4阳性中,4例发展为NMO.结论 低年龄组患者视神经炎视力预后较好;中年龄组女性视神经炎患者AQP-4检测阳性率高,发展为NMO的几率也较高;应该重视IDON视神经炎患者AQP-4的检测,以达到早期发现和及时治疗的目的.

Objective To investigate the clinical characteristics and turnover of idiopathic demyelinated optic neuritis（IDON） in patients of different ages. Methods The clinical data of 137 patients who were diagnosed as IDON in the general hospital of PLA between May 2009 and December 2010 were collected and divided into three groups according to their ages ： group A（ ≤ 18 years old）, group B（ between 19 and 45 years old）, and group C （ ≥46 years old）. Results The ratio of male to female in group A was 1：1, and the ratios in group B and C were 1 ： 1.8 and 1 ： 1.7, respectively. There were 32.8% of the patients in group B who had the complication of oculogyria pain or headache, and the proportion was higher than those in the other two groups. The proportions of patients with retrobulbar optic neuritis and papillitis in the three groups were close to each other. There were respectively 73.1% ,56.2% ,and 45% of patients whose sight was recovered to more than O. 5, and the differences among the three groups were significant （P 〈 O. 05 ）. As to the sight prognosis,group A was the best, and the next was group B and C. In group B, the female patients with both ill eyes had ahigher rate of positive AQP4 than the females in the other two groups （P 〈 0.05）. During the two-year follow-up, among the 6 cases of positive AQP-4, there was one case developed into neuromyelitis optica（NMO）and one developed into multiple sclerosis （MS）. Among the 13 case of positive AQP-4,there were 4 developed into NMO. Conclusion The patients in the lower age group have a better eye sight prognosis. Women with optic neuritis in the middle-age group have a high ratio of positive AQP4 and also a higher probability of NMO. The detection of AQP4 must be paid great attention in the patients with IDON for an early discovery of the disease and timely treatment.