儿童视神经炎临床特点及预后分析

Clinical features and outcome of pediatric optic neuritis

目的探讨儿童视神经炎的发病特点，为视神经炎患儿的诊疗及护理提供依据。设计回顾性病例系列。研究对象2010年1月1日至2012年12月31日就诊于解放军总医院的75例（124眼）儿童视神经炎患者。方法回顾性分析75例（124眼）儿童视神经炎患者的病例资料，记录其发病诱因、发病特点、临床表现，分析其临床特点。跟踪随访6～42个月，进一步分析其预后及转归。主要指标发病诱因、临床表现、复发率及预后。结果人组患者平均年龄（10．67±3．57）岁，其中女性56例（74．67％），29例（38．67％）患者发病前有明确诱因。所有患者发病以来均有不同程度的视力下降，49例（65．33％）患者双眼同时或先后发病。32例（42．67％）患者发病时伴有眼痛或眼球转动痛。所有患者发病眼视盘均有不同程度颜色变淡并与发病时间有关，约51．52％的患者病情复发，但近70％的患者视力恢复〉0．5。分别有4例（6．78％）及9例（15．25％）患者转变为多发性硬化及视神经脊髓炎。结论儿童视神经炎以严重的视力下降、双眼发病为主及良好的预后为特点；年龄偏大的女性患者较易转变为视神经脊髓炎。

Objective To study the characteristics of pediatric optic neuritis for the better treatment and nursing for them. Design Retrospective case series. Participants 75 cases （124 eyes） with pediatric optic neuritis （〈16 years） from Jan. 2010 to Dec. 2012 in General Hospital of PLA. Methods Retrospective analysis of clinical data of 75 cases （124 eyes） with pediatric optic neuritis was conducted, collecting and analyzing their predisposing factors, clinical features. The follow-up was for 6-42 months to get further analysis for their prognosis and outcomes. Main Outcome Measures Predisposing factors, clinical features, and prognosis. Results The mean age of scheduled patients was 10.67±3.57 years, with 56 females （74.67%） . 29 patients （38.67%） had causes before onset, and all patients had different levels of vision loss. 49 patients （65.33%） exhibited bilateral diseases. In total, 32 patients （42.67%） had eye pain or eye pain with movement. All children followed up exhibited optic disc pallor. 51.52% of patients had recurrent optic neuritis, but visual acuity had recovered to 0.5 in 70% of patients. The final diagnosis of these patients were 4 multiple sclerosis （6.78%） and 9neuromyelitis optica （15.25%）. Conclusion The clinical characteristics of pediatric optic neuritis were severe bilateral vision loss and complete recovery. Compared with developing multiple sclerosis, female and older patients were in the risk of developing neuromyelitis optica.