儿童急性视神经炎的临床特征和疗效分析

Clinical features and therapeutic effect of acute pediatric optic neuritis

目的:探讨儿童急性视神经炎的临床特征和糖皮质激素大剂量冲击治疗的疗效。方法:收集2006-06/2014-06南京医科大学附属南京儿童医院眼科收治的58例16岁以下急性视神经炎患儿的临床资料,研究大剂量甲基强的松龙冲击治疗前后患眼视力、眼底检查和瞳孔大小等变化情况,以评估治疗的效果。结果:患儿58例有103眼患病,病因明确与感染有关占55.2%,1例2眼进展为播散性脑脊髓炎,其余病因不明。治疗3mo后80.5%患眼视力恢复到0.7以上,其中约2/3视力恢复到1.0以上,低于0.1的仅为3.9%;治疗1mo时视力、视野、VEP检查结果均显示无改善者2眼(1.9%),激素大剂量冲击治疗的治愈率60.2%,总体有效率为98.1%。结论:在儿童视神经炎中,感染是首发病因,应用大剂量糖皮质激素冲击治疗效果显著,值得推广。

AIM：To investigate the clinical features of acute pediatric optic neuritis and the therapeutic effect of high —dose methylprednisolone pulse therapy.·METHODS：Fifty-eight cases with acute pediatric optic neuritis hospitalized in the ophthalmological department of Nanjing Children＇s Hospital Affiliated to Nanjing Medical University from June 2006 to June 2014 were enrolled.The therapeutic effect of high- dose methylprednisolone pulse therapy for the patients below16 was evaluated using comparison of changing of effected eyes＇ sights,fundus examination and pupil size between pre- and post-therapy.·RESULTS：Among the 58 cases,103 eyes got acute pediatric optic neuritis,while 55.2%etiological factors were clearly related to infect.One child（2 eyes）developed to disseminated encephalomyelitis and others unclear.The visual acuity recovered up to 0.7 in 80.5%patients,including almost 2/3 eyes were ≥1.0,while only3.9%of them were ≤0.1 at 3mo after the therapy.Only two eyes did not show a significant improvement in visual acuity,visual fields and visual evoked response at 1mo after the therapy,reaching a frequency of 1.9%.The recovery rate of high-dose glucocorticoid pulse therapy was 60.2%,while the general effective rate was 98.1%.·CONCLUSION：Infection is the main cause of pediatric optic neuritis.The therapeutic effect of high- dose glucocorticoid pulse therapy is significant,and is valuable to spread.