非典型视神经炎的诊断及治疗研究进展

Research advance on diagnosis and treatment for atypical optic neuritis

视神经炎（optic neuritis,ON）是导致青、中年人群视力丧失的最常见神经眼科疾病之一。以往简单地按照发病部位分类诊断,未从发病机制及临床特征区分,已不能满足目前临床诊疗需求。结合病因学、临床特征及预后,目前国际最新的分类诊断为典型ON及非典型ON。典型ON特指与多发性硬化（multiple sclerosis,MS）或中枢神经系统脱髓鞘疾病相关,治疗效果及预后相对良好。而非典型ON病因复杂,临床表现、治疗方法、预后亦不尽相同。目前国际上有多个ON治疗方面的Ⅰ级循证医学证据,但鉴于遗传背景、地理环境及种族不同,尚无定论。我国缺乏此类多中心、大样本、大范围的研究证据,我们对ON,特别是非典型ON的诊疗进展作一综述,为进一步提高其临床诊疗的规范化与个体化提供一些建议。

Optic neuritis（ ON） is one of the most common causes of vision loss by neural eye diseases in youth and middleaged. In the past,the diagnosis simply according to the risk position, which did not distinguish fromthe pathogenesis and clinical characteristics,can not meet the current clinical diagnosis and treatment needs.Combining with the etiology,clinical characteristics and prognosis, the latest classification of the current international diagnosis of ON are typical and atypical ON.Typical ON relates to multiple sclerosis（ MS） or demyelinating disease of the central nervous system,it has a relatively good therapeutic effect and prognosis.Rather than,atypical ON has complex etiology,clinical manifestation,and the treatment and prognosis are also different. At present there are many international ON treatment guidelines with level I evidence-based medical evidence, but with different genetic background,geographical environment and ethnic groups,they are not been determined. China lacks of such a multicenter large sample,a wide range of research evidence. In this paper,we will summarize the progress of the diagnosis and treatment about ON,especially about the atypical ON,in order to provide some suggestions to further improve the standardization and individualization for clinical diagnosis and treatment on ON.