OCT对多发性硬化与视神经脊髓炎谱系疾病患者视功能损伤的评价

Assessment of the damage to visual function by optical coherence tomography in patients with multiple sclerosis or neuromyelitis optica spectrum disorders

目的:利用光学相干断层扫描(OCT)检测复发缓解型多发性硬化(RRMS)与视神经脊髓炎谱系疾病(NMOSD)患者的视乳头周围视网膜神经纤维层(pRNFL)和黄斑区神经节细胞复合体(GCC)厚度,探讨疾病所致的视神经及轴突损伤情况。方法:回顾性病例对照分析。收集2014-08/2016-01首都医科大学附属北京天坛医院收治的RRMS患者60例、NMOSD-AQP4抗体阳性患者48例、NMOSD-AQP4抗体阴性患者35例及正常对照健康人群60例,通过OCT检测pRNFL(包括平均和上方、下方、鼻侧、颞侧四个象限)和GCC(包括平均和上方、下方两个象限)的厚度,采用单因素方差分析或秩和检验进行比较分析。结果:RRMS、NMOSD-AQP4抗体阳性及NMOSD-AQP4抗体阴性组pRNFL(平均和四个象限)及GCC厚度(平均和上方、下方)均较正常对照组减少,差异有统计学意义(P<0.01),其中NMOSD-AQP4抗体阳性组的pRNFL及GCC厚度最薄。组间pRNFL厚度比较:NMOSD-AQP4抗体阳性组与RRMS组相比,四个象限pRNFL厚度均明显变薄,差异有统计学意义(P<0.01);NMOSD-AQP4抗体阳性组与NMOSD-AQP4抗体阴性组相比,下方、鼻侧、颞侧象限pRNFL均更薄,差异有统计学意义(P<0.05),上方pRNFL厚度无统计学差异(P>0.05);NMOSD-AQP4抗体阴性组和RRMS组相比,上方pRNFL厚度更薄,差异有统计学意义(P<0.05),下方、鼻侧、颞侧象限pRNFL厚度上无统计学差异(P>0.05)。组间GCC厚度比较:NMOSDAQP4抗体阳性组上方、下方象限GCC厚度比RRMS组和NMOSD-AQP4抗体阴性组变薄明显,差异有统计学意义(P<0.05),NMOSD-AQP4抗体阴性组和RRMS组相比,上方GCC厚度更薄,差异有统计学意义(P<0.01),下方GCC厚度无统计学差异(P>0.05)。结论:NMOSD-AQP4抗体阳性患者的轴突损伤最明显,RRMS患者损伤最轻,而NMOSD-AQP4抗体阴性患者介于二者之间,且与RRMS更为相似。

AIM：To evaluate the optic nerve and axon impairment of relapsing - remitting multiple sclerosis （ RRMS） and neuromyelitis optica spectrum disorders （ NMOSD ） via detecting the peripapillary retinal nerve fiber layer （pRNFL） and the ganglion cell complex（ GCC） thickness by optic coherence tomography（OCT）. METHODS： Retrospective case control study. Two hundred three cases were collected from August 2014 to January 2016 in Beijing Tian Tan Hospital. They were divided into four groups, including the normal group （n=60）, the RRMS group （ n = 60 ）, the NMOSD anti -aquaporin- 4 autoantibody seropositive（ NMOSD- AQP4 -Ab seropositive） group （n= 48）, and the NMOSD-AQP4-Abseronegative group （n = 35）. All people were detected for the average and four quadrants （ superior, inferior, nasal, temporal） of pRNFL thickness and the average and two quadrants （superior, inferior） of GCC thickness with OCT. One way analysis of variance or nonparametric tests was used to compare the differences of pRNFL and GCC thickness between groups. RESULTS： Comparing with the normal group, the average and all quadrants of pRNFL and GCC thickness in the RRMS, the NMOSD - AQP4 - Ab seropositive and the NMOSD-AQP4-Ab seronegative group were thinner （P〈0. 01）. Among them, the pRNFL and GCC thickness in the NMOSD- AQP4 - Ab seropositive group was the thinnest. Differences between groups in the pRNFL thickness：compared with the RRMS group, all quadrants of pRNFL and GCC thickness in the NMOSD-AQP4-Ab seropositive group were significantly thinner（P〈0. 01）; compared with the NMOSD- AQP4- Ab seronegative group, the inferior, nasal and temporal pRNFL thickness in the NMOSD-AQP4-Ab seropositive group were significantly thinner（P〈0. 05）, while the superior quadrant did not show significant differences（ P 〉 0. 05）; compared with the RRMS group, the superior pRNFL thickness in the NMOSD - AQP4 - Ab seronegative group was significantly thinner （ P 〈 0. 05）, while the inferior, nasal and temporal quadrants did not show significant differences （ P 〉 0. 05 ）. Differences between groups in the GCC thickness： compared with both the RRMS and the NMOSD- AQP4- Ab seronegative group, all quadrants of GCC thickness in the NMOSD -AQP4-Ab seropositive group were significantly thinner （P〈0. 05）; compared with the RRMS group, the superior GCC thickness in the NMOSD - AQP4 - Ab seronegative group was significantly thinner（P〈0. 01）, while the inferior quadrant did not show significant difference（P〉0.05）. CONCLUSION： The optic nerve and axon impairment in NMOSD - AQP4 - Ab seropositive group was the most severe and the impairment in RRMS group was the least severe. The impairment in NMOSD - AQP4 - Ab seronegative group was between the former two, and could be more similar to that of RMMS.