RNFL厚度检测在不同类型特发性视神经炎鉴别诊断中的应用

The application of retinal nerve fibre layer thickness detection in early differential diagnosis among various types of idiopathic optic neuritis

目的探讨视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度检测在不同类型特发性视神经炎(ION)鉴别诊断中的应用。方法回顾性收集2012-09—2017-09复旦大学附属华山医院神经内科和眼科收治的不同类型ION患者83例,其中首发症状仅为视神经炎的多发性硬化(MS-ON)患者18例,视神经脊髓炎谱系病(NMOSD-ON)患者45例,其他脱髓鞘相关性视神经炎(O-ION)20例,另收集19名健康志愿者作为对照(HC组)。采用光学相干断层成像术(OCT)检测并比较各组眼RNFL厚度的差异,同时比较AQP4-IgG阳性和阴性NMOSD-ON患者受累眼RNFL厚度的差异。结果 MS-ON、NMOSD-ON和O-ION的平均RNFL厚度及各象限RNFL厚度均较HC组显著变薄(P<0.01),且NMOSD-ON患者鼻侧象限RNFL厚度较MS-ON和O-ION组变薄(P<0.05)。AQP4-IgG阳性NMOSD-ON患者下侧象限RNFL厚度较AQP4-IgG阴性者薄(P<0.05)。MS-ON无视神经炎表现的眼(非受累眼)平均及各象限RNFL厚度与HC组比较差异无统计学意义(P>0.05)。结论 NMOSD-ON鼻侧RNFL厚度较MS-ON和O-ION显著变薄,可能有助于不同类型ION的鉴别。

Objective To explore the application of retinal nerve fibre layer（RNFL）thickness detection in differential diagnosis among various types of idiopathic optic neuritis（ION）.Methods Data of RNFL thickness of 83 patients with ION at Huashan Hospital affiliated to Fudan University from September 2012 to September 2017 were retrospectively analyzed,including 18 multiple sclerosis patients（MS-ON）,45 patients with neuromyelitis optica spectrum disorders（NMOSD-ON）,and 20 patients with other idiopathic optic neuritis（O-ION）.19 healthy volunteers were collected as controls.Optical coherence tomography（OCT）was used to detect the RNFL thickness in all the subjects.The results were compared between MS-ON,NMOSD-ON and OION,while RNFL thicknesses of AQP4-IgG＋and AQP4-IgG-NMOSD patients were also compared.ResultsIn each quadrant RNFL thicknesses of MS-ON,NMOSD-ON and O-ION groups were thinner than those of HC（P〈0.01）.RNFL thicknesses of unaffected eyes of MS-ON were not different from those of HC（P〈0.05）.In comparison with MS-ON and O-ION,NMOSD-ON had thinner nasal RNFL（P〈0.05）.There were no difference of RNFL thickness between MS-ON and O-ION patients（P〈0.05）.NMOSD-ON patients with positive AQP4-IgG had thinner inferior RNFL than those with negative AQP4-IgG（P〈0.05）.ConclusionsNMOSD-ON patients has a significantly thinner nasal RNFL thickness than MS-ON and O-ION patients,which may contribute to the clinical differentiation among various types of idiopathic optic neuritis.