视神经炎67例临床特征分析

Clinical characteristics of 67 cases of optic neuritis

目的分析视神经炎患者的临床和流行病学特征,为临床诊疗提供思路。方法回顾分析2017年1月1日至12月30日在山西省眼科医院眼底病科确诊为特发性脱髓鞘性视神经炎的患者67例85只眼。记录患者的人口学特征、最佳矫正视力、眼压等眼科常规检查、视觉诱发电位(VEP)、视盘光学相干断层扫描(OCT)和视野等眼科检查、眼眶磁共振成像(MRI)检查、血清学检查、视神经脊髓炎抗体结果,并分析其临床特征。结果发病年龄7～69岁,平均年龄(40±16)岁,双眼发病者18例(26.9%);男性24例30眼(35.8%);女性43例55眼(64.1%); 15例抗NMO抗体阳性,6例抗MOG抗体检查阳性,2例抗核抗体检查阳性。57.7%患眼视力损伤程度达4级及以上。VEP异常表现为潜伏期延长,波幅降低。视野异常多表现为弥散性绝对及相对暗点。67例患者眼眶MRI均发现异常,表现为视视神经不同节段的形态信号异常,长T2信号和T1增强扫描可见强化,有1例患者呈现大脑半球脱髓鞘病变。67例患者中,抗体检查阴性者44例,15例抗NMO抗体阳性,6例抗MOG抗体检查阳性,2例抗核抗体检查阳性。结论视神经炎严重影响患者视功能,眼眶MRI可以作为视神经炎诊断和鉴别诊断的一种方法。VEP结合视野检查将有助于更准确的评估视神经的病变损伤程度。视神经脊髓炎抗体和自身免疫性抗体的检测可评估患者的预后及发现相关的全身疾病。

Objective To determine the clinical and epidemiological characteristics of patients with optic neuritis, and to provide evidences for clinical diagnosis and treatment. Methods The clinical data of 67 patients, who were diagnosed with idiopathic demyelinating optic neuritis in the Department of Ophthalmology, Shanxi Provincial Eye Hospital between January 1, 2017 and December 30, 2017 were retrospectively analyzed. The routine ophthalmic examinations (demographic characteristics, best corrected visual acuity and intraocular pressure), ophthalmologic examinations (VEP, optic disc OCT and visual field), orbital MRI examination, serological examination, and results of optic neuromyelitis antibody were recorded, and the clinical characteristics were analyzed. Results The age of onset was 7~69 years old, and the average age was (40±16) years old. Eighteen cases (26.9%) were diagnosed with lesions at both eyes, including 35.8% males (n=24, 30 eyes) and 64.1% females (n=43, 55 eyes). There were 15 cases of positive anti-NMO antibody, 6 of positive anti-MOG antibody, and 2 of positive anti-nuclear antibody. 57.7% patients were diagnosed with visual impairment of grade 4 or above. VEP abnormalities showed increase in latency and decrease in amplitude. The abnormal field of view was mostly expressed as diffuse absolute and relatively dark spots. The orbital MRI showed abnormal findings in 67 patients, as reflected by abnormal morphological signals in different segments of the optic nerve. The enhanced scan showed enhancement of long T2 signal and T1 signal. One patient presented with demyelination of the cerebral hemisphere. Of the 67 patients, 44 were negative for antibody test, 15 were positive for anti-NMO antibody, 17 were positive for anti-MOG antibody, and 2 were positive for anti-nuclear antibody. Conclusion Optic neuritis seriously affects patients′ visual function. The orbital MRI may be used as a method for the diagnosis and differential diagnosis of optic neuritis. VEP combined with visual field examination will favor more accurately assessment on the level of lesion damage in optic nerve. Determination of optic neuromyelitis antibodies and autoimmune antibodies may assess the prognosis and identify the related systemic diseases.