血浆置换治疗难治性视神经炎急性期患眼的视力预后

Visual improvement of therapeutic plasma exchange for refractory optic neuritis patients in acute phase

目的观察治疗性血浆置换(TPE)治疗难治性视神经炎(ON)急性期患眼的视力预后。方法2015年1月至2016年8月在中国人民解放军总医院神经眼科诊治的难治性ON患者44例75只眼纳入研究。其中,男性11例,女性33例;平均年龄(39.1±13.9)岁。双眼发病31例,单眼发病13例。所有患眼存在严重视功能下降或糖皮质激素冲击治疗后视功能无明显改善;病程超过2周,视力恶化时间超过10 d,2周后仍持续恶化。对所有患眼行TPE治疗。记录患者治疗前及治疗后24 h的BCVA,并采用视功能评分标准对患眼BCVA进行评分。同时观察TPE治疗的不良反应发生情况。治疗前后视力评分比较采用配对t检验,治疗前后视力评分的相关性采用Linear-by-Linear相关分析。结果75只眼治疗前后平均视力评分分别为(5.56±1.69)、(3.89±2.13)分。治疗前后平均视力评分比较,差异有统计学意义(t=6.77,P<0.001)。75只眼中,视力评分至少提高1分48只眼,即总体视力提高率为64.0%;尤以初始视力为光感的患者疗效显著,视力提高率为82.4%;初始视力为数指的患者,视力提高率75.0%;初始视力为无光感的患者,视力提高率为67.7%。Linear-by-Linear相关分析结果显示,治疗前后视力评分变化呈显著线性相关(r=0.398,P=0.01)。TPE治疗过程中5例出现低钙反应、过敏反应等轻度不良反应,给予相应纠正后控制良好。结论TPE治疗难治性ON急性期可提高患眼视力。

Objective To evaluate the visual improvement of therapeutic plasma exchange (TPE) for refractory optic neuritis (ON) patients in acute phase. Methods Seventy-five affected eyes from 44 refractory ON patients with severe visual defect or resistance to high-dose intravenous methylprednisolone (IVMP) therapy, who were admitted to The Chinese PLA General Hospital between January 2015 and August 2016, were recruited and received TPE therapy. Among these patients, 11 were male and 33 were female;the average age was 39.1±13.9;31 patients had two affected eyes, 13 patients had one affected eye. The course of the disease on the group of patients were more than 2 weeks, and the visual acuity worsened for more than 10 days and continued to deteriorate. TPE treatment was performed on all of the patients. BCVA was recorded before and 24 h after treatment, and the visual function was scored using visual outcome scale (VOS). At the same time, the adverse reactions of TPE treatment were observed. The paired t-test was used to compare the VOS before and after treatment. The correlation between VOS before and after treatment was analyzed by Linear-by-Linear correlation analysis. Results Among 75 affected eyes, the post-therapy VOS 3.89±2.13 was significantly improved from pre-therapy VOS 5.56±1.69 (t=6.77, P<0.001). Forty-eight of 75 eyes were improved at lease 1 score of VOS, the overall rate of visual improvement was 64.0%. Especially among the eyes with initial vision of light perception, an improved rate of 82.4% was presented. 75.0% in those eyes with initial vision of count fingers and 67.7% in no light perception. Linear-by-Linear correlation analysis showed a significant linear correlation between the scores of VOS before and after TPE treatment (r=0.398, P=0.01). During the course of TPE treatment, 5 patients had mild adverse reactions such as low calcium reaction and allergic reaction and were well controlled after treatment. Conclusion Using TPE to treat refractory ON in acute phased can improve the visual function of patients.