视神经脊髓炎谱系疾病眼球扫视运动异常情况及其临床意义

Saccadic abnormalities and clinical significance in patients with neuromyelitis optica spectrum disorder

目的了解视神经脊髓炎谱系疾病(NMOSD)患者的眼球扫视运动异常情况,探讨眼球扫视运动异常与NMOSD整体残疾状态及视功能状态的关系。方法连续入选于2015年7月至2017年7月间,在首都医科大学附属北京同仁医院神经内科就诊的110例NMOSD患者,采用120 Hz空间分辨率红外视频眼震图系统,进行双眼定量水平扫视运动检查。运用扩展的残疾状态量表(EDSS)对所有入组NMOSD患者进行整体残疾状态评估。运用国立眼科研究院视功能问卷(NEI-VFQ 25)和10项神经眼科补充问卷(Suppl.10),来评估所有入组患者的主观视觉功能状态。结果110例NMOSD中共有68例(61.8%)有水平扫视眼球运动异常,其中扫视潜伏期异常者50例(45.5%),扫视精确度异常者34例(30.9%),扫视速度异常者22例(20.0%)。眼球水平扫视运动异常者较正常者具有更多的颅内病变(P=0.006);扫视运动异常者的EDSS评分显著高于眼球运动正常者(P<0.001)。扫视异常患者比正常患者视功能问卷Supp.10综合分值更低(P=0.004),而NEI-VFQ 25综合分值二者差异无统计学意义(P=0.079)。结论NMOSD患者水平扫视眼球运动异常常见,具有水平扫视异常的患者整体残疾状态及视功能相关生活质量更差。定量水平扫视眼球运动检查可提供患者脑部病变和神经功能损伤的重要信息,临床上应重视NMOSD扫视运动的检查。

Objective To characterize the ocular saccadic abnormality in neuromyelitis optica spectrum disorder(NMOSD)patients,and explore the relationship between ocular saccadic abnormality and the overall disability and visual function state.Methods For the 110 consecutive NMOSD patients who visited the Department of Neurology of Beijing Tongren Hospital from July 2015 to July 2017,a 120 Hz spatial resolution infrared video nystagmus system was used to perform a quantitative horizontal saccade examination.All patients were assessed for overall disability status using the extended disability status scale(EDSS).The subjective visual function status was evaluated using the National Eye Institute-Visual Function Questionnaire(NEI-VFQ 25)and the 10-item neuro-ophthalmic supplement questionnaire(Suppl.10).Results A total of 68(61.8%)of 110 NMOSD patients had horizontal saccadic abnormalities,including 50 cases(45.5%)with abnormal saccade latency,34 cases(30.9%)with abnormal saccade accuracy and 22 cases(20.0%)with abnormal speed.Patients with abnormal saccade had more intracranial lesions and higher EDSS scores than those with normal eye movements(P=0.006 and P<0.001,respectively).Patients with abnormal saccade had lower Supp.10 scores than the normal patient(P=0.004),while there was no significant difference of NEI-VFQ 25 scores between the two groups(P=0.079).Conclusions The horizontal saccadic abnormality is common in the NMOSD patients,and the overall disability status and visual function-related quality of life are worse.Quantitative horizontal saccade examination can provide important information on intracranial lesions and neuronal function impairment,and thus it should be emphasized in clinical settings.