髓鞘少突胶质细胞糖蛋白抗体阳性视神经炎临床特征及预后分析

Clinical features and prognosis analysis of myelin oligodendrocyte glycoprotein antibody-positive optic neuritis

目的分析髓鞘少突胶质细胞糖蛋白(MOG)抗体阳性视神经炎的临床特征和预后。方法回顾性收集2017年1月1日至2019年10月31日首都医科大学附属北京同仁医院神经内科MOG抗体阳性视神经炎患者39例的资料,男25例,女14例,年龄15~80(40±16)岁,根据复发情况分为复发组(n=12)与非复发组(n=27),对其临床表现、复发相关因素、磁共振成像(MRI)表现、治疗及预后情况进行分析。结果共累及眼别63只眼,其中视神经周围炎(OPN)30只,占47.6%(30/63);发作次数1~9次,其中12例发作≥2次。发病时重度视力损害(SVL)有37只眼[58.7%(37/63)],最终随访视力SVL有7只眼[11.1%(7/63)]。视盘水肿48只眼[76.2%(48/63)];视神经MRI长节段病变47只眼[74.6%(47/63)]。1例合并无菌性脑膜炎和脑炎。复发组比非复发组年龄小[(28.5±9.8)岁比(43.3±16.4)岁,P=0.001];两组的性别、是否双侧发病、最初视力、最终视力、视盘是否水肿、头和脊髓是否有病灶以及是否加免疫抑制剂等相比较,差异均无统计学意义(均P>0.05)。所有的患者急性发作期均予甲泼尼龙(MP)冲击治疗,16例加用免疫抑制剂;应用糖皮质激素后疼痛均明显减轻或缓解。结论MOG抗体阳性视神经炎多双眼同时发病,常表现为OPN,多伴视盘水肿,病初视力损害重,但大多视力恢复较好。可能合并脑膜炎和脑炎。视神经MRI显示病变常表现为长节段病变。糖皮质激素可减轻疼痛和促进视功能的恢复。

Objective To investigate the clinical characteristics and prognosis of myelin oligodendrocyte glycoprotein(MOG)antibody-positive optic neuritis(ON).Methods The data of 39 patients with MOG antibody-positive ON in the Department of Neurology of Beijing Tongren Hospital,Capital Medical University from January 1,2017 to October 31,2019 were retrospectively collected.There were 25 males and 14 females,aged from 15 to 80(40±16)years.According to the recurrence,the patients were divided into two groups:the recurrence group(n=12)and the non-recurrence group(n=27).The clinical manifestations,relapse-related factors,magnetic resonance imaging(MRI)manifestations,treatment and prognosis of the two groups were analyzed.Results A total of 63 eyes were involved,including 30 cases of optic perineuritis(OPN),accounting for 47.6%(30/63).The number of attacks ranged from 1 to 9,among which 12 patients had more than 2 attacks.There were 37 eyes[58.7%(37/63)]with severe visual loss(SVL)at the time of onset,and 7 eyes[11.1%(7/63)]with SVL at the final follow-up.Forty-eight eyes[76.2%(48/63)]had optic disc edema.Forty seven eyes[74.6%(47/63)]showed long-segment disease on optic nerve MRI.One case was complicated with aseptic meningitis and encephalitis.The recurrence group was younger than the non-recurrence group[(28.5±9.8)years vs(43.3±16.4)years,P=0.001].There were no statistically significant differences between the two groups in gender,bilateral onset,initial visual acuity,final visual acuity,optic disc edema,head and spinal cord lesions,and immunosuppressant(all P>0.05).All patients were treated with methylprednisolone(MP)pulse therapy during the acute attack,and 16 of them were additively treated with immunosuppressive agents;the pain was alleviated or relieved significantly after the application of glucocorticoids.Conclusions MOG antibody-positive ON often occurred in both eyes at the same time,often manifesting as OPN,often accompanied by optic disc edema,and SVL at the beginning of the disease,but most of the visual recovery was good,might be associated with meningitis and encephalitis.MRI of the optic nerve showed that the lesions often manifested as long-segment lesions.Glucocorticoids could alleviate pain and promote the recovery of visual function.