口服糖皮质激素治疗急性期非动脉炎性前部缺血性视神经病变疗效观察

The effect of oral glucocorticoids on acute non-arteritic anterior ischemic optic neuropathy

目的观察口服糖皮质激素治疗急性期非动脉炎性前部缺血性视神经病变(NAION)的临床疗效。方法前瞻性临床研究。2017年12月至2020年6月于山东省滕州市中心人民医院眼科检查确诊的急性期NAION患者40例40只眼纳入研究。所有患眼均行最佳矫正视力(BCVA)、视盘光相干断层扫描(OCT)检查;BCVA≥0.1的35只眼同时行视野检查。BCVA检查采用国际标准小数视力表进行,统计时换算为最小分辨角对数(logMAR)视力。采用Humphrey全自动视野计行静态视野检查,获取视野平均缺损(MD)值。采用OCT仪测量患眼视盘周围视网膜神经纤维层(pRNFL)厚度。按照患者意愿分为激素治疗组和对照组。均给予维生素B1、甲钴胺口服治疗。激素治疗组给予口服醋酸泼尼松治疗,60 mg/d(不论体重);2周后每5天减少5 mg,减量至40 mg后维持至视盘水肿消退;其后快速减量至停药。治疗后3、6个月采用与治疗前相同的设备和方法行相关检查,观察患眼BCVA、视野MD值、pRNFL厚度变化。两组患眼间BCVA、视野MD值、pRNFL厚度比较采用Mann-Whitney U检验;组内患眼治疗前后BCVA、视野MD值、pRNFL厚度比较采用秩方差分析。结果40例40只眼中,激素治疗组21例21只眼,对照组19例19只眼;两组患者年龄、性别构成比、病程、伴随全身危险因素、BCVA、视野MD值、pRNFL厚度比较,差异均无统计学意义(P>0.05)。治疗后3、6个月,激素治疗组、对照组患眼平均logMAR BCVA分别为0.26±0.32、0.26±0.34和0.28±0.30、0.25±0.32;视野MD值分别为(-15.52±6.87)、(-15.55±6.04)dB和(-14.82±7.48)、(-15.18±6.40)dB;pRNFL厚度分别为(70.38±10.22)、(73.79±11.82)μm和(65.67±10.07)、(69.26±10.85)μm。两组患眼治疗后不同时间logMAR BCVA(Z=-0.014、-0.315,P=1.000、0.768)、视野MD值(Z=-0.041、-0.068,P=0.979、0.957)、pRNFL厚度(Z=-0.965、-1.112,P=0.347、0.270)比较,差异均无统计学意义。结论与对照组比较,口服糖皮质激素治疗急性期NAION,在6个月随访时间内患眼视功能及形态学预后未能获得改善。

Objective To observe the clinical efficacy of oral glucocorticoids in the treatment of acute non-arteritic anterior ischemic optic neuropathy(NAION).Methods A prospective clinical study.From December 2017 to June 2020,40 eyes of 40 patients with acute NAION who were diagnosed in Department of Ophthalmology of Tengzhou Central People's Hospital were included in the study.All the affected eyes underwent best corrected visual acuity(BCVA)and optical coherence tomography(OCT)examination of optic disc;35 eyes(BCVA≥0.1)underwent visual field examination at the same time.The BCVA examination was carried out using the international standard decimal visual acuity chart,which was converted into the logarithm of the minimum angle of resolution(logMAR)visual acuity during statistics.The static visual field inspection was performed with Humphrey automatic perimeter to obtain the average mean deviation(MD)value.The thickness of peripapillary retinal nerve fire layer(pRNFL)around the optic disc of the affected eye was measured with an OCT instrument.According to the wishes of patients,they were divided into hormone treatment group and control group.All were given vitamin B1 and methylcobalamin orally;the hormone treatment group was given oral prednisone acetate treatment,60 mg/d(regardless of body weight);after 2 weeks,the dose was reduced by 5 mg every 5 days,and the dose was reduced to 40 mg and maintained until optic disc edema subsides;thereafter,the dose was quickly reduced until the drug was stopped.Three and 6 months after treatment,the same equipment and methods were used for related examinations before treatment to observe the thickness changes of BCVA,MD,and pRNFL.The thickness of BCVA,MD,and pRNFL between the two groups was compared by Mann-Whitney U test.The thickness of BCVA,MD,and pRNFL before and after treatment within the group was compared by rank analysis of variance.Results Among 40 eyes of 40 cases,21 eyes were in the hormone treatment group,and 19 eyes were in the control group.There were differences in age,sex composition,course of disease,associated systemic risk factors,BCVA,MD,and pRNFL thickness between the two groups.There was no statistical significance(P>0.05).At 3 and 6 months after treatment,the average logMAR BCVA of the eyes of the hormone treatment group and the control group were 0.26±0.32,0.26±0.34,0.28±0.30,0.25±0.32,respectively.The visual field MD were-15.52±6.87,-15.55±6.04 dB and-14.82±7.48,-15.18±6.40 dB;pRNFL thickness was 70.38±10.22,73.79±11.82μm and 65.67±10.07,69.26±10.85μm.LogMAR BCVA(Z=-0.014,-0.315;P=1.000,0.768),visual field MD(Z=-0.041,-0.068;P=0.979,0.957),pRNFL thickness(Z=-0.965,-1.112;P=0.347,0.270),the difference was not statistically significant.Conclusion Compared with the control group,oral glucocorticoid treatment of acute NAION fail to improve the visual function and morphological prognosis during the 6-month follow-up period.