麦考酚酸酯治疗AQP4抗体阳性视神经炎疗效观察

Efficacy of mycophenolate mofetil for AQP4 antibody positive optic neuritis immunotherapy

目的:评价麦考酚酸酯(MMF)对AQP4抗体阳性视神经脊髓炎谱系障碍(NMOSD)患者预防复发和视力预后的作用。方法:回顾性病例研究。收集2017-01/2019-12收治的AQP4抗体阳性NMOSD患者11例,其中男3例,女8例。NMOSD特有的重要临床表现为视神经炎。发病平均年龄36.3±6.0(27~47)岁,平均病程3.4±1.4(2.2~6.8)a。在NMOSD缓解期加用MMF 1a或1a以上。记录应用MMF患者的年复发率(ARR)、最佳矫正视力(BCVA)和不良反应。结果:MMF治疗的中位时间为18(12,36)mo。ARR在基线时为0.66/a,治疗后为0.16/a。91%的患者ARR下降,82%的患者无临床复发。MMF治疗后ARR明显改善(P<0.05)。治疗后平均BCVA与治疗前比较无显著差异(P>0.05)。11例患者中,3例(27%)出现不良反应,其中1例(9%)出现转氨酶升高,2例(18%)出现轻度胃肠道反应。没有因不良反应而停用MMF的情况。结论:MMF治疗AQP4抗体阳性NMOSD患者能在一定程度上降低其视神经炎的ARR,保护患者的视功能。

AIM:To evaluate the efficacy of mycophenolate mofetil(MMF)on the prevention of relapse and visual prognosis of patients in neuromyelitis optica spectrum disorders(NMOSD)with AQP4 antibody positive optic neuritis.METHODS:We retrospectively reviewed 11 patients with initial diagnosis of NMOSD and AQP4 antibody positive optic neuritis from January 2017 to December 2019.Among the 11 patients,3 were male and 8 were female.The unique core clinical manifestation of NMOSD was optic neuritis.The onset age was 36.3±6.0(27-47)years old.Duration of the disease was 3.4±1.4(2.2-6.8)a.MMF was added in the relieving period of NMOSD for 1a or over 1a.Annualized relapsing rate(ARR),best corrected vision activity(BCVA)and adverse reactions of MMF were recorded.RESULTS:The median time of MMF treatment was 18(12,36)mo.The ARR was 0.66/a at baseline and 0.16/a after the treatment.There were 91%of the patients had decreased ARR and 82%of them had no clinical relapse.The patients had significant improvement on ARR after MMF treatment(P<0.05).In total,there was no significant difference between the mean BCVA after treatment and that at baseline(P>0.05).Of the 11 patients,3 patients had side effects(27%),including 1 patient with elevated liver transaminase(9%),and 2 patients with mild gastrointestinal reaction(18%)during follow-up period.None of them discontinued MMF due to adverse events.CONCLUSION:MMF treatment for AQP4 antibody positive NMOSD can reduce the ARR of optic neuritis to a certain extent and protect the visual function of patients.