糖皮质激素治疗外伤性视神经病变的效果及影响因素分析

Analysis of the efficacy and influencing factors of glucocorticoid in the treatment of traumatic optic neuropathy

目的分析糖皮质激素治疗外伤性视神经病变(TON)的效果及影响因素。方法回顾性病例对照研究。以山西医科大学第一医院2020年5月至2021年11月TON 86例(86眼)作为研究对象, 患者分为糖皮质激素脱水治疗组(46例)和甘露醇脱水治疗组(40例)。比较两组疗效及影响因素。结果糖皮质激素治疗组疗效良好率为95.65%(44/46), 高于甘露醇治疗组的60.00%(24/40)(χ2=8.23, P<0.05)。以疗效进行亚分组, 单因素分析中, 疗效良好与疗效不佳在治疗方式(OR=9.20, 95%CI:1.26~67.34, P<0.05)、视神经管骨折(OR=8.08, 95%CI:1.93~33.76, P<0.001)、F-VEP(OR=0.70, 95%CI:0.55~0.89, P=0.026)方面差异有统计学意义(P<0.05)。多因素有序回归中得到疗效的影响因素是治疗方式。结论糖皮质激素治疗TON效果显著, 但是其疗效会受到多种因素的影响, 临床需加以注意。

Objective To analyze the efficacy and influencing factors of glucocorticoid in the treatment of traumatic optic neuropathy(TON).Methods This was a retrospective case control study.A total of 86 eyes of 86 cases of TON from May 2020 to Nov.2021 in the First Hospital of Shanxi Medical University were collected as the research subjects.These patients were divided into the glucocorticoid treatment group of 46 cases and the mannitol treatment group of 40 cases.The efficacy and influencing factors between the two groups were compared.Results The effective rate of treatment in the observation group was 95.65%(44/46),which was higher than the 60.0%(24/40)in the mannitol treatment group,and the difference was statistically significant(χ^(2)=8.23,P<0.05).Patients were divided into subgroups based on the efficacy.In univariate analysis,the difference of good and poor efficacy were statistically significant in the treatment method(OR=9.20,95%CI:1.26-67.34,P<0.05),optic canal fracture(OR=8.08,95%CI:1.93-33.76,P<0.001),F-VEP(OR=0.70,95%CI:0.55-0.89,P=0.026).In the multivariate ordinal regression,the influencing factors for the efficacy of treatment were the treatment methods.Conclusion Glucocorticoids have a significant efficacy in the treatment of TON,but the efficacy will be affected by a variety of factors,and clinical attention should be paid to.