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急性双眼重症视神经炎临床免疫特征及视功能转归预测因素 被引量:5

Clinical and immunological characteristics and predicted factors of vision outcome in patients with acute severe bilateral optic neuritis
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摘要 目的分析急性双眼重症视神经炎的临床及免疫学特征,探讨其视功能转归及复发的可能预测因素,为最大可能地挽救视力,避免或减轻残疾提供参考。方法回顾并随访2013年1月至2015年6月间,在北京同仁医院神经内科就诊并入院治疗的急性双眼重症视神经炎患者48例。观察其临床特征、免疫学状态、神经影像学特征,并对影响视功能转归及复发的预测因素进行统计学分析。结果急性双眼重症视神经炎占同期视神经炎总数的7.3%;在随访期内无复发者35例(72.9%),有复发或出现其他中枢结构受累者13例(27.1%);48例患者中AQP4-IgG阳性者11例(22.9%),相较于抗体阴性的双眼重症视神经炎,AQP4-IgG阳性者有更高的年复发率(P〈0.001)和更差的视功能预后(P=0.034);疾病达峰时视力水平(P=0.004)、急性期治疗反应(P=0.012)、视神经受累节段数(P:0.016)与视功能的随访终点预后独立相关;AQP4-IgG阳性(OR13.486,95%CI1.971-16.263)、合并自身免疫抗体(OR5.591,95%CI1.502-15.621)与复发独立相关。结论急性双眼重症视神经炎致残致盲率高,临床并不少见。本组患者AQP4-IgG阳性率较低,在随访期内的复发率也较低,是否需要长期免疫治疗需要个体化考虑。疾病达峰时视力、视神经受累节段数、早期治疗反应与视功能的预后有关,AQP4-IgG阳性与复发有关。抗体阴性的双眼重症视神经炎是否为异质性疾病,以及与经典的NMO或NMOSD的关系值得进一步研究。 Objective To analyze the clinical and immunological characteristics of acute severe bilateral optic neuritis, and to explore the predictive factors of vision outcome and relapse so as to save visual function and avoid or alleviate vision disability. Methods Forty-eight inpatients confirmed with acute severe bilateral optic neuritis from January 2013 to June 2015 were included and followed up. The clinical features, immunological findings, optic nerve imaging, visual function outcome and predictors of relapse were statistically analyzed. Results Acute severe bilateral optic neuritis accounted for 7.3% of the total number of optic neuritis in the same period. There were 35 cases (72. 9% ) with monophasie course, and 13 cases (27. 1% ) with recurrence or other central nervous system involvement during the follow-up period; 11 (22. 9% ) in 48 patients with positive AQP4-IgG; AQP4-IgG-positive patients had a higher recurrence rate ( P 〈 0. 001 ) and poorer visual function prognosis ( P = 0. 034 ) than antibody-negative patients ; the baseline visual acuity ( P = 0. 004 ), early treatment response ( P = 0. 012 ) and number of involved optic nerve segments (P = 0. 016) were associated with end point visual function. Positive AQP4-IgG( OR 13.486,95% CI 1. 971 - 16. 263 ) and eombining with other autoimmune antibodies ( OR 5. 591, 95% CI 1. 502 - 15. 621 )were independently assoeiated with relapse. Conclusions Aeute severe bilateral optic neuritis is not unusual and may cause blindness or visual disability. The positive rate of AQP4-IgG and the reeurrence rate of the disease are low in our study. The necessity for long-term immunotherapy requires individual consideration. The baseline visual acuity, involved segment number of optic nerve and response to early treatment are associated with prognosis of visual funetion. Patients with AQP4-IgG positive and other autoimmune antibodies are easy to relapse. Whether the antibody-negative bilateral optic neuritis is a heterogeneous diseas
作者 孙厚亮 崔世磊 刘磊 孟超 江汉秋 张晓君 王佳伟 Sun Houliang;Cui Shilei;Liu Lei;Meng Chao;Jiang Hanqiu;Zhang Xiaojun;Wang Jiawei.(Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China)
出处 《中华医学杂志》 CAS CSCD 北大核心 2018年第21期1674-1678,共5页 National Medical Journal of China
关键词 视神经炎 视神经脊髓炎谱系疾病 水通道蛋白4 视力 Optic neuritis Neuromyelitis optic spectrum disorder AQP4 Vision
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