双侧视盘肿胀的病因构成及临床特征分析  

An analysis of the etiology composition and clinical characteristics of bilateral optic disc swelling

作　　者：汪晓楠[1] 王佳伟[1] Wang Xiaonan;Wang Jiawei(Department of Neurology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院神经内科,北京100730

出　　处：《中华医学杂志》2024年第1期31-37,共7页National Medical Journal of China

摘　　要：目的探讨双侧视盘肿胀(ODS)患者的病因构成及临床特征。方法回顾性检索2017年1月至2021年6月北京同仁医院神经内科病房收治的所有初诊为双侧ODS患者的医疗记录,进行病因分类并获得人口统计学和临床信息,比较临床特征的差异。结果共纳入双侧ODS 131例,男56例,女75例,年龄15~73(39±14)岁。双侧ODS最常见的病因是颅内压增高(56/131,42.7%),其次是视神经炎(ON)(40/131,30.5%),其他的病因包括血管性视神经病变(13/131,9.9%)、假性视乳头水肿(9/131,6.9%)、葡萄膜炎(6/131,4.6%)、中毒性视神经病(3/131,2.3%),不明原因占4/131(3.1%)。特发性颅高压(IIH)(43/56,76.8%)是视乳头水肿最常见的病因。在ODS两种主要病因颅内压增高和ON临床特征的比较中,发病年龄、性别、眼痛或头痛以及眼底盘周出血的发生率差异无统计学意义(均P>0.05),视敏度异常及低视力在ON组较颅内压增高组更常见[36/40(90%)比33/56(58.9%),P=0.001;35/80(43.8%)比22/112(19.6%),P<0.001],重度视乳头水肿在颅内压增高组更常见[38/112(33.9%)比9/80(11.3%),P<0.001]。结论虽然双侧ODS最常见的病因是颅内压增高,但也可由其他多种病因引发。在对中国患者的研究中,ON是需要重点鉴别的病因。Objective To investigate the etiology composition and clinical characteristics of bilateral optic disc swelling(ODS).Methods The medical records of all newly diagnosed bilateral ODS patients admitted to the neurology ward of Beijing Tongren Hospital from January 2017 to June 2021 were retrospectively searched to classify the etiology,obtain demographic and clinical information,and compare the differences in clinical characteristics.Results A total of 131 patients with bilateral ODS were included,including 56 males and 75 females,aged 15-73(39±14)years.The most common cause of the bilateral ODS was increased intracranial pressure(ICP)(56/131,42.7%),followed by optic neuritis(ON)(40/131,30.5%).Other causes included vascular optic neuropathy(13/131,9.9%),pseudopilledema(9/131,6.9%);uveitis(6/131,4.6%),toxic optic neuropathy(3/131,2.3%)and unknown causes(4/131,3.1%).Idiopathic intracranial hypertension(IIH)(43/56,76.8%)was the most common etiology for papilledema.In the comparison of the two main causes of intracranial hypertension and the clinical characteristics of ON in ODS,there was no statistically significant difference in the incidence of age,gender,complaints of ocular pain or headache,and hemorrhage of optic disc(P>0.05).Visual acuity abnormalities and low vision were more common in ON group than the increased ICP group[36/40(90%)vs 33/56(58.9%),P=0.001;35/80(43.8%)vs 22/112(19.6%),P<0.001],while severe papilledema was more common in increased ICP group[38/112(33.9%)vs 9/80(11.3%),P<0.001].Conclusions The most common cause for bilateral ODS is increased ICP,but it can also be triggered by a variety of other causes.Optic neuritis(ON)is the most important differentiating disease in the study of Chinese patients.

关 键 词：视乳头水肿 双侧视盘肿胀 病因构成 颅内压增高 视神经炎 病例系列研究 

分 类 号：R774.62[医药卫生—眼科]