脱髓鞘性视神经病变的临床特征  

Characteristics of Optic Involvement in Central Nervous System Demyelinating Diseases

作　　者：吴茜[1] 陈博[1] 柯高潭 李斌[2] 卜碧涛[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院神经内科,武汉430070 [2]华中科技大学同济医学院附属同济医院眼科,武汉430070

出　　处：《神经损伤与功能重建》2015年第2期125-127,共3页Neural Injury and Functional Reconstruction

摘　　要：目的:回顾性分析脱髓鞘性视神经病变的临床特征。方法:收集我院特发性视神经炎(IDON)患者71例(IDON组)、视神经脊髓炎(NMO)患者69例(NMO组)、有视神经病变的多发性硬化(MS)患者64例(MS组)共204例患者的临床资料。结果:本组中有17例MS、26例NMO由IDON转化而来,但脱髓鞘性视神经病变也可发生在中枢神经系统脱髓鞘事件之后或者同时发生。NMO容易合并血清免疫学异常,MS容易累及双侧视神经且以球后视神经病变多见,IDON和NMO视功能障碍更为严重。随访生存分析表明,合并颅内病灶或血清免疫学异常的IDON患者转化为MS或NMO的风险明显高于其他正常患者。结论:脱髓鞘性视神经病变的诊断要严格遵循诊断流程,正确鉴别这3种疾病对制定治疗方案延缓疾病进展、降低致残率及判断预后具有重要意义。Objective： To retrospectively analyze clinical features of demyelinating optic neuropathy. Methods：The data of 204 cases with demyelinating optic neuropathy were reviewed, including 71 patients with idiopathic optic neuritis（IDON）, 69 cases with neuromyelitis optica（NMO）, and 64 multiple sclerosis（MS） patients. Seventeen cases of MS and 26 cases of NMO were transformed from IDON. Results： Demyelinating optic neuropathy occurred after the CNS demyelinating events or at the same time. Bilateral and retrobulbar optic neuritis were commonly seen in MS while the visual dysfunction in the ON and NMO patients were more severe than that in the MS cases. Follow-up survival analysis showed that the intracranial demyelinating lesions and abnormal serum immunological profiles in IDON were high risk factors for transforming into MS or NMO. Conclusion： Demyelinating optic neuropathy needs strict ophthalmological and neurological evaluation. Correct diagnosis is pivotal to the proper treatment and to predicting the outcome of demyelinating optic involvement.

关 键 词：脱髓鞘性视神经病变 视神经脊髓炎 多发性硬化 特发性视神经炎 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.04[医药卫生—临床医学]