中等剂量糖皮质激素治疗外伤性视神经病变早期疗效和安全性分析  

Study of early effect and safety of medium-dose glucocorticoid therapy in patients with traumatic optic neuropath

作　　者：朱捷[1] 诸震波[1] 徐毅[1] 刘在尧[1] 张蕴[1] Zhu Jie;Zhu Zhenbo;Xu Yi;Liu Zaiyao;Zhang Yun(Emergency Department,Beijing Tongren Hospital,CMU,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院急诊科,100730

出　　处：《中华急诊医学杂志》2020年第3期404-408,共5页Chinese Journal of Emergency Medicine

摘　　要：目的评价中等剂量激素治疗外伤性视神经病变(traumatic optic neuropathy,TON)的早期疗效及安全性。方法回顾性收集2015年5月至2018年12月在北京同仁医院急诊外科就诊且符合纳入标准的外伤性视神经病变患者138例,根据治疗方法分为试验组(70例)和对照组(68例),试验组给予中等剂量甲泼尼龙琥珀酸钠500 mg/d,治疗3 d后减量至40 mg/d,治疗4 d,并辅以神经营养等药物治疗,对照组除激素其余与对照组相同方法治疗,疗程均为7 d。所有患者行视觉诱发电位检查。比较两组患者疗效和不良反应发生率,对可能影响视力改善的因素的不同水平进行亚组分析,筛选出使用激素治疗可获得更好的早期疗效的优势人群。结果试验组有效率为44.28%(31/70),对照组有效率为26.47%(18/68),两组有效率差异有统计学意义(χ^2=0.471,P<0.05);亚组分析中发现,以年龄、伤后有无光感和视觉诱发电位(visual evoked potential,VEP)检查结果作为分层因素时,两组治疗后有效率差异有统计学意义(P<0.05),提示<50岁(OR=2.649)、伤后残留光感(OR=3.590)和VEP未熄灭患者(OR=3.700),应用激素治疗可能获得较好的早期疗效,两组药物不良反应发生率分别为13.89%(10/70)和11.27%(8/68),组间差异无统计学意义(χ^2=0.223,P>0.05)。结论中等剂量激素治疗外伤性视神经病变能够获得较好的早期疗效且安全。Objective To observe the clinical early effect and safety of medium-dose glucocorticoid therapy in patients with traumatic optic neuropathy(TON).Methods A total of 150 TON patients who met the entry criteria at our hospital from May 2015 to December 2018 were enrolled into our study and divided into the treatment group and the control group according to the treatment,75 cases in each group.Patients in the control group were treated with dehydration,neurotrophy.Patients in the treatment group were added medium-dose corticosteroids 500 mg/d for 3 days,and then reduced to 40 mg/d for 4 days on the basis of the control group.All the patients were treated with 7 days,and visual evoked potential(VEP)measurement was carried out in all cases.The efficacy and safety based on the changing of visual acuity were evaluated.Results The effective rate of the treatment group was 44.28%(31/70),and of control group was 26.47%(18/68),with statistically significant difference(χ^2=0.471,P<0.05);Subgroup analysis indicated that when age,visual acuity or VEP change were taken as stratification factors,differences in effective rates between the two groups were statistically significant(P<0.05).Patients'age less than 50 years(OR=2.649),visual acuity light perception(OR=3.590)or VEP showing no wave(OR=3.700)were the dominant population.The incidence of adverse drug reactions in the treatment and control groups were 13.89%(10/70)and 11.27%(8/68)respectively,and the difference was not statistically significant(χ^2=0.223,P>0.05).Conclusions Patients who receive a medium-dose glucocorticoid after traumatic optic neuropathy gain better visual acuity.

关 键 词：视神经损伤 外伤性视神经病变 糖皮质激素 视觉诱发电位 

分 类 号：R779.1[医药卫生—眼科]