水痘-带状疱疹病毒感染相关视神经病变五例临床分析  

Five cases of optic neuropathy associated with varicella zoster virus infection

作　　者：孟超[1] 赖春涛[1] 景筠[1] 孙厚亮[1] 江汉秋[1] 杨庆林[1] 刘磊[1] 王佳伟[1] Meng Chao;Lai Chuntao;Jing Yun;Sun Houliang;Jiang Hanqiu;Yang Qinglin;Liu Lei;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》2020年第23期1812-1815,共4页National Medical Journal of China

摘　　要：目的探讨水痘-带状疱疹病毒(VZV)感染相关视神经病变的临床特征、治疗和预后。方法回顾性病例分析方法。收集北京同仁医院神经内科病房自2014年1月1日至2019年3月31日VZV感染相关视神经病变5例,对其临床表现、治疗及预后等进行临床分析。结果5例患者共受累7只眼;有3例(3/5)累及单眼,2例(2/5)双视神经均累及。随访期间均未见复发。重度视力损害4只眼(4/7),非重度视力损害3只眼(3/7)。视力明显改善1只眼(1/7);好转2只眼(2/7);无变化4只眼(4/7)。急性期的MRI均见视神经和(或)鞘膜的异常信号。例3在发病后第2天给予抗病毒和激素治疗,视力恢复较好;余4例视力预后均差。结论头面部VZV感染可引起严重的视神经病变,导致重度视功能障碍,且预后欠佳,但复发少见。此部位的VZV感染建议早期静脉应用抗病毒药物(阿昔洛韦最佳)及激素,最好72 h内用药,以尽量避免和减轻继发的视神经病变。Objective To investigate the clinical characteristics,treatment and prognosis of optic neuropathy associated with varicella zoster virus(VZV).Methods Five cases of optic neuropathy associated with VZV infection from Department of Neurology between January 1,2014 and March 31,2019 were retrospectively collected.The clinical manifestations,treatment and prognosis were analyzed.Results There were 7 eyes involved in 5 cases,3 cases(3/5)involved only one eye,and 2 cases(2/5)involved both optic nerves.During the follow-up time,no recurrence was found.Severe visual impairment occurred in 4 eyes(4/7)and non-severe visual impairment in 3 eyes(3/7).Visual acuity improved significantly in 1 eye(1/7),turned better in 2 eyes(2/7),and remained unchanged in 4 eyes(4/7).In acute phase,abnormal signals of optic nerve and/or sheath were observed on MR images.Case 3 received antiviral and hormone therapy on the second day after the onset of the disease,and the visual acuity recovered well;the other 4 cases had poor prognosis.Conclusions Head and face VZV infection can cause serious optic neuropathy,leading to severe visual dysfunction,and poor prognosis,but recurrence is rare.Early intravenous administration of antiviral drugs(acyclovir is the best)and hormones are recommended for VZV infection in this area.It is best to use drugs within 72 hours in order to avoid and reduce secondary optic neuropathy as far as possible.

关 键 词：水痘-带状疱疹病毒 视神经炎 视神经周围炎 

分 类 号：R752.12[医药卫生—皮肤病学与性病学] R774.6[医药卫生—临床医学]