感染性及感染相关性视神经病变的病因和临床特征分析  

Etiology and ophthalmic characteristics of infectious and infection-related optic neuropathies

作　　者：孙传宾[1] 肖庆[1] 白海霞 许丹妮 唐文博 SUN Chuanbin;XIAO Qing;BAI Haixia;XU Danni;TANG Wenbo(Eye Center,Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院眼科中心,杭州310009

出　　处：《眼科学报》2020年第5期327-336,共10页Eye Science

摘　　要：目的:总结并报告感染性和感染相关性视神经病变的病原学和眼科临床表现特征。方法:本研究为回顾性病例研究,纳入2014年5月至2020年4月在浙江大学医学院附属第二医院神经眼科门诊确诊为感染性和感染相关性视神经病变,临床检查和实验室检测资料齐全,且随访时间≥2个月的患者,按照病原学和眼科临床表现特征对患者进行分类分析。结果:共纳入经实验室检测确诊的感染性和感染相关性视神经病变患者139例234眼,其中感染性视神经病变90例153眼,感染相关性视神经病变49例81眼。病原微生物构成为:梅毒82例140眼(59.8%),结核5例9眼(3.8%),单纯疱疹病毒1型15例28眼(12.0%),2型2例3眼(1.3%),水痘-带状疱疹病毒12例21眼(9.0%),巨细胞病毒4例5眼(2.1%),乙型肝炎病毒11例19眼(8.1%),丙型肝炎病毒3例4眼(1.7%),人类免疫缺陷综合征病毒2例2眼(0.9%),巴尔通体感染2例2眼(0.9%),曲霉菌感染1例1眼(0.4%)。所有感染性和感染相关性视神经病变患者中,眼科临床表现为视乳头炎87例153眼(65.4%),球后视神经炎14例23眼(9.8%),视神经视网膜炎9例13眼(5.6%),非动脉炎性前部缺血性视神经病变10例15眼(6.4%),原因不明的视神经萎缩19例30眼(12.8%)。本研究中,大多数活动期感染性和感染相关性视神经病变经积极治疗后视力有不同程度的改善。部分继发于感染的视神经萎缩患者即使经规范抗感染治疗,视力也无明显改善。结论:感染性视神经病变主要与梅毒和疱疹病毒感染相关,而感染相关性视神经病变主要与疱疹病毒感染、乙型肝炎和结核病相关。眼科临床工作中诊断特发性视神经炎之前,应注意排除感染性和感染相关性视神经病变。Objective:To summarize the etiology and ophthalmic characteristic of infectious and infection-related optic neuropathies.Methods:In this retrospective case series study,patients diagnosed as infectious and infectionrelated optic neuropathies with complete clinical data and at least 2-month follow-up in our neuro-ophthalmic clinic through May 2014 to April 2020 were recruited.All patients were classified and analyzed based on their etiology and ophthalmic manifestations.Results:A total of 139 cases(234 eyes)of infectious and infectionrelated optic neuropathies were recruited in this study,including 90 cases(153 eyes)of infectious optic neuropathy and 49 cases(81 eyes)of infection-related optic neuropathies.The pathogens included syphilis in 82 cases(140 eyes,59.8%),tuberculosis in 5 cases(9 eyes,3.8%),herpes simplex virus type 1 in 15 cases(28 eyes,12.0%),herpes simplex virus type 2 in 2 cases(3 eyes,1.3%),varicella zoster virus in 12 cases(21 eyes,9.0%),cytomegalovirus in 4 cases(5 eyes,2.0%),hepatitis B virus in 11 cases(19 eyes,8.1%),hepatitis C virus in 3 cases(4 eyes,1.7%),human immunodeficiency virus in 2 cases(2 eyes,0.9%),Bartonella in 2 cases(2 eyes,0.9%)and Aspergillus in 1 case(1 eye,0.4%).The ophthalmic manifestation was papillitis in 87 cases(153 eyes,65.4%),retrobulbar optic neuritis in 14 cases(23 eyes,9.8%),optic neuroretinitis in 9 cases(13 eyes,5.6%),anterior ischemic optic neuropathy in 10 cases(15 eyes,6.4%)and inexplicable optic atrophy in 19 cases(30 eyes,12.8%).After treatment,most patients with active infectious and infection-related optic neuropathies showed visual improvement,whereas the visual acuity of patients with optic atrophy secondary to infectious optic neuropathies was not improved even after standard anti-infection therapies.Conclusion:Infectious optic neuropathies are mainly related to syphilis and herpes viruses,while infection-related optic neuropathies are predominantly associated with herpes viruses,hepatitis B virus infection and tuberculosis.Infectious and infection-relat

关 键 词：感染性视神经病变 感染相关性视神经病变 梅毒 结核 疱疹病毒 

分 类 号：R774.6[医药卫生—眼科]