慢性复发性炎性视神经病变的鉴别诊断及治疗进展  

Progress in differential diagnosis and treatment of chronic relapsing inflammatory optic neuropathy

作　　者：廖良[1] 韦企平[1] LIAO Liang;WEI Qiping(Department of Ophthalmology,Dongfang Hospital,Beijing University of Chinese Medicine,Beijing 100078,China)

机构地区：[1]北京中医药大学东方医院眼科,北京100078

出　　处：《中国中医眼科杂志》2021年第10期745-747,共3页China Journal of Chinese Ophthalmology

基　　金：国家自然科学基金项目(81973909)。

摘　　要：慢性复发性炎性视神经病变是一种病因不明、病情反复发作且对糖皮质激素治疗高度敏感的视神经炎(ON)。其病因可能和免疫介导等有关,特征是至少大于1次的孤立发病的ON,极明显的糖皮质激素依赖及MRI脑部和脊柱检查无异常。确诊本病必须全面检查并排除可能潜在的全身性疾病或神经系统病因。治疗上该病常因误诊为特发性脱髓鞘性视神经炎,仅予常规糖皮质激素治疗和较短用药疗程而导致病情进展,实际上本病应予及时、足量糖皮质激素治疗,并可能要求长期使用糖皮质激素或免疫抑制剂来避免复发。目前本病临床报道少,可能与对该病认识不足有关,其鉴别诊断和治疗需引起临床医师的重视。Chronic relapsing inflammatory optic neuropathy(CRION)is a kind of optic neuritis(ON)with unknown etiology,recurrent episodes and high sensitivity to glucocorticoid therapy.Its etiology may be related to immune disorders,characterized by at least one isolated onset of ON,very obvious glucocorticoid dependence,and no abnormalities in MRI brain and spine examination.A definitive diagnosis of CRION must be comprehensively examined and the possible underlying systemic disease or neuropathy should be ruled out.This disease is often misdiagnosed as idiopathic demyelinating optic neuritis,which is only treated with conventional glucocorticoids with a short course of medication,causing disease progression.In fact,CRION should be treated with timely and sufficient glucocorticoids,and may require long-term use of glucocorticoids or immunosuppressants to avoid recurrence.At present,there are few clinical reports of the disease,which may be related to the lack of understanding of the disease.The differential diagnosis and treatment of CRION should be paid more attention to by clinicians.

关 键 词：慢性复发性炎性视神经病变 特发性脱髓鞘性视神经炎 鉴别诊断 糖皮质激素 

分 类 号：R774.61[医药卫生—眼科]