中国人不同类型视神经炎临床特征分析--3年随访研究  

Clinical characteristics of different types of optic neuritis in Chinese patients:a 3-year follow-up study

作　　者：冯超逸 陈倩 赵桂宪 李振新 陈伟民 孙平 沙炎 孙兴怀 王敏 田国红[1,5] FENG Chaoyi;CHEN Qian;ZHAO Guixian;LI Zhenxin;CHEN Weimin;SUN Ping;SHA Yan;SUN Xinghuai;WANG Min;TIAN Guohong(Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China;Department of Neurology,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Neurology,Deji Hospital,Shanghai 200331,China;Departmentof Radiology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China;NHC Key Laboratoryof Myopia(Fudan University),Key Laboratory of Visual Impairment and Restoration(Fudan University),Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031 [2]复旦大学附属华山医院神经科,上海200040 [3]上海德济医院神经内科,上海200331 [4]复旦大学附属眼耳鼻喉科医院放射科,上海200031 [5]国家卫健委及中国医学科学院近视眼重点实验室(复旦大学)上海市视觉损害与重建重点实验室(复旦大学),上海200031

出　　处：《中国眼耳鼻喉科杂志》2022年第1期7-11,19,共6页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：国家自然科学基金重大项目课题(81790641)。

摘　　要：目的观察并随访以血清抗体分型的视神经炎(ON)患者临床特征及转归。方法单中心队列研究。纳入2015年1月~2017年3月在复旦大学附属眼耳鼻喉科医院首次确诊的ON患者,按照血清抗体类型分组:抗髓鞘寡突胶质细胞糖蛋白抗体阳性组(MOG-ON)、抗水通道蛋白4抗体阳性组(AQP4-ON)及2种抗体均阴性组(seronegative-ON),评估视觉功能及光学相干层析成像(OCT),并随访3年。结果共纳入评估患者280例(405眼),其中MOG-ON组57例(20.4%)、AQP4-ON组98例(35.0%)、seronegative-ON组125例(44.6%)。3年后随访各组患者,MOG-ON组和seronegative-ON组最佳矫正视力高于0.8的眼数相仿,且均较AQP4-ON组明显增多(P=0.001)。MOG-ON组和AQP4-ON组的复发率相当,均高于seronegative-ON组(P<0.001)。3年后,MOG-ON组和AQP4-ON组视盘周围视网膜神经纤维层(RNFL)厚度相似,分别为(63.41±13.39)μm和(59.40±11.46)μm(P=0.476),均较seronegative-ON组[(74.06±11.14)μm,P=0.001]明显变薄。黄斑区神经节细胞-内丛状层(GCIPL)厚度呈现同样的趋势。结论MOG-ON组患者与seronegative-ON组患者视力预后较好,但MOG-ON组患者不论RNFL或GCIPL均明显变薄。AQP4-ON组患者视力预后差,且OCT随访RNFL与GCIPL显著变薄。Objective To evaluate the clinical characteristics of optic neuritis(ON)with different phenotypes.Methods This prospective study recruited new-onset ON patients between January 2015 and March 2017 in the Eye&ENT Hospital of Fudan University.Patients were followed up for 3 years.Clinical characteristics and optical coherence tomography were evaluated among the myelin oligodendrocyte glycoprotein-seropositive(MOG-ON),aquaporin-4-seropositive(AQP4-ON),and double-seronegative(seronegative-ON)groups.Results In total,280 patients(405 eyes)were included(MOG-ON:n=57,20.4%;AQP4-ON:n=98,35.0%;seronegative-ON:n=125,44.6%).The proportion of eyes with best corrected visual acuity(BCVA)better than 0.8 at the 3-year follow-up was similar between the MOG-ON and the seronegative�ON groups,and both higher than the AQP4-ON group(P=0.001).Relapse rates were higher in the MOG-ON and the AQP4-ON groups than in the seronegative-ON group(P<0.001).Average retinal nerve fiber layer(RNFL)thickness at the end of the 3-year follow-up was similar between the MOG-ON and the AQP4-ON groups(63.41±13.39μm and 59.40±11.46μm,P=0.476),but both were thinner than that of the seronegative-ON group(74.06±11.14μm,P=0.001).Macular ganglion cell and inner plexiform layer complex(GCIPL)revealed the same pattern.Conclusions Despite thinning of RNFL and GCIPL,the MOG-ON group’s outcome was as favorable as that of the seronegative-ON group,whereas the AQP4-ON group showed unsatisfactory results.

关 键 词：视神经炎 视神经脊髓炎 水通道蛋白4 髓鞘寡突胶质细胞糖蛋白 光学相干层析成像 

分 类 号：R774.61[医药卫生—眼科]