VEP OCT及mfVEP在小儿视神经炎诊断及病情转归中的应用  

Application of VEP OCT and MfVEP in the Diagnosis and Disease Outcomes of Pediatric Optic Neuritis

作　　者：滑会兰[1] 赵敬聪[1] 田海霞 尚李娅[1] 刘晓瑜[1] 孙会会 柴松[2] HUA Huilan;ZHAO Jingcong;TIAN Haixia(Hebei Children's Hospital, Hebei Shijiazhuang 050031, China)

机构地区：[1]河北省儿童医院眼科,河北石家庄050031 [2]河北医科大学第二医院眼科,河北石家庄050000

出　　处：《河北医学》2022年第4期628-634,共7页Hebei Medicine

基　　金：河北省2020年度医学科学研究课题计划项目,(编号:20200663)。

摘　　要：目的:分析不同病因PON患儿的临床特点。探索VEP、OCT以及mfVEP在PON诊断中的价值及临床转归中的意义。方法:收集河北省儿童医院神经内科病区及眼科病区经专业医师确诊符合视神经炎诊断的儿童60例,按照不同的病因分为孤立性视神经炎组(ON组)28例、多发性硬化组(MS组)11例、急性播散性脑脊髓炎组(ADEM组)14例、视神经脊髓炎谱系障碍组(NMOSD组)7例,选择同期健康体检者30例,作为对照组。观察不同组别的PON患儿在影像学、血清学以及眼部检查的差异。同时,于初诊、半月、1月、3月、6月及1年行VEP、OCT以及mfVEP检查,观察上述检查在疾病及转归中的变化。结果:对比MS和NMOSD组,ON组患儿易表现为单眼发病,ADEM组患儿易表现为双眼发病(P<0.05);在疾病急性期,ON组MS组对视力的影响较小,ADEM组和NMOSD组对视力的影响大(P<0.001);相对于MS和ADEM组,ON组患儿对激素较为敏感,而NMOSD组对激素不敏感或效果较差(P<0.05)。VEP检查对MS的鉴别诊断具有意义,可以从一定程度上反应治疗的效果;OCT检查可以直观的反应NMOSD组的pRNFL明显变薄,可作为NMOSD的鉴别诊断,可评估NMOSD的疾病进展,并以此制定出相应的治疗方案。mfVEP检测在视神经的损伤及追踪恢复上的检查应用价值要优于传统VEP和视野检测。结论:VEP、OCT及mfVEP检测可以更直观的反映不同病因PON患儿的特点,值得临床进一步推广。Objective:To analyze clinical characteristics of PON with different causes and to explore the value of VEP,OCT and mfVEP in the diagnosis of PON and its significance in clinical outcomes.Methods:Sixty children in the neurology ward and ophthalmology ward of Hebei Children's Hospital who were confirmed by professional physicians to be eligible for the diagnosis of optic neuritis were collected and divided into 28 cases in the isolated optic neuritis group(ON group),11 cases in the multiple sclerosis group(MS group),14 cases in the acute disseminated encephalomyelitis group(ADEM group)and 7 cases in the optic neuromyelitis optica spectrum disorder group(NMOSD group)according to different etiologies,and 30 children for physical examination in the same period were selected as the healthy controls.The children with PON in different groups were observed for differences in imaging,serology and eye examination.VEP,OCT and mfVEP were also performed at the first visit,at half a month,one month,three months,six months and one year to observe the changes in the disease and its outcome.Results:When comparing the MS and NMOSD groups,ON children were prone to monocular onset and ADEM children were prone to binocular onset(P<0.05);In the acute phase of the disease,vision was less affected in the ON group and in the MS group,and greatly in the ADEM and NMOSD groups(P<0.001);compared to the MS and ADEM groups,children in the ON group were more sensitive to hormones,while the NMOSD group was insensitive or less effective(P<0.05);VEP examination is meaningful for the differential diagnosis of MS,and can reflect the effect of treatment to some extent;OCT examination can visually reflectthe significant thinning of the pRNFL in the NMOSD group,which can be used as a differential diagnosis of NMOSD and can be used to assess the disease progression of NMOSD and develop the corresponding treatment regimen.The mfVEP test is better than the conventional VEP and visual field tests in detecting damage to the optic nerve and tracking recovery.

关 键 词：小儿视神经炎 病因诊断 光学相干断层扫描 视觉诱发电位 多焦视诱发电位 

分 类 号：R74[医药卫生—神经病学与精神病学]