免疫吸附治疗视神经脊髓炎谱系疾病相关性视神经炎的效果  

Efficacy of immunoadsorption in the treatment of optic neuritis associated with neuromyelitis optica spectrum disorders

作　　者：梅妮 黄树其 陈伟民 张振 Mei Ni;Huang Shuqi;Chen Weimi;Zhang Zhen(Neurology Department,Shanghai Tianyou Hospital,Shanghai 200333,China;Neurology Department,Shanghai Deji Hospital,Shanghai 200333,China)

机构地区：[1]上海天佑医院神经内科,200333 [2]上海德济医院神经内科,200333

出　　处：《眼科》2022年第5期381-385,共5页Ophthalmology in China

摘　　要：目的初步评价免疫吸附对视神经脊髓炎谱系疾病相关性视神经炎(NMOSD-ON)的治疗效果。设计前瞻性同期非随机对照临床试验。研究对象纳入2017年11月~2020年7月就诊于上海德济医院的NMOSD-ON AQP4抗体阳性患者75例,均为急性发作时激素冲击治疗14天左右视力无明显恢复者。方法根据患者意愿将其分成研究组39例,对照组36例。研究组在激素冲击递减治疗基础上,予免疫吸附治疗法进行强化治疗,对照组仅继续使用激素冲击后递减治疗。治疗有效定义为视力上升不小于1级或抗体滴度下降至1:32及以下或转阴。主要指标治疗有效率、视力、AQP4-IgG滴度。结果研究组治疗总体有效率76.92%,高于对照组38.89%(χ^(2)=9.65,P=0.002)。研究组视力提高率74.1%(43/58)高于对照组17.5%(10/57)(χ^(2)=34.81,P=0.000)。研究组抗体滴度下降率94.87%(37/39)高于对照组30.56%(11/36)(χ^(2)=30.88,P=0.000)。结论免疫吸附治疗能有效降低激素冲击治疗效果不敏感患者特异性抗体滴度,促进其视力恢复,对于急性期及亚急性期NMOSD-ON疗效好于激素冲击后递减治疗。(眼科,2022,31:381-385)Objective To investigate the therapeutic effect of immunoadsorption on neuromyelitis optica spectrum disease-associated optic neuritis(NMOSD-ON).Design Prospective concurrent non-randomized controlled clinical trial.Participants The data of 75 Patients with AQP4 antibody positive patients who were treated in Shanghai Deji Hospital from November 2017 to July 2020 with NMOSD-ON were collected.All patients had no obvious recovery of visual acuity after 14 days of steroid pulse therapy during acute attack.Methods 39 cases were included in the study group and 36 cases in the control group according to patients'choice.The study group was given intensive treatment with immunoadsorption therapy on the basis of hormonal pulse-decrease therapy,while the control group only continued to use steroid-pulse and post-decrease therapy.The changes of specific antibody(AQP4-IgG)titer and vision recovery in the two groups of patients before and after treatment were retrospectively analyzed.The antibody titer was detected by CBA method,and the data was statistically analyzed by SPSS25.0.Main Outcome Measures Clinical effect,visual acuity distribution,and titer changes.Results The overall effective rate of the study group was 76.92%,which was higher than the control group which was 38.89%(χ^(2)=9.65,P=0.002).The improvement rate of visual acuity in the study group was 74.1%(43/58),which was higher than the control group which was 17.5%(10/57)(χ^(2)=34.81,P=0.000).The antibody titer decline rate in the study group was 94.87%(37/39),which was higher than the control group which was 30.56%(11/36)(χ^(2)=30.88,P=0.000).Conclusion Immunoadsorption therapy can effectively reduce the specific antibody titer in patients who are not sensitive to the effect of steroid pulse therapy,and promote the recovery of vision.For acute and subacute NMOSD-ON,immunoadsorption is more effective than hormonal pulse-decrease therapy.(Ophthalmol CHN,2022,31:381-385)

关 键 词：视神经脊髓炎谱系疾病 视神经炎 免疫吸附 

分 类 号：R744.52[医药卫生—神经病学与精神病学]