72例视神经脊髓炎相关性视神经炎患者临床特点分析  

Clinical characteristics of 72 cases with neuromyelitis optical associated optic neuritis

作　　者：韩梦雨 秦亚丽 矫毓娟[3] 焦劲松[3] 马传政 金明[1] HAN Meng-yu;QIN Ya-li;JIAO Yu-juan;JIAO Jin-song;MA Chuan-zheng;JIN Ming(Ophthalmology Department,China-Japan Friendship Hospital,Beijing 100029,China;Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510120,China;Department of Neurology,China-Japan Friendship Hospital,Beijing 100029,China;Graduate School of Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]中日友好医院眼科,北京100029 [2]广东省中医院,广东广州510120 [3]中日友好医院神经科,北京100029 [4]北京中医药大学研究生院,北京100029

出　　处：《海南医学院学报》2022年第22期1724-1731,共8页Journal of Hainan Medical University

基　　金：中央高水平医院临床科研业务费;中日友好医院“菁英计划”人才培育工程(ZRJY2021-QM24);国家自然科学基金项目(82174440)。

摘　　要：目的:分析视神经脊髓炎相关性视神经炎(neuromyelitis optical associated optic neuritis,NMOON)患者的临床特点,为防治该类疾病提供参考和依据。方法:对2016年1月~2019年12月就诊于中日友好医院的72例以ON为首发临床表现的NMO患者病历资料进行回顾性分析总结,包括一般资料、发病特点、病程进展、合并疾病、免疫学检验、治疗反应及预后等。结果:72例NMO-ON患者,发病年龄中位数33岁;男女比约为1∶5.54;病程中位数67个月,以“复发-缓解”为主。61.11%患者双眼先后累及,ON发病次数中位数为2次,ON二次发作时间中位数是3个月;1、3年复发率分别约55.56%和73.61%;91.67%患者单独ON起病,ON累及单眼者占81.94%;19.44%患者伴诱因,最常见为上呼吸道感染;15.28%患者伴系统性免疫性疾病,最常伴发干燥综合征及甲状腺疾病;75.64%患者首发视力小于0.1,抗水通道蛋白4抗体(aquaporin-4 immunoglobulin G,AQP4-IgG)状态(P=0.032,OR=2.55)和发病年龄(P=0.037,OR=3.93)是影响患者首发视力的独立危险因素;至末次随访时间,单侧致盲率约48.61%,致患者单侧致盲ON发作中位数为2次;73.61%患者出现其他神经系统的累及,脊髓(61.11%)是最常见的复发部位。80.00%(48/60)患者血清AQP4-IgG阳性;18例(25.00%)伴其他系统性免疫性抗体,最常见伴ANA抗体阳性。结论:NMO-ON患者首次发病多ON单独起病,单侧累及,女性中青年高发,漫长的病程多见双侧视神经受累及多次复发,AQP4-IgG状态和发病年龄是影响NMO患者首次发病视功能的独立危险因素,大多数患者AQP4-IgG血清阳性,部分患者伴发以干燥综合征和甲状腺疾病为代表的系统性免疫性疾病,该病临床高危,需要及早进行明确诊断和治疗干预。Objective:To analyze the clinical characteristics of neuromyelitis optical associated optic neuritis NMO-ON patients,and to provide reference and basis for the prevention and treatment accordingly.Methods:The medical records of 72NMO patients with ON as the first clinical manifestation in China-Japan Friendship Hospital from January 2016 to December 2019were retrospectively analyzed and summarized,including general information,morbidity characteristics,course of disease,comorbid diseases,immunological tests,treatment response and prognosis,etc.Results:Totally 72 NMO-ON patients had a median age of 33 years.The ratio of male to female is about 1∶5.54;The median course was 67 months,mainly"relapse-remission".Totally 61.11%patients were successively involved in both eyes,the median incidence of ON was 2 times,and the median time of the second onset of ON was 3 months.The 1-year and 3-year recurrence rates were 55.56%and 73.61%,respectively.Around91.67%of the patients had the onset of ON alone,and 81.94%of the patients had monocular involvement.About 19.44%patients were associated with inducement,the most common was upper respiratory tract infection;15.28%patients were associated with systemic immune diseases,most commonly associated with Sjogren’s syndrome and thyroid diseases and 75.64%patients had first visual acuity less than 0.1,aquaporin-4 immunoglobulin G(AQP4-IgG)status(P=0.032,OR=2.55)and onset age(P=0.037,OR=3.93)were independent risk factors for first visual acuity.Up to the last follow-up time,the rate of unilateral blindness was about 48.61%,and the median of unilateral blindness ON was 2 times.Other nervous system involvement occurred in73.61%of patients,and spinal cord(61.11%)was the most common site of recurrence.Serum AQP4-IgG was positive in80.00%(48/60)of patients.A total of 18 cases(25.00%)were associated with other systemic immune antibodies,most commonly associated with ANA antibody positivity.Conclusions:The first onset of NMO-ON patients is mostly ON alone,with unilateral involvement and h

关 键 词：视神经脊髓炎 视神经炎 临床特点 

分 类 号：R744.52[医药卫生—神经病学与精神病学]