脱髓鞘性视神经炎患者角膜神经纤维改变及其与视力的相关性分析  

Changes of corneal nerve fiber and the correlation analysis with visual acuity in demyelinating optical neuritispatients

作　　者：赵蕊 王乐滢 陈春丽 张婧 郭思彤 陈菲[1] 刘洪娟 姜利斌[1] Zhao Rui;Wang Leying;Chen Chunli;Zhang Jing;Guo Sitong;Chen Fei;Liu Hongjuan;Jiang Libin(Beijing Tongren Hospital Affiliated to Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院眼科,北京100730

出　　处：《中华眼底病杂志》2023年第4期312-317,共6页Chinese Journal of Ocular Fundus Diseases

基　　金：北京市自然科学基金(7222028);首都卫生发展科研专项基金(首发2020-2-1082)。

摘　　要：目的观察分析脱髓鞘性视神经炎(DON)患者角膜神经纤维改变及其与视力的相关性。方法横断面研究。2021年3月至2022年7月于首都医科大学附属北京同仁医院神经眼科检查确诊的DON患者27例39只眼纳入研究。依据血清学检测结果,将患者分为水通道蛋白4(AQP4)抗体相关视神经炎(AQP4-ON)、髓鞘少突胶质细胞糖蛋白(MOG)抗体相关视神经炎(MOG-ON),分别为15例19只眼、12例20只眼。依据既往是否有糖皮质激素(以下简称为激素)治疗史,将患者分为激素治疗组、未行激素治疗组,分别为17例27只眼、10例12只眼。选取同期年龄、性别匹配的健康志愿者20名20只眼作为对照组。所有受检眼均行最佳矫正视力(BCVA)、活体共聚焦显微镜(IVCM)检查。采用Snellen标准对数视力表行BCVA检查,统计时换算为最小分辨角对数(1ogMAR)视力;采用HRT-3型IVCM检测受检眼角膜神经纤维长度(CNFL)、角膜神经纤维密度(CNFD)、角膜神经纤维分支长度(CNBL)、角膜神经纤维分支密度(CNBD)、角膜树状细胞密度。组间参数比较采用t检验及Kruskal-Wallis秩和检验;logMARBCVA与角膜神经纤维改变的相关性分析采用Spearman相关分析法。结果果DON组、对照组受检眼CNFL、CNFD、CNBL分别为(10.67±2.55)mm/mm^(2)、(57.78±12.35)根/mm^(2)、(3.27±1.34)mm/mm^(2)和(13.74±3.05)mm/mm^(2)(70.95±13.14)根/mm^(2)、(4.22±1.03)mm/mm^(2);两组患眼CNFL、CNFD、CNBL比较,差异有统计学意义(t=4.089、3.795、2.773,P<0.05)。MOG-ON组、AQP4-ON组患眼CNFL、CNBL、CNBD分别为(12.02±2.13)mm/mm^(2)、(3.80±1.19)mm/mm^(2)、(47.97±8.86)根/mm^(2)和(9.25±2.19)mm/mm^(2)(2.72±1.19)mm/mm^(2)、(39.43±13.86)根/mm^(2);两组患眼CNFL、CNBL、CNBD比较,差异均有统计学意义(t=-4.002、-2.706、-2.306,P<0.05)。激素治疗组、未行激素治疗组患眼角膜树状细胞密度分别为(24.43±8.32)、(41.22±9.86)个/mm^(2);两组患眼角膜树状细胞密度比较,差异有统�Objective To investigate the changes in the nerve fiber layer of the cornea in patients with demyelinating optic neuritis(DON)and its correlation with visual acuity.Methods A cross-sectional study.From March 2021 to July 2022,27 cases(39 eyes)of DON patients diagnosed in the Department of Neurology and Ophthalmology of Beijing Tongren Hospital Affiliated to Capital Medical University were enrolled in this study.According to the serological test results,the patients were divided into aquaporin 4 antibody associated optic neuritis(AQP4-ON group)and myelin oligodendrocyte glycoprotein antibody associated optic neuritis(MOG-ON group),with 15 cases(19 eyes)and 12 cases(20 eyes)respectively.According to previous history of glucocorticoid treatment,the patients were divided into glucocorticoid treated group and non-glucocorticoid treated group,with 17 cases(27 eyes)and 10 cases(12 eyes)respectively.Twenty healthy volunteers(20 eyes)with age-and gender-matched were selected as the control group.All eyes underwent best corrected visual acuity(BCVA)and in vivo confocal microscopy(IVCM)examinations.BCVA was performed using Snellen's standard logarithmic visual acuity chart,which was converted into logarithmic minimum angle resolution(logMAR)visual acuity during statistics.The corneal nerve fiber length(CNFL),corneal nerve fiber density(CNFD),corneal nerve fiber branch length(CNBL),corneal nerve fiber branch density(CNBD)and the density of corneal dendritic cells(DC)were detected by IVCM examination.Parameter comparison between groups by t-test and Kruskal-Wallis rank sum test.The correlation between logMAR BCVA and pamameters of corneal nerve fibers were analyzed using Spearman analysis.Results The CNFL,CNFD,and CNBL of the DON group and the control group were(10.67±2.55)mm/mm^(2),(57.78±12.35)root/mm^(2),(3.27±1.34)mm/mm^(2),and(13.74±3.05)mm/mm^(2),(70.95±13.14)root/mm^(2),and(4.22±1.03)mm/mm^(2),respectively;the difference in CNFL,CNFD,and CNBL between the two groups were statistically significant(t=4.089,3.795,2.7

关 键 词：脱髓鞘性视神经炎 角膜神经纤维 水通道蛋白4 骼髓鞘少突胶质细胞糖蛋白 角膜共聚焦显微镜 

分 类 号：R744.52[医药卫生—神经病学与精神病学]