甲泼尼龙冲击治疗总剂量对视神经脊髓炎谱系疾病相关视神经炎患者最佳矫正视力和治疗后复发次数的影响  

Effects of total dose of methylprednisolone pulse therapy on best corrected visual acuity and the number of recurrences after treatment in patients with neuromyelitis optica spectrum disorders-associated optic neuritis

作　　者：张育 郝敏 王峻峰[1] Zhang Yu;Hao Min;Wang Junfeng(Shanxi Eye Hospital,Taiyuan 030000,China;Shanxi Children's Hospital,Taiyuan 030000,China)

机构地区：[1]山西省眼科医院,太原030000 [2]山西省儿童医院,太原030000

出　　处：《中华眼底病杂志》2024年第8期624-629,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察静脉注射甲泼尼龙(IVMP)冲击治疗总剂量对视神经脊髓炎谱系疾病相关视神经炎(NMOSD-ON)患者最佳矫正视力(BCVA)、治疗后复发次数的影响。方法回顾性临床研究。2020年3月至2023年2月在山西省眼科医院检查确诊的NMOSD-ON患者23例27只眼纳人研究。所有患眼均采用国际标准视力表行BCVA检查,统计时换算为最小分辨角对数(logMAR)视力。所有患者采用基于细胞检测技术的间接免疫荧光法行血清水通道蛋白4抗体(AQP4-IgG)检测。依据中国视神经脊髓炎谱系疾病诊断与治疗指南(2021版)给予患者IVMP冲击治疗。其中,给予1000、500mg/d的IVMP冲击治疗分别为18、5例,连续3~5d,其后酌情减量为500mg/d或250mg/d,连续2~3d。治疗过程中IVMP冲击总剂量平均为4500mg(1500~5250mg)。将初始、治疗后BCVA分为≤0.1、>0.1~<0.5、≥0.5三个区间,观察治疗后1周及1、3、6个月不同BCVA区间的变化情况。年龄、病程、IVMP总剂量等不同条件下BCVA比较采用Mann-WhiteneyU检验。不同复发次数者之间BCVA比较采用Kruskal-Wallis检验。IVMP总剂量对治疗后6个月随访期间复发次数的影响行检验。Logistic回归分析法分析IVMP治疗6个月后BCVA≥0.5的影响因素;Spearman相关性分析法分析△logMARBCVA与IVMP冲击总剂量的相关性。结果23例27只眼中,男性3例,女性20例;年龄中位数35岁;发病时间中位数为5d。AQP4-IgG阳性、阴性分别为21(91.30%,21/23)、2(8.70%,2/23)例。初始为首发病程者3例(13.04%,3/23)4只眼(14.81%,4/27);复发病程者20例(86.96%,20/23)23只眼(85.19%,23/27)。患者初始至糖皮质激素治疗的干预时间中位数为7d。治疗后6个月随访期间,复发5例(21.74%,5/23)6只眼(22.22%,6/27),均为初始复发病程者。其中,复发1次、≥2次分别为4(66.67%,4/6)、2(33.33%,2/6)只眼。初始、治疗后6个月BCVA≤0.1、>0.1~<0.5、≥0.5分别为20、4、3只眼及3、13、11只眼。初始、治疗后不同时间BCObjective To observe the effect of intravenous methylprednisolone(IVMP)pulse therapy on the best corrected visual acuity(BCVA)and the number of relapses in patients with neuromyelitis optica spectrum disorder-related optic neuritis(NMOSD-ON)after total IVMP dose.Methods A retrospective clinical study.From March 2020 to February 2023,23 patients of 27 eyes with NMOSD-ON in Shanxi Eye Hospital were included in the study.BCVA examinations were performed on all affected eyes using the international standard visual acuity chart,which was statistically converted into logMAR visual acuity.Serum aquaporin-4 antibody(AQP4-IgG)was detected by indirect immunofluorescence assay based on cell detection technology in all patients.According to Guideline for the diagnosis and treatment of NMOSD spectrum disorders in China(2021 edition),patients were given IVMP impact therapy.Among them,18 and 5 patients received 1000 and 500 mg/d IVMP pulse therapy respectively for 3-5 consecutive days,followed by a reduction to 500 or 250 mg/d for 2-3 consecutive days.The average total IVMP dose during the treatment was 4500 mg(1500-5250 mg).The changes in BCVA at 1 week,1 month,3 months,and 6 months after treatment were observed for the initial and post-treatment BCVA of≤0.1,>0.1-<0.5,and≥0.5.The changes of BCVA at 1 week and 1,3 and 6 months after treatment were observed.The comparison of BCVA between different age,disease duration,and IVMP total dose conditions was performed using the Mann-Whitney U test.The comparison of BCVA between different relapse times was performed using the Kruskal-Wallis test.The influence of IVMP total dose on the number of relapses during the 6-month follow-up was analyzed using x^(2) test.The factors affecting BCVA≥0.5 after 6 months of IVMP treatment were analyzed by logistic regression,and the correlation between AlogMAR BCVA and IVMP pulse total dose was analyzed by Spearman correlation.Results In 23 cases with 27 eyes,there were 3 males and 20 females.The median age was 35 years.The median duration of i

关 键 词：视神经脊髓炎谱系疾病 视神经炎 甲泼尼龙总剂量 最佳矫正视力 复发次数 

分 类 号：R744.52[医药卫生—神经病学与精神病学] R774.6[医药卫生—临床医学]