以水平性视野缺损起病的视神经炎亚型及其临床特征分析  

Optic neuritis subtypes and clinical characteristics in patients presenting with altitudinal visual field defects

作　　者：毛贝[1] 崔世磊[1] 王佳伟[1] Mao Bei;Cui Shilei;Wang Jiawei(Department of Neurology,Beijing Tongren Hospital,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神经内科,北京100730

出　　处：《眼科》2024年第6期429-434,共6页Ophthalmology in China

摘　　要：目的总结以水平性视野缺损起病的视神经炎(ON)亚型、临床特征及治疗转归。设计回顾性病例系列。研究对象2022年1月至2024年6月在北京同仁医院神经内科住院治疗的以水平性视野缺损起病的视神经炎22例。方法收集患者的一般资料、临床特征、辅助化验和检查结果、治疗方式及转归,分析患者的临床特征。主要指标视盘水肿程度及是否伴出血、Humphrey视野指数(VFI)、视神经增强MRI情况、最佳矫正视力(BCVA)、血清中枢神经系统脱髓鞘抗体和风湿免疫指标结果、脑脊液寡克隆区带(OB)、是否伴眼痛/转眼痛以及治疗方案。结果22例患者的男女比例为1:1,平均发病年龄(45.6±12.6)岁。其中单侧孤立性ON 10例(45.5%),髓鞘少突胶质细胞糖蛋白抗体相关ON 3例(13.6%),水通道蛋白4抗体相关ON 2例(9.1%),自身免疫病相关ON 7例(31.8%)。13例(59.1%)患者伴有眼痛。19眼(86.4%)存在视盘水肿,54.5%为轻度水肿。17例(77.3%)存在视神经MRI信号异常,眶内段、管内段和颅内段受累分别为16例(72.7%)、6例(27.3%)、3例(13.6%)。所有患者在急性期接受糖皮质激素治疗,10例患者在缓解期接受免疫治疗。病程3个月,患者VFI平均值由病初的(53.0±8.0)%显著提高至(79.8±13.5)%(P<0.001);7眼(31.8%)视力完全恢复,3眼(13.6%)视力明显改善,6眼(27.3%)视力好转,6眼(27.3%)无明显提高或提高尚未达到好转级别。结论水平性视野缺损可见于多种ON亚型,以视神经前部受累为主,糖皮质激素和免疫抑制剂治疗有助于视功能较好恢复。Objective To summarize the subtypes,clinical features,and treatment outcomes of optic neuritis(ON)patients presenting with altitudinal visual field defects.Design Retrospective case series.Participants Twenty-two ON patients with altitudinal visual field defects admitted to the Neurology Department of Beijing Tongren Hospital from January 2022 to June 2024.Method Clinical data,laboratory findings,imaging results,treatment and outcomes were collected and analyzed.Main Outcome Measures The degree of optic disc edema and presence of hemorrhage,Humphrey visual field index(VFI),optic nerve enhancement on MRI,best-corrected visual acuity(BCVA),serum demyelinating antibodies and rheumatological markers,cerebrospinal fluid oligoclonal bands(OCBs),presence of ocular or periocular pain,and treatment strategies.Results The study included 22 ON patients with a male-to-female ratio of 1:1 and a mean onset age of(45.6±12.6)years.Among them,10 cases(45.5%)were diagnosed with single isolated optic neuritis(SION),3 cases(13.6%)with MOG-IgG associated ON,2 cases(9.1%)with AQP4-IgG associated ON,and 7 cases(31.8%)with autoimmune-related ON.Thirteen patients(59.1%)experienced ocular pain,and optic disc edema was observed in 19 eyes(86.4%),with 54.5%classified as mild.Seventeen patients(77.3%)demonstrated abnormal optic nerve signals on MRI,with involvement of the intraorbital segment in 16 cases(72.7%),canalicular segment in 6 cases(27.3%),and intracranial segment in 3 cases(13.6%).All patients received corticosteroid therapy during the acute phase,and 10 patients underwent immunosuppressive therapy during the remission phase.After three months,there was a significant improvement in VFI,with an average increase from(53.0±8.0)%at the onset of the disease to(79.8±13.5)%(P<0.001),7 eyes(31.8%)achieved complete visual recovery,3 eyes(13.6%)experienced significant improvement in vision,and 6 eyes(27.3%)showed partial improvement,and 6 eyes(27.3%)showed no significant betterment or betterment that had not yet reached the level of impro

关 键 词：视神经炎 水平性视野缺损 磁共振成像 

分 类 号：R774.6[医药卫生—眼科]