急性视神经炎复发的危险因素—针对视神经炎治疗试验（ONTT）的Cox回归分析

发布时间：2018-03-04 02:37

本文选题：急性视神经炎　切入点：复发　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：一、目的:约有30%的急性视神经炎患者在5年内会经历至少一次的复发。目前尚缺乏种族和视神经炎复发是否有关的研究。另外,由于缺乏针对视神经炎复发危险因素的前瞻性研究,我们仍不确定除了糖皮质激素的剂量,是否还存在其他影响急性视经炎复发的危险因素。本研究旨在通过对既往ONTT数据进行cox回归分析,来探究急性视神经炎复发的危险因素。二、方法:根据既往北美视神经炎治疗试验(optic neuritis treatment trail,ONTT)(前瞻性随机对照试验,RCT)的原始研究数据,将患者按照复发、未复发重新分组。提取每位已纳入且未失访患者的信息后,使用spss23.0对所得数据进行Kaplan-Meier检验的初筛后,使用cox回归分析并得出结论。提取患者生存时间、状态、治疗组和年龄、性别、种族、视力等自变量。三、结果:Kaplan-Meier分析提示年龄(p=0.012)和治疗组(p=0.015)与急性视神经炎的复发有关。而性别、种族、MRI结果、对比敏感度、视力(logMARETDRS)、视盘水肿、眼底出血、黄斑渗出、眼痛、确诊多发性硬化、多发性硬化家族史、神经症状病史、过去30年病毒感染史、以北纬40°生活了15年和发病季节和急性视神经炎的复发无关。COX回归分析发现发病年龄=30岁(HR:1.570,95%CI:1.133-2.175,p=0.007)和单纯口服泼尼松(1 mg/kg/day)(HR:1.694,95%CI:1.145-2.507,p=0.008)是视神经炎复发的独立危险因素。四、结论:年龄小于等于30岁和口服泼尼松(1mg/kg/day)是急性视神经炎复发的危险因素。建议临床工作者在治疗急性视神经炎时不单纯使用泼尼松,并对发病年龄小于等于30岁的患者进行积极的随访,及早进行干预,降低特发性视神经炎的复发风险,以改善预后。
[Abstract]:Objective: about 30% patients with acute optic neuritis will experience at least one relapse within 5 years. In the absence of a prospective study of the risk factors for recurrence of optic neuritis, we are still uncertain about the dose of glucocorticoids, Whether there are other risk factors affecting the recurrence of acute optic neuritis. This study was designed to explore the risk factors for the recurrence of acute optic neuritis by using cox regression analysis of past ONTT data. Methods: according to the original study data of Optic neuritis treatment ONTT (prospective randomized controlled trial), the patients were reclassified according to recurrence and no recurrence. After using spss23.0 to screen the obtained data for Kaplan-Meier test, cox regression analysis was used to draw the conclusion. Independent variables such as survival time, state, treatment group and age, sex, race, vision were extracted. Results the age of p0.012) and the treatment group p0.015) were associated with the recurrence of acute optic neuritis. Sex, race, MRI findings, contrast sensitivity, visual acuity, optic disk edema, fundus hemorrhage, macular exudation, eye pain, multiple sclerosis, A family history of multiple sclerosis, a history of neurological symptoms, a history of viral infection in the past 30 years, After 15 years of living at 40 掳N and no correlation between the onset season and the recurrence of acute optic neuritis. Cox regression analysis found that HR1: 1.570,95CI1: 1.133-2.175% (CI: 1.133-2.175) and prednisone (1.69495 CIW 1.145-2.507p0.008) were independent risk factors for the recurrence of optic neuritis. Conclusion: age less than 30 years and oral prednisone 1 mg / kg / day are risk factors for recurrence of acute optic neuritis. It is recommended that clinical workers should not use prednisone alone in the treatment of acute optic neuritis. In order to improve prognosis, early intervention was carried out to reduce the risk of recurrence of idiopathic optic neuritis.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R774.61

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