49例视神经炎临床回顾分析

发布时间：2018-09-07 16:30

【摘要】：目的研究吉林大学第一医院眼科住院治疗的视神经炎患者发病原因、临床特点并比较不同治疗方案的治疗效果,寻找疗效最显著的治疗方案。对象和方法回顾性分析2005年1月至2010年12月在吉林大学第一医院眼科住院,确诊为视神经炎的患者49例71眼(双眼22例,单眼27例),视神经乳头炎30例,球后视神经炎19例,男性22例、女性27例,年龄从4岁~71岁,平均年龄35.1岁。行常规眼科检查与体格检查,并给予不同的治疗方法。治疗组a为静点甲基强的松龙后改为口服强的松,治疗组b为静点地塞米松后改为口服强的松,治疗组c为单纯口服强的松,对照组未给予全身激素治疗。上述四种治疗方案联合各种辅助治疗,地塞米松球旁注射、血管扩张剂、能量合剂、维生素、中药等综合治疗,有明确病因者同时进行病因治疗,例如有细菌感染症状者给予抗生素,有病毒感染症状者给予抗病毒药物。用X2检验进行统计学分析,探讨其发病原因、视力、眼痛、瞳孔、眼底、视野和视觉诱发电位的变化及不同治疗方案的治疗效果。结果发病原因有上呼吸道感染3例、鼻窦炎2例、视神经脊髓炎2例、多发性硬化1例、梅毒1例、牙龈炎症1例、肺炎1例、脑脊髓炎1例、眶蜂窝织炎1例、余36例无明确病因。入院时矫正视力无光感至低于0.1有36眼,大于等于0.1小于0.5有22眼,大于等于0.5有13眼;24例有眼痛,25例无眼痛;31例瞳孔运动障碍,18例无瞳孔运动障碍;30例眼底有不同程度异常表现,19例眼底未见异常;45例视野出现各种各样的异常表现,4例未查;29例视觉诱发电位潜伏期延长或(和)振幅降低,8例正常,12例未查;1例头部MRI出现脑白质脱髓鞘改变,21例未见异常,27例未查;经全身大剂量激素冲击,局部球旁注射,血管扩张药,能量合剂,维生素B族,中药等综合治疗,治疗组a有效率为96.2%,治疗组b为60.0%,治疗组c为88.9%;对照组未给全身激素,有效率为76.9%。结论吉林大学第一医院近6年内视神经乳头炎发病率明显较球后视神经炎发病率高,发病年龄多在15岁~55岁,平均年龄35.1岁;发病原因多种多样,多未发现明确发病原因,部分由急、慢性感染引起,部分由多发性硬化与视神经脊髓炎引起;入院时矫正视力0.1的患者占50.7%,视野改变多种多样,以中心和旁中心暗点最为常见。上述几项结果与西方国家相比均有明显的差异,而更接近于同为东方国家的日本,可见东西方国家之间的种族差异是不可忽略的因素。治疗方面,首先强调病因的探寻和及早进行治疗,但由于病因复杂,至今尚无统一有效的标准治疗方案。我们仍以ONTT研究结果作为指南,即给予甲基强的松龙冲击疗法后改为口服激素,并联合血管扩张剂、能量合剂、维生素,必要时可加用抗生素或抗病毒药物等综合治疗方法,而且本组研究结果也进一步证实了此方案的疗效显著性。
[Abstract]:Objective to study the causes and clinical characteristics of optic neuritis in the first Hospital of Jilin University. Participants and methods from January 2005 to December 2010, 71 eyes (22 eyes, 27 eyes) of 49 patients with optic neuritis, 30 cases with optic papilltis and 19 cases with retrobulbar optic neuritis, were retrospectively analyzed, who were hospitalized in the first Hospital of Jilin University from January 2005 to December 2010. There were 22 males and 27 females, aged from 4 years to 71 years, with an average age of 35.1 years. Routine ophthalmic examination and physical examination were performed, and different treatments were given. The treatment group a was oral prednisone after intravenous methylprednisolone, the treatment group b was oral prednisone after intravenous dexamethasone, the treatment group c was oral prednisone, and the control group was not treated with systemic hormone. The four treatments mentioned above are combined with various adjuvant treatments, including dexamethasone injection, vasodilators, energy mixture, vitamins, Chinese medicine and so on. Those with definite etiology are treated with etiology at the same time. For example, those with symptoms of bacterial infection were given antibiotics, and those with symptoms of viral infection were given antiviral drugs. The causes, visual acuity, pain, pupil, fundus, visual field and visual evoked potential were analyzed by X2 test. Results there were 3 cases of upper respiratory tract infection, 2 cases of sinusitis, 2 cases of optic neuromyelitis, 1 case of multiple sclerosis, 1 case of syphilis, 1 case of gingival inflammation, 1 case of pneumonia, 1 case of encephalomyelitis and 1 case of orbital cellulitis. The other 36 cases had no definite etiology. At admission, the corrected visual acuity was less than 0.1 in 36 eyes, but greater than 0.1 in 22 eyes, but less than 0.5 in 22 eyes. More than 0.5 there are 13 eyes with pain in 24 cases, 25 cases without eye pain, 31 cases with pupillary dyskinesia, 18 cases without pupil motor disorder, 30 cases with fundus abnormalities, 19 cases without abnormal fundus and 45 cases with various abnormal surface of visual field. The latency of visual evoked potential (VEP) was prolonged or / and amplitude decreased in 29 cases. In 8 cases, 12 cases were normal and 1 case had no MRI. 21 cases had no abnormal demyelination of white matter. 27 cases were not detected. The effective rate of treatment group a was 96.2g, treatment group b was 60.0g, treatment group c was 88.99.The control group was not given systemic hormone. The effective rate is 76. 9%. Conclusion the incidence of optic papilltis in the first Hospital of Jilin University in recent 6 years was significantly higher than that in Retrobulbar optic neuritis. The incidence age of optic papilltis was more than that of Retrobulbar optic neuritis, with an average age of 35.1 years. It was caused partly by acute and chronic infection, partly by multiple sclerosis and optic neuromyelitis. The above results are obviously different from those of the western countries, and are closer to that of Japan, which is an oriental country, so the racial difference between the East and the West can not be ignored. In the aspect of treatment, the first emphasis is on the exploration of etiology and early treatment, but due to the complexity of the cause, there is no uniform and effective standard treatment. We are still guided by the ONTT study, which is to give methylprednisolone shock therapy to oral hormones, combined with vasodilators, energy agents, vitamins and, if necessary, antibiotics or antiviral drugs. The results of this study further confirmed the efficacy of this scheme.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R774.6

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