光相干连续断层成像术在视神经脊髓炎谱系病的临床应用

目的探讨光相干连续断层成像术(OCT)在视神经脊髓炎谱系病(NMOSD)的临床应用。方法利用OCT对49例NMOSD患者(NMOSD组)和1 5例健康对照志愿者(对照组)视乳头周围视网膜神经纤维层(RNFL)厚度进行比较;NMOSD组再根据是否伴视神经炎、水通道蛋白抗体状态(AQP4-IgG)等对NMOSD组分为伴视神经炎(NMOSD-ON)亚组(34例);不伴视神经炎(NMOSD-NON)亚组(15例)。比较各亚组的RNFL厚度差异;采用扩展病残状态评分(EDSS)评价神经功能缺损程度,分析EDSS与RNFL是否存在相关性。结果 NMOSD患者受累眼的RNFL各象限厚度与未受累眼和对照组比较显著变薄(P0.01);NMOSD未受累眼与对照组比较,RNFL厚度差异无显著性(P0.05)。AQP4-IgG阳性或阴性NMOSD-ON亚组的RNFL厚度比较差异无显著性(P0.05);RNFL厚度变化与NMOSD残障的严重程度无相关性(P0.05)。结论 RNFL变薄仅在NMOSD受累眼表现,厚度变化与AQP4-IgG无关,OCT可能有助于临床对NMOSD诊疗提供参考指标。

The Application of Optical Coherence Tomography in Neuromyelitis Optica Spectrum Disease

Aim To investigate the valuation of optical coherence tomography (OCT) in neuromyelitis optica spectrum disease (NMOSD).Methods The retinal nerve fiber layer (RNFL) of forty-nine patients with NMOSD and fifteen healthy controls were examined and compared by OCT.The differences of RNFL in subgroups of NMOSD,which were divided by the presence of optic neuritis or the status of AQP4-IgG,were studied.Expanded Disability Status Scale (EDSS) score of NMOSD patients with ON attacks were evaluated and used in the analysis of relationship with RNFL.Results RNFL in all quarters were thinner in ON-attacked eyes of NMOSD in contrast with non-ON-attacked eyes of NMOSD and HC (P＜0.01),while non-ON-attacked eyes of NMOSD had no significant RNFL differences with those of HC (P＞0.05).In NMOSD with ON,no significant RNFL differences were found between AQP4-IgG-positive and AQP4-IgG-negative patients (P＞0.05) and there were no relationship between EDSS and RNFL (P＞0.05).Conclusion RNFL reduce only at the ON-attacked eyes in NMOSD and these changes was not decided by the AQP4-IgG,OCT may contribute for the differential diagnosis and evaluation of therapeutic effects of NMOSD.