双眼非动脉炎性前部缺血性视神经病变患者的临床特点和预后分析

目的：研究双眼非动脉炎性前部缺血性视神经病变(nonarteritic ischemic optic neuropathy， NAION)患者的临床特点及其预后的影响因素。

方法：回顾2006年以来我院收治的双眼发病NAION患者的临床资料，包括发病特点、治疗方法、人口统计学特征、病史、视功能指标(视力、视野)等，并对影响视功能预后的相关因素进行统计分析。

结果：研究共纳入61例(122眼)双眼NAION患者，其中男性39例，女性22例，平均年龄58.0±11.0岁，就诊时平均病程12.5mo(IQR 4.75～26.5)，初诊时最佳矫正视力中位数为0.7 LogMAR(IQR 0.2～1.3)。就诊时38眼仍有不同程度视盘水肿，76眼视盘色淡或苍白。典型的视野缺损类型分别为下方近水平半盲(38眼)、鼻上方缺损(21眼)、鼻下方缺损(16眼)、上方近水平半盲(13眼)，以及近管状视野(12眼)。纳入患者中31例伴有高血压、高血脂、糖尿病或其他心脑血管疾病。患者随访时间的中位数为12mo(IQR 6.0～23.5)，随访期间视力中位数由0.7 LogMAR(IQR 0.2～1.3)提高至0.4 LogMAR(IQR 0.175～1.1)，其中45眼(36.9%)的视力提高了2行或以上。男性患者和女性患者的视力比较，初诊时及随访后两者均无统计学差异(Z=-0.521，-1.600，P>0.05)。伴有心脑血管疾病的患者与不伴心脑血管疾病者比较，初诊时两组患者视力无统计学差异(Z=-1.103，P>0.05)，但末次随访时不伴有心脑血管疾病的患者的视力明显优于伴心脑血管疾病的患者(Z=-2.090，P<0.05)。首发眼和后发病眼的末次随访视力均优于初诊视力(P=0.003，0.019)，且首发眼的视力在随访期间的提高幅度高于后发病眼的视力提高幅度(分别为0.2 LogMAR及0.1 LogMAR)，但差异尚无统计学意义(P=0.195)。

结论：本研究统计分析了双眼NAION患者的人口统计学特征、发病率、病史、视功能指标(视力、视野)等，现有随访数据表明，不伴心脑血管疾病的双眼NAION患者视力改善幅度优于患心脑血管疾病者，且首发眼视力预后可能优于后发病眼。但目前尚缺乏足够证据，仍需进一步研究。

Clinical characteristics and prognosis of bilateral nonarteritic ischemic optic neuropathy patients in 61 cases

AIM: To evaluate the clinical characteristics of patients with bilateral nonarteritic ischemic optic neuropathy(NAION)and the prognosis of NAION's impact factors.

METHODS: NAION patients with both eyes onset from 2006 were included in this study, their clinical characteristics, treatment methods, the demographic index, medical history, visual acuity, visual field and other clinical data of NAION, including the impact factors of the prognosis, were obtained statistically.

RESULTS: A total of 61 patients(122 eyes)have been diagnosed with NAION bilaterally, including 39 males and 22 females, with an average age of 58.0±11.0 years old, and the duration of the first onset was 12.5mo(IQR 4.75-26.5). The median of the best log MAR corrected visual acuity of the 122 eyes at initial visit were 0.7 logMAR(IQR 0.2-1.3), optic disc edema was seen in 38 eyes while optic disc saw in 76 eyes were pale or white. The most common types of visual field defects were inferior altitudinal visual field defect(38 eyes), supero-nasal defect(21 eyes), infero-nasal defect(16 eyes), superior altitudinal visual field defect(13 eyes), and tubular visual field defect(12 eyes). Among all the patients, there were 31 accompanied with hypertension, hyperlipidemia, diabetes, or a history of other cardiovascular and cerebrovascular diseases. After an median of 12mo(IQR 6-23.5)of follow-up observation, the visual acuity has been increased from 0.7 logMAR(IQR 0.2-1.3)to 0.4 logMAR(IQR 0.175-1.1), in which 45 eyes(36.9%)increased 2 lines or more. Best corrected visual acuity(BCVA)had no significant differences(Z=-0.521, -1.600, P>0.05)between the male and female patients at initial visit and during follow-up. BCVA of patients accompanied with cardiovascular or cerebrovascular disease had no significant differences(Z=-1.103, P>0.05)from those without cardiovascular or cerebrovascular disease before the treatment, while there were significant differences(Z=-2.090,P<0.05)between the two type of patients at their last follow-up visit. The visual acuity of the earlier onset cases and the later onset cases were both significantly higher(P=0.003, 0.019)than that at last visit, while BCVA of earlier onset cases improved more than later onset cases(median with 0.2 and 0.1 logMAR respectively, P=0.195)though there was no significant differences.

CONCLUSION: After summarizing the demographic index, incidence, medical history, visual acuity, and visual field characteristics of the bilateral NAION patients, we found that patients who were accompanied with cardiovascular or cerebrovascular disease and the later onset eyes might had a poor prognosis than the others, though there were further evidence needed to support this finding.