特发性脱髓鞘性视神经炎的临床转归

目的 了解特发性脱髓鞘性视神经炎(IDON)临床转归、转化为多发性硬化(MS)或视神经脊髓炎(NMO)的比例以及相关影响因素.方法 对确诊且临床资料完整的IDON患者进行病例回顾及随访,记录视功能和其他神经功能变化以及MS或NMO转化率,应用卡方检验分析不同临床特征对转化率的影响.结果 共入组资料完整且完成随访的IDON患者107例.多数患者视力恢复较好,12例(11.2%)在随访期间转化为MS或NMO.全部12例患者均符合2005年修订的McDonald诊断标准,其中4例符合1999年NMO诊断标准,其余8例中部分表现为"视神经脊髓型MS".复发性IDON较首次发病患者、伴头颅MRI异常较MRI正常者转化为MS或NMO的比例高,分别为23.1%和4.4%(χ2=6.899,P<0.01)以及18.2%和8.1%.是否伴有视乳头水肿以及不同视力损害程度组之间转化为MS或NMO的比例没有差异.结论 该组IDON患者转化为MS或NMO的比例为11.2%.复发性IDON和伴有头颅MRI异常的患者更易转化为MS或NMO.

Conversion of idiopathic demyelinating optic neuritis to multiple sclerosis: its rate and risks

Objective To investigate the clinical prognosis of idiopathic demyelinating optic neuritis (IDON), the rate of its conversion to multiple sclerosis (MS) or neuromyelitis optica (NMO) and its clinical features related to the conversion.Methods Patients satisfying our entry criteria for IDON hospitalized in Beijing Tongren Hospital during the period from 2002 to 2007 were re-evaluated with follow-ups for 6-months to 5-years.The McDonald diagnostic criteria for MS (revised, 2005) was used to diagnose MS in these subjects during follow-up and the diagnosis of NMO utilized 1999 Wingerchuk' s NMO criteria.The Chi-Squared χ2 test was applied to statistically analyze association of clinical features and development of MS or NMO.Results In 107 recruited IDON cases with complete clinical data and follow-up, 12 cases (11.2%) developed into MS or NMO during follow-up period.All 12 cases met the revised McDonald criteria, of which 4 cases met NMO criteria and the remaining eight cases showed some clinical evidence of "optic-spinal MS (OS-MS)".A significantly higher conversion rate of 23.1% was found in recurrent IDON than the 4.4% in single-episode cases (χ2 = 6.899, P < 0.01) .Convesion rate of female patiends (17.2%) is significantly higher than male patients (4.1%, χ2 = 4.620, P < 0.05).Conversion rate of 18.2% in patients with initially abnormal brain MRI was higher than rate of 8.1% in cases with normal brain MRI, but the difference was not statistically significant.No difference was found between presence or absence of swollen disc, nor severity of vision loss.Conclusions In a group of IDON patients, 11.2% developed into MS and NMO or clinically indicative OS-MS.Recurrent IDON and female gender suggested higher risk of developing MS or NMO.