以急性视神经炎首发的多发性硬化视神经功能障碍分析

目的 探讨以急性视神经炎(acute optic neuritis,AON)为首发的多发性硬化(multiple sclerosis,MS)视神经功能的改变特点,及时治疗并尽大可能恢复视神经功能.方法 对每例以视神经炎为首发的MS患者行视力、眼底、视野及视诱发电位检查,部分患者行CT或者MRI,脑脊液测定和寡克隆区带检查.采用χ2检验与t检验对患者视神经功能改变的特点进行分析.结果 (1)视神经功能检查:所有患者均有视力下降;不同程度的视神经萎缩、视神经乳头水肿表现;客观检查显示视野损害、视诱发电位、色觉异常;与无伴AON的MS患者进行比较,在视力下降及视神经乳头水肿方面差异均有统计学意义;视诱发电位检查均存在异常,表现在P100潜伏期延长,AON组异常率为63.6%～72.7%,无伴AON的MS组为21.4%～28.5%,两组相比差异有显著性意义(P＜0.05).(2)脑脊液免疫球蛋白检查:视神经炎鞘内IgG合成率低于无伴AON组(P＜0.01).(3)所有患者经大剂量肾上腺素糖皮质激素及时治疗后,视力恢复到0.5以上者约31.2%～36.3%.结论 AON是MS的最常见症状之一,视神经炎与MS视神经脊髓炎型的视神经损害发生频率高且程度重,迫切需要对AON患者进行早期诊断,并及时给予大剂量肾上腺素糖皮质激素治疗.

The clinical studay on visual function changes in multiple sclerosis with acute optic neuritis

Objective To studay the visual functional disorders of multiple sclerosis with optic neuritis and treat them early to remedy visual function effectively. Methods Visual acuity, funduscopy,visual evoked potentials (VEP), visual field defect, CT and/or MRI were assessed in cases of MS with optic neuritis and MS without optic neuritis patients. CSF determinations and oligoclomal bands were assessed in part of them, by x2 and t test. Results (1)Abnomal visual function test results were commonly observed in patients on visual acuity, optic atrophy, papilledema, visual field defect, VEP. Patients with AON had visual acuity less than 0.1 (P＜0.05 ), compaired with MS without AON. VEP showed the abnormalities in 63.6%～72.7% of MS with AON and 21.4%～28.5% of MS without AON with the feature of prolonged potential time (P＜0.05), compaired with MS without AON. (2)CSF oligoclonal bands were comparable, but CSG IgG synthesis rates in patients with AON were less than in MS without AON (P＜0.05).(3)The rates of visual acuity over 0.5 after high dose of corticosteroid in part of patients were about 31.2%～36.3%. Conclusions Optic neuritis was a common feature of MS. The visual disorders in patients with optic neuritis and MS were common and serious. There were abnormal immunological responses in AON as well as in MS so, the early disgnosis and treatment of high dose of corticosteroid for AON is necessary and imperative.