多发性硬化与视神经脊髓炎患者的眼部特征及其治疗效果

目的 观察伴有眼部异常的多发性硬化(MS)及视神经脊髓炎(NMO)患者的眼部特征及治疗效果.方法 回顾分析我院确诊为MS及NMO且伴有眼部异常的107例患者的临床资料.其中,MS患者81例,NMO患者26例.所有患者均接受MRI、腰椎穿刺脑脊液(CSF)检测红、白细胞计数、蛋白含量及寡克隆带,确定MS及NMO临床诊断.对所有患者行视力、裂隙灯显微镜、眼底等常规眼科检查,并行计算机视野和视觉诱发电位(VEP)检查,对比分析MS、MMO患者眼部临床特征的异同.对患者进行大剂量甲泼尼龙冲击治疗或中药活血化瘀、营养神经治疗后,分析不同治疗方法对眼部症状改善的影响.所有患者随访1个月～5年,平均随访时间26个月.结果 MS患者中球后视神经炎24例,占MS患者总数的29.6%;麻痹性斜视和复视36例,占44.4%.NMO患者中急性视盘炎12例,占NMO患者总数的46.2%;球后视神经炎14例,占53.8%.MS和NMO患者视野检查异常率分别为71.6%、96.2%.MRI检查结果显示MS患者脱髓鞘斑块位于脑室旁最常见;NMO患者病灶多累及脊髓.脑脊液检查结果显示MS患者寡克隆带阳性率为75.3%,NMO患者为19.2%.MS和NMO患者VEP检查主要表现为P100波潜伏期延长和(或)波幅降低.接受甲泼尼龙冲击治疗与未接受冲击治疗的患者视力提高率分别为84.7%、80.0%,差异无统计学意义(χ2=0.221,P>0.05).结论 MS及NMO患者均可能发生视神经炎.糖皮质激素冲击治疗可加速患者眼部症状的改善.

Ocular manifestation of multiple sclerosis and neuromyelitis optica

Objective To observe the ocular manifestations and therapeutic effect of multiple sclerosis (MS) and neuromyelitis optica (NMO) with ocular symptoms. Methods The clinical data of 107 patients who was diagnosed with MS and NMO with ocular symptoms in our hospital were retrospectively analyzed, including 81 MS patients and 26 NMO patients. The counting of erythocytes and leukocyte, protein content and oligoclonal bands were detected by MRI and cerebrospinal fluid (CSF) in order to ensure the clinical diagnosis with MS and NMO. All the patients had undergone regular ophthalmologic examination of visual acuity,slit lamp microscope and fundus examination. In addition, visual field and visual evoked potential (VEP) examination were performed to analyze the clinical characteristics of ocular manifestations. The patients were received therapy with large dose methyl-prednisolone or activating blood and dissolving stasis and trophic nerve by Chinese medicine. The effects of three methods on ocular manifestations were analyzed. All the patients were followed up for one month to five years. Results Among 81 MS patients,retrobulbar neuritis occurred in 24 patients (29. 6%), the other common symptoms included paralytic strabismus and diplopia(30.3%). Among 26 NMO patients, acute papillitis occurred in 12 (46. 2%), while retrobulbar neuritis occurred in 14 (53. 8%). The most common symptom of both MS and NMO was impaired vision and high abnormal rate. The results of MRI showed that demyelinating lesions beside ventricle was the most performance in MS patients,while abnormalities in spinal cord were found in NMO patients. The results of CSF showed that the positive oligoclonal bands was 75.3% and 19.2% in MS and NMO patients respectively. The potential time delay and (or) amplitude declination were observed by VEP. Large dose methyl-prednisolone can improve vision and diplopia in a short period. Conclusion The abnormal ocular manifestations of MS and NMO patients are common and complicated. Ocular symptoms has important reference value in the early diagnosis of MS and NMO.