甲泼尼龙琥珀酸钠冲击治疗对急性视神经炎患者视功能及血清AQP4-Ab、ANAs水平的影响
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摘要
目的探讨甲泼尼龙琥珀酸钠冲击治疗对急性视神经炎患者视功能及血清水通道蛋白4抗体(AQP4-Ab)、抗核抗体(ANAs)的影响。方法我院收治的120例(188眼)急性视神经炎患者,按随机数表法分为观察组和对照组各60例(92眼、96眼),前者给予甲泼尼龙琥珀酸钠冲击和泼尼松治疗,后者给予地塞米松和泼尼松治疗。治疗结束后评估临床疗效,3个月复查视力情况,并于治疗前后空腹采血,检测自身免疫抗体AQP4-Ab、ANAs阳性率。结果两组近期疗效比较差异无统计学意义(P>0.05),但观察组总有效率高于对照组(P<0.05)。两组治疗结束后及治疗后3个月视力均高于治疗前,且观察组高于对照组(P<0.05)。两组治疗结束后AQP4-Ab、ANAs阳性率均低于治疗前,且观察组低于对照组(P<0.05)。结论甲泼尼龙琥珀酸钠冲击治疗急性视神经炎疗效可观,可提高患者视功能及降低自身免疫抗体阳性率。
Objective To investigate the effect of pulse therapy of methylprednisolone sodium succinate on the visual function and serum aquaporin 4 antibody( AQP4 Ab) and antinuclear antibody( ANAs) in patients with acute optic neuritis. Methods One hundred and twenty patients( 188 eyes) with acute optic neuritis who were admitted to the ophthalmology department of our hospital were randomly divided into experimental group( 60 cases and 92 eyes) and control group( 60 cases,96 eyes).The experimental group was treated with pulse therapy of methylprednisolone sodium succinate and prednisone while the control group was treated with dexamethasone and prednisone.After treatment,the clinical efficacy was evaluated. The visual acuity was reexamined 3 months later. Fasting blood samples were collected before and after treatment to detect the positive rates of AQP4-Ab and ANAs.Results There was no significant difference in the short-term curative effect between the two groups( P > 0. 05). However,the total effective rate in the experimental group was significantly higher than that in the control group( P < 0. 05).The visual acuity was increased after treatment and 3 months later( P < 0. 05).The increase in the experimental group was significantly greater than that in the control group( P < 0. 05).The positive rate of AQP4-Ab and ANAs after treatment was lower than before treatment in the two groups( P > 0. 05).The positive rate in the experimental group was significantly lower than that in the control group( P < 0. 05). Conclusion The pulse therapy of methylprednisolone sodium succinate is significantly effective in the treatment of acute optic neuritis.It can improve the visual function in patients and decrease the positive rates of autoantibodies.
Objective To investigate the effect of pulse therapy of methylprednisolone sodium succinate on the visual function and serum aquaporin 4 antibody( AQP4 Ab) and antinuclear antibody( ANAs) in patients with acute optic neuritis. Methods One hundred and twenty patients( 188 eyes) with acute optic neuritis who were admitted to the ophthalmology department of our hospital were randomly divided into experimental group( 60 cases and 92 eyes) and control group( 60 cases,96 eyes).The experimental group was treated with pulse therapy of methylprednisolone sodium succinate and prednisone while the control group was treated with dexamethasone and prednisone.After treatment,the clinical efficacy was evaluated. The visual acuity was reexamined 3 months later. Fasting blood samples were collected before and after treatment to detect the positive rates of AQP4-Ab and ANAs.Results There was no significant difference in the short-term curative effect between the two groups( P > 0. 05). However,the total effective rate in the experimental group was significantly higher than that in the control group( P < 0. 05).The visual acuity was increased after treatment and 3 months later( P < 0. 05).The increase in the experimental group was significantly greater than that in the control group( P < 0. 05).The positive rate of AQP4-Ab and ANAs after treatment was lower than before treatment in the two groups( P > 0. 05).The positive rate in the experimental group was significantly lower than that in the control group( P < 0. 05). Conclusion The pulse therapy of methylprednisolone sodium succinate is significantly effective in the treatment of acute optic neuritis.It can improve the visual function in patients and decrease the positive rates of autoantibodies.
引文
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[7]陈萍.大剂量甲基强的松龙冲击疗法对急性视神经炎的疗效及自身免疫抗体的影响[J].中国实用神经疾病杂志,2014,17(3):8-11.
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[9]赵朔,徐全刚,魏世辉.视神经脊髓炎相关性视神经炎临床研究进展[J].中华眼底病杂志,2015,31(6):605-608.
[10]赵源庆,郭家亮,唐慧玲,等.难治性噪声性耳聋鼓室注射甲泼尼龙琥珀酸钠的疗效[J].中华劳动卫生职业病杂志,2015,33(7):547-548.
[11]王琴,白宁艳,颜学梅,等.大剂量甲泼尼龙琥珀酸钠冲击疗法治疗急性视神经炎56例体会[J].中国实用眼科杂志,2016,34(3):270-272.
[2]彭春霞,曹珊珊,赵朔,等.水通道蛋白-4抗体阳性视神经炎患者视网膜神经纤维层及黄斑区内层视网膜结构改变观察[J].中华眼底病杂志,2015,31(6):536-540.
[3]李敏,秦新月.多种方法检测视神经脊髓炎患者血清及脑脊液中水通道蛋白4抗体的临床应用[J].中国实验诊断学,2015,19(8):1261-1263.
[4]凤鸣.眼科全书[M].北京:人民卫生出版社,1996:3168.
[5]和寅放,薛玲,鲁成,等.大剂量甲泼尼龙冲击治疗急性球后视神经炎的疗效观察[J].眼科新进展,2011,31(7):675-677.
[6]朱向红,曹峥.间歇性激素冲击疗法对急性球后视神经炎患者视功能恢复及自身免疫抗体的影响[J].中国实用神经疾病杂志,2017,20(8):65-68.
[7]陈萍.大剂量甲基强的松龙冲击疗法对急性视神经炎的疗效及自身免疫抗体的影响[J].中国实用神经疾病杂志,2014,17(3):8-11.
[8]曾嵘.不同剂量甲泼尼龙治疗小儿严重脓毒症疗效比较[J].成都医学院学报,2014,9(6):734-737.
[9]赵朔,徐全刚,魏世辉.视神经脊髓炎相关性视神经炎临床研究进展[J].中华眼底病杂志,2015,31(6):605-608.
[10]赵源庆,郭家亮,唐慧玲,等.难治性噪声性耳聋鼓室注射甲泼尼龙琥珀酸钠的疗效[J].中华劳动卫生职业病杂志,2015,33(7):547-548.
[11]王琴,白宁艳,颜学梅,等.大剂量甲泼尼龙琥珀酸钠冲击疗法治疗急性视神经炎56例体会[J].中国实用眼科杂志,2016,34(3):270-272.