七叶皂苷钠联合甲强龙冲击疗法对急性视神经炎患者视力恢复的影响
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摘要
目的探究七叶皂苷钠联合甲强龙冲击疗法对急性视神经炎(AON)患者视力恢复的影响。方法选取2014-10—2016-10许昌市中心医院AON患者104例(共104只眼),随机数字表法分为2组各52例(各52只眼)。对照组予以甲强龙冲击疗法,研究组予以甲强龙冲击疗法+七叶皂苷钠,2组均治疗1个月。统计2组临床疗效、视力及视野恢复情况、不良反应发生情况。结果研究组临床疗效(98. 08%)高于对照组(80. 77%),差异有统计学意义(P<0. 05);治疗后研究组在≥1. 0、0. 5～0. 9所占比例均高于对照组,在0. 1～0. 4、<0. 1所占比例低于对照组,差异有统计学意义(P<0. 05);治疗后研究组在中心暗点、哑铃状暗点、旁中心暗点、生理盲点扩大、周边视野向心性缩小所占比例均低于对照组,差异有统计学意义(P<0. 05);研究组不良反应发生率(11. 54%)与对照组比较(17. 31%),差异无统计学意义(P>0. 05)。结论七叶皂苷钠联合甲强龙冲击疗法可明显改善AON患者视力及视野恢复情况,提高治疗效果,且具有较高安全性。
Objective To investigate the sodium aescinate combined with methylprednisolone therapy on vision recovery in patients with acute optic neuritis (AON). Methods 104 cases (104 eyes) of AON patients in our hospital from October 2014 to October 2016 were randomly divided into groups with each 52 cases (52 eyes). The control group was treated with methylprednisolone therapy,and the study group was treated with methylprednisolone therapy + sodium aescinate. Both groups were treated for 1month. The clinical efficacy,recovery of visual acuity and visual field and incidence of adverse reactions were compared between the two groups. Results The clinical efficacy of the study group (98. 08%) was higher than that of the control group (80. 77%),and the difference was statistically significant (P< 0. 05). After treatment,the proportion in the range of ≥1. 0 and during 0.5 ～ 0.9 of the study group was higher than that of the control group,and the proportion in the range during 0. 1 ～ 0. 4 and < 0. 1 was lower than that of the control group,and the difference was statistically significant (P < 0. 05). After treatment,the proportion of center dark point,dumbbell shaped dark point,side center dark point,enlargement of physiological blind spot and concentric contraction of the peripheral visual field of the study group was lower than that of the control group,and the difference was statistically significant (P< 0. 05).The incidence of adverse reactions in the study group (11. 54%) was significantly lower than that in the control group (17. 31%),but the difference was not statistically significant (P> 0. 05). Conclusion The sodium aescinate combined with methylprednisolone therapy can significantly improve the recovery of vision and visual field of AON patients,and improve the therapeutic effect. And it has high safety.
Objective To investigate the sodium aescinate combined with methylprednisolone therapy on vision recovery in patients with acute optic neuritis (AON). Methods 104 cases (104 eyes) of AON patients in our hospital from October 2014 to October 2016 were randomly divided into groups with each 52 cases (52 eyes). The control group was treated with methylprednisolone therapy,and the study group was treated with methylprednisolone therapy + sodium aescinate. Both groups were treated for 1month. The clinical efficacy,recovery of visual acuity and visual field and incidence of adverse reactions were compared between the two groups. Results The clinical efficacy of the study group (98. 08%) was higher than that of the control group (80. 77%),and the difference was statistically significant (P< 0. 05). After treatment,the proportion in the range of ≥1. 0 and during 0.5 ～ 0.9 of the study group was higher than that of the control group,and the proportion in the range during 0. 1 ～ 0. 4 and < 0. 1 was lower than that of the control group,and the difference was statistically significant (P < 0. 05). After treatment,the proportion of center dark point,dumbbell shaped dark point,side center dark point,enlargement of physiological blind spot and concentric contraction of the peripheral visual field of the study group was lower than that of the control group,and the difference was statistically significant (P< 0. 05).The incidence of adverse reactions in the study group (11. 54%) was significantly lower than that in the control group (17. 31%),but the difference was not statistically significant (P> 0. 05). Conclusion The sodium aescinate combined with methylprednisolone therapy can significantly improve the recovery of vision and visual field of AON patients,and improve the therapeutic effect. And it has high safety.
引文
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[17]JEFFERIS J M,LITTLEWOOD R,PEPPER I M,et al.AStereotyped Syndrome with Retro-Ocular Pain,Photophobia,and Visual Disturbance Masquerading as Optic Neuritis:Case Series[J].Neuroophthalmology,2018,42(6):339-342.doi:10.1080/01658107.2018.1437753.
[18]LEVY M,GIOVANNONI G,HAWKES C,et al.Refining the Nosology of Antigen-Specific Diseases Within the Spectrum of Neuromyelitis Optica[J].Mult Scler Relat Disord,2018,25(10):A1-A2.doi:10.1016/j.msard.2018.09.027.
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[20]KUMAR R,PAUL B S,SINGH G,et al.Therapeutic efficacy of plasma exchange in neuromyelitis optica[J].Ann Indian Acad Neurol,2018,21(2):140-143.doi:10.4103/aian.AIAN_330_17.
[21]MARZOLI S B,CRISCUOLI A.Pain in optic neuropathies[J].Neurol Sci,2018,39(Suppl 1):25-31.doi:10.1007/s10072-018-3334-1.
[22]JARIUS S,PAUL F,AKTAS O,et al.Mog encephalomyelitis:international recommendations on diagnosis and antibody testing[J].J Neuroinflammation,2018,15(1):134.doi:10.1186/s12974-018-1144-2.
[23]SAHRAIAN M A,MOGHADASI A N,AZIMI A R,et al.Diagnosis and management of Neuromyelitis Optica Spectrum Disorder(NMOSD)in Iran:A consensus guideline and recommendations[J].Mult Scler Relat Disord,2017,18(11):144-151.doi:10.1016/j.msard.2017.09.015.
[24]VOLKMAN T,HEMINGWAY C.A case of seroposi-tive Neuromyelitis Optica in a paediatric patient with coexisting acute nephrotic syndrome[J].Mult Scler Relat Disord,2017,18(11):103-105.doi:10.1016/j.msard.2017.09.009.
[25]BANSAL R,SINGH R,TAKKAR A,et al.Combined central retinal artery and vein occlusion with optic perineuritis following herpes zoster dermatitis in an immunocompetent child[J].Indian J Ophthalmol,2017,65(11):1 233-1 235.doi:10.4103/ijo.IJO_480_17.
[26]RUSESCU B V,DIEDERICH N J,TSOBO C,et al.Mog antibody-associated optic neuritis in the setting of acute CMV infection[J].J Neurol Sci,2017,15(11):44-46.doi:10.1016/j.jns.2017.09.011.
[27]NEUTEBOOM R,WILBUR C,VAN PELT D,et al.The Spectrum of Inflammatory Acquired Demyelinat-ing Syndromes in Children[J].Semin Pediatr Neurol,2017,24(3):189-200.doi:10.1016/j.spen.2017.08.007.
[28]VERMERSCH P,OUTTERYCK O,FERRIBY D,et al.Myelitis as a differential diagnosis of spinal cord tumors[J].Neurochirurgie,2017,63(5):349-355.doi:10.1016/j.neuchi.2017.06.004.
[29]PESCHL P,SCHANDA K,ZEKA B,et al.Human antibodies against the myelin oligodendrocyte glycopro-tein can cause complement-dependent demyelination[J].JNeuroinflammation,2017,14(1):208.doi:10.1186/s12974-017-0984-5.
[30]MARIOTTO S,FERRARI S,MONACO S,et al.Clinical spectrum and Ig G subclass analysis of anti-myelin oligodendrocyte glycoprotein antibody-associated syndromes:a multicenter study[J].J Neurol,2017,264(12):2 420-2430.doi:10.1007/s00415-017-8635-4.
[31]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.
[32]PATTERSON S L,GOGLIN S E.Neuromyelitis Optica[J].Rheum Dis Clin North Am,2017,43(4):579-591.doi:10.1016/j.rdc.2017.06.007.
[2]MATHEY G,MICHAUD M,PITTION-VOUYOVITCH S,et al.Classification and diagnostic criteria for demyelinating diseases of the central nervous system:Where do we stand today[J]?Rev Neurol(Paris),2018,174(6):378-390.doi:10.1016/j.neurol.2018.01.368.
[3]MELTZER E,PRASAD S.Review.updates and controversies in the management of acute optic neuritis[J].Asia Pac JOphthalmol(Phila),2018,7(4):251-256.doi:10.22608/APO.2018108.
[4]SOBHANIAN M J,AGARWAL R,MELTZER E,et al.Identification and treatment of the visual processing asymmetry in MS patients with optic neuritis:The Pulfrich phenomenon[J].J Neurol Sci,2018,387(4):60-69.doi:10.1016/j.jns.2018.01.029.
[5]GUTMAN J M,KUPERSMITH M,GALETTA S,et al.Anti-myelin oligodendrocyte glycoprotein(MOG)antibodies in patients with optic neuritis and seizures[J].JNeurol Sci,2018,387(4):170-173.doi:10.1016/j.jns.2018.01.042.
[6]PELLEGRINI F,LEE A G,CERCATO C.Multicentric glioblastoma multiforme mimicking optic neuritis[J].Neuroophthalmology,2017,42(2):112-116.doi:10.1080/01658107.2017.1350194.
[7]ADESINA O O,SCOTT MCNALLY J,SALZMAN K L,et al.Diffusion-weighted imaging and post-contrast enhancement in differentiating optic neuritis and nonarteritic anterior optic neuropathy[J].Neuroophthalmology,2017,42(2):90-98.doi:10.1080/01658107.2017.1356856.
[8]BAK E,KIM N,KHWARG S I,et al.Case series:herpes zoster ophthalmicus with acute orbital inflammation[J].Optom Vis Sci,2018,95(4):405-410.doi:10.1097/OPX.0000000000001204.
[9]GAJAMANGE S,RAFFELT D,DHOLLANDER T,et al.Fibre-specific white matter changes in multiple sclerosis patients with optic neuritis[J].Neuroimage Clin,2017,29(9):60-68.doi:10.1016/j.nicl.2017.09.027.
[10]HOLLEN C,SUHAIB O,FARROW A,et al.Elderly-onset neuromyelitis optica spectrum disorder with pre-existing prednisone allergy[J].Case Rep Neurol,2018,10(1):25-28.doi:10.1159/000485120.
[11]MARIOTTO S,MONACO S,PESCHL P,et al.Mog antibody seropositivity in a patient with encephalitis:beyond the classical syndrome[J].BMC Neurol,2017,17(1):190.doi:10.1186/s12883-017-0971-6.
[12]SOELBERG K,JARIUS S,SKEJOE H,et al.A populationbased prospective study of optic neuritis[J].Mult Scler,2017,23(14):1 893-1 901.doi:10.1177/1352458517734070.
[13]CHANG M Y,PINELES S L.Pediatric optic neuritis[J].Semin Pediatr Neurol,2017,24(2):122-128.doi:10.1016/j.spen.2017.04.004.
[14]JADE J D,BANSI S,SINGHAL B.Rituximab in neuromyelitis optica spectrum disorders:Our experience[J].Ann Indian Acad Neurol,2017,20(3):229-232.doi:10.4103/aian.AIAN_499_16.
[15]KANG H,CHEN T,LI H,et al,WEI S.Prognostic factors and disease course in aquaporin-4 antibody-positive Chinese patients with acute optic neuritis[J].J Neurol,2017,264(10):2 130-2 140.doi:10.1007/s00415-017-8606-9.
[16]ABTAHI M A,DEHGHANI A,ETEMADIFAR M,et al.A-cute vision loss in multiple sclerosis:Optic neuritis or central serous chorioretinopathy[J]?Mult Scler Relat Disord,2018,27(10):147-150.doi:10.1016/j.msard.2018.09.034.
[17]JEFFERIS J M,LITTLEWOOD R,PEPPER I M,et al.AStereotyped Syndrome with Retro-Ocular Pain,Photophobia,and Visual Disturbance Masquerading as Optic Neuritis:Case Series[J].Neuroophthalmology,2018,42(6):339-342.doi:10.1080/01658107.2018.1437753.
[18]LEVY M,GIOVANNONI G,HAWKES C,et al.Refining the Nosology of Antigen-Specific Diseases Within the Spectrum of Neuromyelitis Optica[J].Mult Scler Relat Disord,2018,25(10):A1-A2.doi:10.1016/j.msard.2018.09.027.
[19]NAUMOVSKA M,SHEIKH R,BENGTSSON B,et al.Visual outcome is similar in optic neuritis patients treated with oral and i.v.high-dose methylprednisol-one:a retrospective study on 56 patients[J].BMC Neurol,2018,18(1):160.doi:10.1186/s12883-018-1165-6.
[20]KUMAR R,PAUL B S,SINGH G,et al.Therapeutic efficacy of plasma exchange in neuromyelitis optica[J].Ann Indian Acad Neurol,2018,21(2):140-143.doi:10.4103/aian.AIAN_330_17.
[21]MARZOLI S B,CRISCUOLI A.Pain in optic neuropathies[J].Neurol Sci,2018,39(Suppl 1):25-31.doi:10.1007/s10072-018-3334-1.
[22]JARIUS S,PAUL F,AKTAS O,et al.Mog encephalomyelitis:international recommendations on diagnosis and antibody testing[J].J Neuroinflammation,2018,15(1):134.doi:10.1186/s12974-018-1144-2.
[23]SAHRAIAN M A,MOGHADASI A N,AZIMI A R,et al.Diagnosis and management of Neuromyelitis Optica Spectrum Disorder(NMOSD)in Iran:A consensus guideline and recommendations[J].Mult Scler Relat Disord,2017,18(11):144-151.doi:10.1016/j.msard.2017.09.015.
[24]VOLKMAN T,HEMINGWAY C.A case of seroposi-tive Neuromyelitis Optica in a paediatric patient with coexisting acute nephrotic syndrome[J].Mult Scler Relat Disord,2017,18(11):103-105.doi:10.1016/j.msard.2017.09.009.
[25]BANSAL R,SINGH R,TAKKAR A,et al.Combined central retinal artery and vein occlusion with optic perineuritis following herpes zoster dermatitis in an immunocompetent child[J].Indian J Ophthalmol,2017,65(11):1 233-1 235.doi:10.4103/ijo.IJO_480_17.
[26]RUSESCU B V,DIEDERICH N J,TSOBO C,et al.Mog antibody-associated optic neuritis in the setting of acute CMV infection[J].J Neurol Sci,2017,15(11):44-46.doi:10.1016/j.jns.2017.09.011.
[27]NEUTEBOOM R,WILBUR C,VAN PELT D,et al.The Spectrum of Inflammatory Acquired Demyelinat-ing Syndromes in Children[J].Semin Pediatr Neurol,2017,24(3):189-200.doi:10.1016/j.spen.2017.08.007.
[28]VERMERSCH P,OUTTERYCK O,FERRIBY D,et al.Myelitis as a differential diagnosis of spinal cord tumors[J].Neurochirurgie,2017,63(5):349-355.doi:10.1016/j.neuchi.2017.06.004.
[29]PESCHL P,SCHANDA K,ZEKA B,et al.Human antibodies against the myelin oligodendrocyte glycopro-tein can cause complement-dependent demyelination[J].JNeuroinflammation,2017,14(1):208.doi:10.1186/s12974-017-0984-5.
[30]MARIOTTO S,FERRARI S,MONACO S,et al.Clinical spectrum and Ig G subclass analysis of anti-myelin oligodendrocyte glycoprotein antibody-associated syndromes:a multicenter study[J].J Neurol,2017,264(12):2 420-2430.doi:10.1007/s00415-017-8635-4.
[31]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.
[32]PATTERSON S L,GOGLIN S E.Neuromyelitis Optica[J].Rheum Dis Clin North Am,2017,43(4):579-591.doi:10.1016/j.rdc.2017.06.007.