Du Yi, Li Jing-Jing, Zhang Yu-Jiao, Li Kaijun, He Jian-Feng
Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
PLoS One. 2014 Sep 25;9(9):e108580. doi: 10.1371/journal.pone.0108580. eCollection 2014.
Approximately 30-50% of idiopathic optic neuritis (ION) patients experience one or multiple episodes of recurrence. The aim of this study was to search for risk factors for ION recurrence.
Clinical data on hospitalized patients diagnosed with ION between January 2003 and January 2011 at the First Affiliated Hospital of Guangxi Medical University were retrospectively collected. Univariate and multivariate analyses were performed on factors that might cause ION recurrence. In total, 115 ION cases (32 recurrent and 83 non-recurrent cases) with complete data were analyzed. The length of the follow-up period ranged from 12 to 108 months (median: 42 months).
The univariate analysis showed that the recurrence rate for unilateral ION was higher than that for bilateral ION (40% vs. 12%, p=0.001). Underlying diseases had a significant impact on recurrence (p<0.001): the recurrence rates due to neuromyelitis optica (NMO), multiple sclerosis (MS), demyelinating lesions alone of the central nervous system, and unknown causes were 89%, 70%, 41%, and 8.7%, respectively. The multivariate analysis showed that the factors causing relatively high recurrence rates included NMO (odds ratio [OR], 73.5; 95% confidence interval [CI], 7.3 to 740.9), MS (OR, 33.9; 95% CI, 5.2 to 222.2), and demyelinating lesions alone (OR, 8.9; 95% CI, 2.3 to 34.4), unilateral involvement (OR, 5.7; 95% CI, 1.5 to 21.3), relatively low initial glucocorticoid dosage (equivalent to ≤ 100 mg prednisone/day) (OR, 4.3; 95% CI, 1.0 to 17.9).
Underlying diseases, laterality (unilateral or bilateral), and initial glucocorticoid dosage are important risk factors of ION recurrence. Clinical physicians are advised to treat ION patients with a sufficient dose of glucocorticoid in the initial treatment stage to reduce the recurrence risk.
约30%-50%的特发性视神经炎（ION）患者会经历一次或多次复发。本研究旨在寻找ION复发的危险因素。
回顾性收集2003年1月至2011年1月在广西医科大学第一附属医院住院诊断为ION的患者的临床资料。对可能导致ION复发的因素进行单因素和多因素分析。共分析了115例资料完整的ION病例（32例复发和83例未复发）。随访时间为12至108个月（中位数：42个月）。
单因素分析显示，单侧ION的复发率高于双侧ION（40%对12%，p=0.001）。基础疾病对复发有显著影响（p<0.001）：视神经脊髓炎（NMO）、多发性硬化（MS）、单纯中枢神经系统脱髓鞘病变和病因不明导致的复发率分别为89%、70%、41%和8.7%。多因素分析显示，导致较高复发率的因素包括NMO（比值比[OR]，73.5；95%置信区间[CI]，7.3至740.9）、MS（OR，33.9；95%CI，5.2至222.2）、单纯脱髓鞘病变（OR，8.9；95%CI，2.3至34.4）、单侧受累（OR，5.7；95%CI，1.5至21.3）、初始糖皮质激素剂量相对较低（相当于≤100mg泼尼松/天）（OR，4.3；95%CI，1.0至17.9）。
基础疾病、病变侧别（单侧或双侧）和初始糖皮质激素剂量是ION复发的重要危险因素。建议临床医生在初始治疗阶段用足够剂量的糖皮质激素治疗ION患者以降低复发风险。
