Sun H L, Cui S L, Liu L, Meng C, Jiang H Q, Zhang X J, Wang J W
Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2018 Jun 5;98(21):1674-1678. doi: 10.3760/cma.j.issn.0376-2491.2018.21.011.
To analyze the clinical and immunological characteristics of acute severe bilateral optic neuritis, and to explore the predictive factors of vision outcome and relapse so as to save visual function and avoid or alleviate vision disability. Forty-eight inpatients confirmed with acute severe bilateral optic neuritis from January 2013 to June 2015 were included and followed up. The clinical features, immunological findings, optic nerve imaging, visual function outcome and predictors of relapse were statistically analyzed. Acute severe bilateral optic neuritis accounted for 7.3% of the total number of optic neuritis in the same period. There were 35 cases (72.9%) with monophasic course, and 13 cases (27.1%) with recurrence or other central nervous system involvement during the follow-up period; 11 (22.9%) in 48 patients with positive AQP4-IgG; AQP4-IgG-positive patients had a higher recurrence rate (<0.001) and poorer visual function prognosis (=0.034) than antibody-negative patients; the baseline visual acuity (=0.004), early treatment response (=0.012) and number of involved optic nerve segments (=0.016) were associated with end point visual function. Positive AQP4-IgG( 13.486, 95% 1.971-16.263)and combining with other autoimmune antibodies ( 5.591, 95% 1.502-15.621)were independently associated with relapse. Acute severe bilateral optic neuritis is not unusual and may cause blindness or visual disability. The positive rate of AQP4-IgG and the recurrence rate of the disease are low in our study. The necessity for long-term immunotherapy requires individual consideration. The baseline visual acuity, involved segment number of optic nerve and response to early treatment are associated with prognosis of visual function. Patients with AQP4-IgG positive and other autoimmune antibodies are easy to relapse. Whether the antibody-negative bilateral optic neuritis is a heterogeneous disease and the relationship with classic NMO or NMOSD deserve further research.
分析急性重度双侧视神经炎的临床和免疫学特征，探讨视力预后及复发的预测因素，以挽救视功能，避免或减轻视力残疾。纳入2013年1月至2015年6月确诊为急性重度双侧视神经炎的48例住院患者并进行随访。对临床特征、免疫学检查结果、视神经影像学、视功能转归及复发预测因素进行统计学分析。急性重度双侧视神经炎占同期视神经炎总数的7.3%。35例（72.9%）为单相病程，13例（27.1%）在随访期间复发或合并其他中枢神经系统受累；48例患者中11例（22.9%）AQP4-IgG阳性；AQP4-IgG阳性患者的复发率（<0.001）高于抗体阴性患者，视功能预后更差（=0.034）；基线视力（=0.004）、早期治疗反应（=0.012）及受累视神经节段数（=0.016）与终点视功能相关。AQP4-IgG阳性（13.486，95% 1.971 - 16.263）及合并其他自身免疫抗体（5.
