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伴有抗髓鞘少突胶质细胞糖蛋白自身抗体的视神经炎的临床表现

Clinical presentation of optic neuritis with autoantibodies anti-myelin oligodendrocyte glycoprotein.

作者信息

Ducloyer Jean-Baptiste, Michel Laure, Wiertlewski Sandrine, Lebranchu Pierre

机构信息

1 Department of Ophthalmology, University Hospital of Nantes, Nantes, France.

2 Department of Neurology, University Hospital of Nantes, Nantes, France.

出版信息

Eur J Ophthalmol. 2019 Mar;29(2):257-261. doi: 10.1177/1120672118784797. Epub 2018 Jul 4.

Abstract

PURPOSE

: Myelin oligodendrocyte glycoprotein autoantibodies are associated with certain optic neuritis. Little data are known about the specificity of the initial ophthalmologic presentation.

METHODS

: A monocentric retrospective study (2013-2017) of all patients diagnosed with myelin oligodendrocyte glycoprotein+ optic neuritis in a tertiary ophthalmologic unit was conducted. The primary objective was to define the clinical ophthalmologic description of the first episode. The secondary objective was to evaluate the evolution and final diagnosis.

RESULTS

: A total of nine patients were included. There was no female predominance (sex ratio f/m = 0.8). At the first optic neuritis episode, the average age was 39.3 years (17-67 years, standard deviation: 18.4). Initial visual acuity was low (+1.07logMAR, standard deviation: 0.77); 5 eyes out of 15 had visual acuity +2logMAR or worse. Optic neuritis was mostly painful (8/9) and bilateral (6/9) but asymmetric. Optic disk swelling was reported in 9/15 eyes and 7/9 patients and was significantly associated with lower visual acuity in the acute phase (+1.46logMAR, standard deviation: 0.67 vs +0.5, standard deviation: 0.55; p = 0.03). After a mean observation period of 3.3 years (0.6-9.4 years, standard deviation: 3.4), median visual acuity was 0.05logMAR. All five patients were followed up for more than 1 year (5.4 years, standard deviation: 3.2) had 3-8 relapses (mean: 4.4, standard deviation: 2.1; annualized relapse rate: 1.2, standard deviation: 0.9). Final diagnosis was chronic relapsing idiopathic optic neuritis (n = 4), clinically isolated optic neuritis (n = 3), and neuromyelitis optica spectrum disorder aquaporin 4- (n = 2).

CONCLUSION

: Myelin oligodendrocyte glycoprotein+ optic neuritis has an atypical clinical presentation compared with multiple sclerosis and neuromyelitis optica spectrum disorder aquaporin 4+. Its evolution is closer to neuromyelitis optica spectrum disorder aquaporin 4+, with a better visual outcome.

摘要

目的

髓鞘少突胶质细胞糖蛋白自身抗体与某些视神经炎相关。关于初始眼科表现的特异性,已知数据较少。

方法

对一家三级眼科单位中所有诊断为髓鞘少突胶质细胞糖蛋白阳性视神经炎的患者进行了一项单中心回顾性研究(2013 - 2017年)。主要目的是确定首发发作的临床眼科描述。次要目的是评估病情演变及最终诊断。

结果

共纳入9例患者。无女性优势(性别比f/m = 0.8)。在首次视神经炎发作时,平均年龄为39.3岁(17 - 67岁,标准差:18.4)。初始视力较低(+1.07logMAR,标准差:0.77);15只眼中有5只眼视力为+2logMAR或更差。视神经炎大多伴有疼痛(8/9)且为双侧性(6/9)但不对称。15只眼中有9只眼以及9例患者中有7例报告有视盘肿胀,且在急性期视盘肿胀与较低视力显著相关(+1.46logMAR,标准差:0.67对比+0.5,标准差:0.55;p = 0.03)。经过平均3.3年(0.6 - 9.4年,标准差:3.4)的观察期后,中位视力为0.05logMAR。所有5例随访超过1年(5.4年,标准差:3.2)的患者有3 - 8次复发(平均:4.4,标准差:2.1;年化复发率:1.2,标准差:0.9)。最终诊断为慢性复发性特发性视神经炎(n = 4)、临床孤立性视神经炎(n = 3)以及视神经脊髓炎谱系障碍水通道蛋白4阴性(n = 2)。

结论

与多发性硬化和视神经脊髓炎谱系障碍水通道蛋白4阳性相比,髓鞘少突胶质细胞糖蛋白阳性视神经炎具有非典型的临床表现。其病情演变更接近视神经脊髓炎谱系障碍水通道蛋白4阳性,视力预后较好。

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