Song H L, Wei S H
Department of Ophthalmology, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Yan Ke Za Zhi. 2019 Mar 11;55(3):174-179. doi: 10.3760/cma.j.issn.0412-4081.2019.03.005.
To investigate the clinical characteristics and prognosis of myelin oligodendrocyte glycoprotein(MOG) antibody-positive optic neuritis (MOG-ON). Retrospective case series study. A total of 65 patients diagnosed with MOG-ON at the Department of Ophthalmology of the Chinese People's Liberation Army General Hospital during January 2016 and October 2017 were selected. The patients underwent examinations including best corrected visual acuity (BCVA), fundus color photography, optical coherence tomography (OCT) and magnetic resonance imaging (MRI). The patients were tested for serum levels of antibodies for aquaporin 4 and MOG with a cell-based assay. The follow-up duration ranged from 14 to 217 months. Statistical analyses of patients' clinical features, neuroimaging features and prognosis were conducted. The independent-sample test or Mann-Whitney test for continuous variable data and the χ(2) test or Fisher exact test for classified variable data and rates were used. There were 35 children (<18 years) and 30 adults (≥18 years) patients. Thirty-seven patients were female and 28 patients were male. The mean age of onset was (23±16) years (range of 3-61 years). There were 40 unilateral patients and 25 bilateral patients at the first onset. Fifty-five patients (84.6%) suffered from eye pain at the first onset and the incidence in children was significantly lower than that in adult [74.3% (26/35) and 96.7% (29/30), 0.016]. Abnormal autoimmune antibodies were found in 13 patients (20.0%).And 47.8% (43/90) eyes had optic disc edema. Sixty percent (39/65) were recurrent optic neuritis and 73.8% (48/65) were bilateral diseases at final visit. Orbital MRI scans showed T(2) hyperintensity of optic nerve in 98.4% patients (62/63). Head MRI scans showed demyelinating lesions of the brain in 12/19 patients. Within 2 weeks of onset, 78.9%(71/90) of the affected eyes had BCVA ≤ 0.1. The visual impairment of the children and adult was serious, and there was no significant difference (0.650). After treatment with corticosteroid, visual acuity improved in all affect eyes. After the initial attack, 95.6%(86/90) of the affected eyes had BCVA ≥ 0.5. The children and adult had good visual recovery, and there was no significant difference (0.061). At the final visit, 86.7%(98/113) of the eyes had BCVA ≥ 0.5, the children had better visual recovery than adult [logarithm of the minimum angle of resolution, 0.10±0.35 . 0.32±0.53, -2.526, 0.013].Three children (8.6%) were diagnosed with acute disseminated encephalomyelitis. The average thickness of peripapillary retinal nerve fiber layers (pRNFL) and macular ganglion cell-inner plexiform layers (mGCIPL) were (69.90±12.49) μm and (59.58±7.91) μm at least 6 months after optic neuritis attack. There were different degrees atrophy and not statistically different in pRNFL and mGCIPL between children and adult (0.606, 0.223). The clinical characteristics of MOG-ON are diverse. The children patients are more common and have better recovery of visual acuity. Additionally, some patients have demyelinating lesions in the brain. -.
探讨髓鞘少突胶质细胞糖蛋白(MOG)抗体阳性视神经炎(MOG-ON)的临床特征及预后。回顾性病例系列研究。选取2016年1月至2017年10月在中国人民解放军总医院眼科确诊为MOG-ON的65例患者。患者接受了包括最佳矫正视力(BCVA)、眼底彩色照相、光学相干断层扫描(OCT)和磁共振成像(MRI)等检查。采用基于细胞的检测方法检测患者血清中水通道蛋白4和MOG抗体水平。随访时间为14至217个月。对患者的临床特征、神经影像学特征及预后进行统计分析。连续变量数据采用独立样本t检验或Mann-Whitney U检验,分类变量数据及率采用χ²检验或Fisher确切概率法。有35例儿童(<18岁)和30例成人(≥18岁)患者。女性37例,男性28例。平均发病年龄为(23±16)岁(范围3至61岁)。首发时单侧患者40例,双侧患者25例。55例患者(84.6%)首发时有眼痛,儿童发病率明显低于成人[74.3%(26/35)和96.7%(29/30),P = 0.016]。13例患者(20.0%)发现自身免疫抗体异常。47.8%(43/90)的患眼有视盘水肿。60%(39/65)为复发性视神经炎,末次随访时73.8%(48/65)为双侧疾病。眼眶MRI扫描显示98.4%患者(62/63)视神经T2高信号。头部MRI扫描显示19例患者中有12例脑内有脱髓鞘病变。发病2周内,78.9%(71/90)的患眼BCVA≤0.1。儿童和成人的视力损害均严重,差异无统计学意义(P = 0.650)。经糖皮质激素治疗后,所有患眼视力均有改善。首次发作后,95.6%(86/90)的患眼BCVA≥0.5。儿童和成人视力恢复良好,差异无统计学意义(P = 0.061)。末次随访时,86.7%(98/113)的患眼BCVA≥0.5,儿童视力恢复优于成人[最小分辨角对数,0.10±0.35比0.32±0.53,t = -2.526,P = 0.013]。3例儿童(8.6%)诊断为急性播散性脑脊髓炎。视神经炎发作至少6个月后,视乳头周围视网膜神经纤维层(pRNFL)和黄斑神经节细胞-内丛状层(mGCIPL)的平均厚度分别为(69.90±12.49)μm和(59.58±7.91)μm。儿童和成人的pRNFL和mGCIPL有不同程度萎缩,差异无统计学意义(P = 0.606,P = 0.223)。MOG-ON的临床特征多样。儿童患者较为常见,视力恢复较好。此外,部分患者脑内有脱髓鞘病变。