中国人群中血浆置换治疗严重急性孤立性视神经炎后的视力改善：一项前瞻性病例系列研究。
Vision improvement in severe acute isolated optic neuritis after plasma exchange treatment in Chinese population: a prospective case series study.
作者信息
Tan Shaoying, Ng Tsz Kin, Xu Quangang, Yang Mo, Zhuang Yuan, Zhao Jie, Zhou Huanfen, Teng Da, Wei Shihui
机构信息
Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China.
Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong 515041, China.
出版信息
Ther Adv Neurol Disord. 2020 Aug 21;13:1756286420947977. doi: 10.1177/1756286420947977. eCollection 2020.
BACKGROUND
Plasma exchange (PE) is often considered as an effective treatment for neuromyelitis optica spectrum disorder (NMOSD) and several inflammatory demyelinating disorders of the central nervous system. This study aimed to evaluate the visual outcomes of Chinese patients with severe acute isolated optic neuritis (ON) who received PE therapy after high-dose intravenous methylprednisolone (IVMP) treatment.
METHODS
Thirty-seven acute isolated ON patients experiencing their first attack of severe visual impairment without neurological disability were recruited. All subjects received five cycles of double-filtration plasmapheresis. Visual acuity (VA) was documented at onset, 1 day before PE treatment, at each cycle of PE therapy and at the 1-month follow-up visit.
RESULTS
This study included 26 female (70.3%) and 11 male (29.7%) subjects, and 18 subjects (48.6%) had bilateral involvement. The time window between onset and PE treatment was 27.3 ± 12.7 days (range: 6-53 days). Mean VA (logMAR) of the studied eyes at onset, 1-day before PE treatment/after IVMP and after the fifth PE treatment were 3.41 ± 1.50, 2.61 ± 1.64 and 1.66 ± 1.52, respectively ( < 0.001). Nineteen eyes (51.4%) showed no light perception at the onset, and 17 eyes (45.9%) improved to Snellen VA >20/800 after IVMP and PE treatments, among which five eyes (13.5%) recovered to Snellen VA 20/20 ( < 0.001). Predictors of good visual outcome included body mass index [odds ratio (OR) = 0.734, = 0.044], serum AQP4 antibody-positive status (OR = 0.004, = 0.001), bilaterality (OR = 0.042, = 0.008) and time window from onset to PE therapy per 1 day (OR = 0.79, = 0.002).
CONCLUSION
This study revealed that PE treatment effectively improves the visual outcomes of patients experiencing their first attack of severe acute isolated ON after high-dose IVMP treatment. Better visual outcomes can be achieved with early PE treatment.
背景
血浆置换（PE）常被视为视神经脊髓炎谱系障碍（NMOSD）及几种中枢神经系统炎性脱髓鞘疾病的有效治疗方法。本研究旨在评估在中国，重度急性孤立性视神经炎（ON）患者在接受大剂量静脉注射甲基强的松龙（IVMP）治疗后接受PE治疗的视觉预后。
方法
招募了37例首次发作严重视力损害且无神经功能障碍的急性孤立性ON患者。所有受试者均接受了五个周期的双重滤过血浆置换。在发病时、PE治疗前1天、PE治疗的每个周期以及1个月随访时记录视力（VA）。
结果
本研究纳入26例女性（70.3%）和11例男性（29.7%）受试者，18例受试者（48.6%）为双侧受累。发病至PE治疗的时间窗为27.3±12.7天（范围：6 - 53天）。研究眼在发病时、PE治疗前1天/IVMP治疗后以及第五次PE治疗后的平均VA（logMAR）分别为3.41±1.50、2.61±1.64和1.66±1.52（P<0.001）。19只眼（51.4%）在发病时无光感，17只眼（45.9%）在IVMP和PE治疗后视力提高至Snellen视力表>20/800，其中5只眼（13.5%）恢复至Snellen视力表20/20（P<0.001）。良好视觉预后的预测因素包括体重指数[比值比（OR）=0.734，P=0.044]、血清水通道蛋白4抗体阳性状态（OR=0.004，P=0.001）、双侧受累（OR=0.042，P=0.008）以及从发病到PE治疗每延迟1天的时间窗（OR=0.79，P=0.002）。
结论
本研究表明，PE治疗可有效改善大剂量IVMP治疗后首次发作的重度急性孤立性ON患者的视觉预后。早期进行PE治疗可获得更好的视觉预后。
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