Meng C, Lai C T, Tao J H, Yang Q L, Liu L, Wang J W
Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2021 May 25;101(19):1415-1420. doi: 10.3760/cma.j.cn112137-20200915-02649.
To investigate the clinical characteristics and prognosis of myelin oligodendrocyte glycoprotein (MOG) antibody-positive optic neuritis (ON). The data of 39 patients with MOG antibody-positive ON in the Department of Neurology of Beijing Tongren Hospital, Capital Medical University from January 1, 2017 to October 31, 2019 were retrospectively collected. There were 25 males and 14 females, aged from 15 to 80 (40±16) years. According to the recurrence, the patients were divided into two groups: the recurrence group (=12) and the non-recurrence group (=27). The clinical manifestations, relapse-related factors, magnetic resonance imaging (MRI) manifestations, treatment and prognosis of the two groups were analyzed. A total of 63 eyes were involved, including 30 cases of optic perineuritis (OPN), accounting for 47.6% (30/63). The number of attacks ranged from 1 to 9, among which 12 patients had more than 2 attacks. There were 37 eyes [58.7% (37/63)] with severe visual loss (SVL) at the time of onset, and 7 eyes [11.1% (7/63)] with SVL at the final follow-up. Forty-eight eyes [76.2% (48/63)] had optic disc edema. Forty seven eyes [74.6% (47/63)] showed long-segment disease on optic nerve MRI. One case was complicated with aseptic meningitis and encephalitis. The recurrence group was younger than the non-recurrence group [(28.5±9.8) years vs (43.3±16.4) years, =0.001]. There were no statistically significant differences between the two groups in gender, bilateral onset, initial visual acuity, final visual acuity, optic disc edema, head and spinal cord lesions, and immunosuppressant (all >0.05). All patients were treated with methylprednisolone (MP) pulse therapy during the acute attack, and 16 of them were additively treated with immunosuppressive agents; the pain was alleviated or relieved significantly after the application of glucocorticoids. MOG antibody-positive ON often occurred in both eyes at the same time, often manifesting as OPN, often accompanied by optic disc edema, and SVL at the beginning of the disease, but most of the visual recovery was good, might be associated with meningitis and encephalitis. MRI of the optic nerve showed that the lesions often manifested as long-segment lesions. Glucocorticoids could alleviate pain and promote the recovery of visual function.
探讨髓鞘少突胶质细胞糖蛋白（MOG）抗体阳性视神经炎（ON）的临床特征及预后。回顾性收集2017年1月1日至2019年10月31日首都医科大学附属北京同仁医院神经内科39例MOG抗体阳性ON患者的资料。其中男性25例，女性14例，年龄15～80（40±16）岁。根据复发情况将患者分为两组：复发组（n = 12）和非复发组（n = 27）。分析两组的临床表现、复发相关因素、磁共振成像（MRI）表现、治疗及预后。共累及63只眼，其中视神经周围炎（OPN）30例，占47.6%（30/63）。发作次数为1～9次，其中发作2次以上者12例。发病时重度视力丧失（SVL）37只眼[58.7%（37/63）]，末次随访时SVL 7只眼[11.1%（7/63）]。视盘水肿48只眼[76.2%（48/63）]。视神经MRI显示长节段病变47只眼[74.6%（47/63）]。1例合并无菌性脑膜炎和脑炎。复发组患者年龄低于非复发组[（28.5±9.8）岁 vs （43.3±16.4）岁，P = 0.001]。两组在性别、双侧发病、初始视力、最终视力、视盘水肿、头颅及脊髓病变、免疫抑制剂使用方面差异均无统计学意义（均P＞0.05）。所有患者急性期均采用甲泼尼龙（MP）冲击治疗，其中16例加用免疫抑制剂治疗；应用糖皮质激素后疼痛明显减轻或缓解。MOG抗体阳性ON常双眼同时发病，常表现为OPN，常伴有视盘水肿，发病初期有SVL，但多数视力恢复良好，可能合并脑膜炎和脑炎。视神经MRI显示病变常表现为长节段病变。糖皮质激素可缓解疼痛，促进视功能恢复。
