摘要
目的分别比较伴和不伴脑部异常的水通道蛋白4抗体阳性的视神经炎(AQP4-ON)与髓鞘少突胶质细胞糖蛋白抗体阳性的视神经炎(MOG-ON)患者视野和光学相干层析血管成像(OCTA)特征,分析其临床特点并讨论可能的影响因素。方法病例对照研究。入组2015年9月~2017年8月就诊于复旦大学附属眼耳鼻喉科医院的AQP4-ON患者30例(48眼),MOG-ON患者21例(32眼),按发作是否伴发脑部异常分组。所有入组患者行颅脑磁共振成像(MRI)和磁共振脊髓成像(MRM)检查;患眼行最佳矫正视力(BCVA)、Humphrey视野、OCTA检查。BCVA检查采用Snellen视力表。Humphery视野记录受检眼视野平均缺损值(MD)、模式标准差(PSD)。OCTA记录受检眼视盘周围毛细血管血流密度(PCVD)、黄斑旁中心凹视网膜浅层毛细血管丛血流密度(SCPVD)、黄斑旁中心凹神经节细胞-内丛状层(GCIPL)厚度、视盘旁神经纤维层(RNFL)厚度。广义分析方程分别分析组间差异,讨论视网膜灌注、结构、功能差异与疾病的相关性。结果伴与不伴脑部异常的AQP4-ON患者,患眼MD、PSD、PCVD、SCPVD差异均无统计学意义。伴发脑部异常的MOG-ON患者较不伴脑部异常者,患眼MD、PCVD明显降低且差异有统计学意义(P=0.045、0.003);PSD、SCPVD差异无统计学意义。结论伴发脑部异常的MOG-ON患眼较不伴发脑部异常者,视网膜和视神经受累可能更重;而AQP4-ON患者眼部受累程度与疾病是否伴脑部异常无明确关联。以上差异可能与AQP4在脑组织和视网膜组织均有表达,而MOG不表达于眼部有关。
Objective To investigate the characteristics and possible inflencing factors of aquaporin 4 positive optic neuritis(AQP4-ON)patients and myelin oligodendrocyte glycoprotein positive optic neuritis(MOG-ON)patients with or without cerebral abnormalities by visual field examination and optical coherence tomography angiography(OCTA).Methods A case-control study.A total of 70 eyes from 51 optic neuritis patients diagnosed in the Eye&ENT Hospital of Fudan University between September 2015 and August 2017 were enrolled.Fourty-eight eyes from 30 participants were diagnosed as AQP4-ON while the other 21 patients with 30 eyes were diagnosed as MOG-ON.Each group was divided into 2 subgroups according to whether they had cerebral abnormalities.All participants received the cranial magnetic resonance imaging(MRI),magnetic resonance myelography(MRM),best corrected visual acuity(BCVA)test using Snellen chart,the visual filed test by Humphrey Filed Analyzer 750 and OCTA.The BCVA,mean deviation(MD),pattern standard deviation(PSD),peripapillary capillary vessel density(PCVD),superficial capillary plexus vessel density(SCPVD),the thickness of ganglion cell and inner plexiform layer(GCIPL)and peripapillary retinal nerve fiber layer(pRNFL)were determined.The generalized estimating equation was performed to compare the differences between groups,and the correlation between the structural and functional differences and the brain clinical features were discussed.Results There was no statistical significant difference between the AQP4-ON participants with or without cerebral abnormalities.According to MOG-ON participants,there was a significant decrease in MD(P=0.045)and PCVD(P=0.003)with cerebral abnormalities compared with those without cerebrum involved.Conclusions The cerebral abnormalities might be a risk factor of retinal damage in MOG-ON rather than AQP4-ON patients.It might be associated with that MOG is not expressed in the eye tissue while AQP4 is expressed in both retina and cerebrum.
作者
熊佳伟
黃詠恒
余建
王敏
XIONG Jiawei;WONG Wenghang;YU Jian;WANG Min(Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China;Department of Ophthalmology,Kiang WuHospital,Macao Special Administration Region 999078,China;NHC Key Laboratory of Myopia(FudanUniversity),Key Laboratory of Visual Impairment and Restoration(Fudan University),Shanghai 200031,China)
出处
《中国眼耳鼻喉科杂志》
2022年第1期47-50,52,共5页
Chinese Journal of Ophthalmology and Otorhinolaryngology
