急性视神经炎冲击疗法临床探究.docVIP

急性视神经炎冲击疗法临床探究 　 【摘要】 目的 评价静脉滴注甲基强的松龙(intravenous methylprednisoloneIVMP)治疗急性视神经炎(acute optic neuritisAON)的临床疗效及疗效的影响因素。方法 总结分析我院2002～2004年住院116例（176眼）患者的临床资料。结果 （1）IVMP治疗后患者的视力、视野、眼底、视觉诱发电位均有不同程度的改善（Plt;0.01）。（2）IVMP的疗效受诸多因素的影响：5～14岁年龄段疗效最好（χ2=13.10Plt;0.05）。就诊时机在15天之内效果好（χ2=29.51Plt;0.01）。就诊时视力与IVMP疗效之间有显著相关性（χ2=18.69Plt;0.05）。其中以0.2～0.5视力组疗效最好。头部MRI无病灶的患者IVMP疗效好（χ2=6.87Plt;0.05）。发病初有眶周疼痛的患者，对IVMP的反应好（χ2=7.42，Plt;0.05）。另一方面，不同性别对IVMP疗效影响差异无显著性（χ2=3.66Pgt;0.05）。脑脊液检查结果与IVMP疗效之间无显著相关性（OB组Pgt;0.05MBP组Pgt;0.05IgG组Pgt;0.05)。结论 大剂量IVMP治疗急性视神经炎合理有效。 【关键词】 甲基强的松龙；视神经炎；临床研究 【Abstract】 Objective To investigate the clinical effect of intravenous high dose methylprednisolone in acute optic neuritis and the factors that influence the effect of this therapy.Methods 116 cases(176 eyes) hospitalized in 2002～2004 were analysed.Results (1)VAoptic disc’visual field and PVEP were improved in different degree after treatment of IVMP and the difference had marked significance(respectively Plt;0.01).(2)The treatment effect of IVMP was influenced by many factors:the best treatment effect was happened with patients from 5 to 14 ages(χ2=13.10’Plt;0.05).The best therapy time was less than 15 days(χ2=29.51’Plt;0.01).The initial therapy VA had prominence relativity with the effect of IVMP therapy(χ2=18.69’Plt;0.05)’and the best effect happened in patients with visual acuity from 0.2 to 0.5.Patients without intracanalicular portion of MRI had better effects(χ2=6.87’Plt;0.05).The absence of orbital pain was statistically correlated with a poorer effects(χ2=7.42’Plt;0.05).The sex had no influence of the effect of IVMP (χ2=3.66’Pgt;0.05).Patients with different outcomes of CSF had no prominence relativity with the effect of IVMP (respective Pgt;0.05’Pgt;0.05’Pgt;0.05).Conclusion IVMP is reasonable and effective for AON. 【Key words】 intravenous methylprednisolone;acute optic neuritis;clinical study 视神经炎（optic neuritisON)是累及视神经的急性或亚急性炎性脱髓鞘病变。由于ON发病率高，致残率高，其治疗越来越受到国内外广大学者的关注。ON是否必须治疗，Kans