早期糖皮质激素冲击疗法对视神经脊髓炎视功能恢复的影响(1)
摘 要 目的：观察早期糖皮质激素冲击疗法对视神经脊髓炎视功能恢复的影响。方法：选取2011年10月-2014年4月在我院住院治疗的视神经脊髓炎(NMO)患者42例(50眼)，随机分为观察组和对照组，各21例。观察组给予注射用甲泼尼龙，注射用地塞米松，泼尼松片口服；对照组患者给予注射用地塞米松，泼尼松片口服。结果：治疗后，观察组患者视力提高总有效率为80.77%，对照组患者为66.67%，两组比较差异具有统计学意义(P<0.05)；治疗后，两组患者视网膜神经纤维层(RNFL)厚度均明显升高，且观察组患者明显高于对照组患者(P<0.05)；观察组患者Barthel指数总评分明显高于对照组患者(P<0.05)。结论：早期糖皮质激素冲击疗法治疗视神经脊髓炎，可促进患者视力和日常生活能力的恢复，疗效显著。
关键词 甲泼尼龙 视神经脊髓炎 视功能
中图分类号：R744.52； R452； R977.11 文献标识码：B 文章编号：1006-1533(2015)03-0035-03
, http://www.100md.com
ABSTRACT Objective： To discuss the effect of early glucocorticoid pulse therapy for the visual function of patients with neuromyelitis optica (NMO). Methods： Forty-two cases of patients with NMO from our hospital during October， 2011 to April， 2014 were selected and randomly divided into an observation group and a control group with 21 cases each. Patients were treated with the intravenous injection of both methylprednisolone and dexamethasone and the oral prednisone in the observation group while the intravenous injection of dexamethasone and the oral prednisone in the control group. Results： After treatment， the total efficiency was 80.77% in the observation group and 66.67% in the control group and their differences were statistically significant (P<0.05). The thickness of retinal nerve fiber layer (RNFL) was all significantly increased after treatment， which was significantly thicker in the observation group than in the control group (P<0.05). The total scores of Barthel index were significantly higher in the observation group than in the control group (P<0.05). Conclusion： Early glucocorticoid pulse therapy for patients with NMO can promote the recovery of visual acuity and daily living ability with obvious curative effect.
, 百拇医药
KEY WORDS methylprednisolone； neuromyelitis optica； visual function
视神经脊髓炎(neuromyelitis optica，NMO)又称德维克(Devic)综合征，是一种同时或相继累及视神经和脊髓的自身免疫性脱髓鞘疾病，临床表现为单眼或双眼视功能障碍[1]。该病肢体瘫痪发生率较高[2]，一旦确诊，应及时给予治疗。目前，临床对于NMO患者的治疗仍主要以糖皮质激素为主[3]。我院眼科采用早期糖皮质激素冲击疗法治疗42例NMO患者，并取得较满意的效果，现报道如下。
资料与方法
一般资料
选取2011年10月-2014年4月在我院住院治疗的视神经脊髓炎(NMO)患者42例，所有患者均符合视神经脊髓炎的诊断标准[4]，入院时视力均低于4.0，双下肢肌力0～4级，MRI见视神经和脊髓脱髓鞘病变，排除由脊髓血管畸形或脊髓压迫症所导致的NMO样临床表现或临床资料不全者。所有患者均自愿参加并签署书面知情同意书。将上述患者随机分为观察组和对照组，其中观察组患者21例，男7例，女14例；年龄21～47岁，平均年龄(32.76±5.62)岁；共26只眼睛视力障碍；对照组组患者21例，男8例，女13例；年龄19～46岁，平均年龄(33.08±5.54)岁；共24只眼睛视力障碍。两组患者性别、年龄、病程、入院时视力和双下肢肌力等一般资料比较差异均无统计学意义(P>0.05)，具有可比性。
治疗方法
观察组患者给予5%葡萄糖注射液500 ml+甲泼尼龙针1 g静脉滴注，1次/d，连续10 d，然后改用5%葡萄糖注射液500 ml+地塞米松10 mg静脉滴注，1次/d，连续5 d，随后给予泼尼松片1 mg/kg清晨顿服，1次/d，连续服用1周，然后每周减量5 mg，直至停药。对照组患者给予给予5%葡萄糖注射液500 ml+地塞米松10 mg静脉滴注，1次/d，连续10 d，随后改用泼尼松片口服，剂量、服药方法及减药方法同观察组。两组患者治疗过程中，均根据病情联合应用抗菌药、维生素、雷尼替丁、钙剂等对症支持药物。, http://www.100md.com(彭红)
关键词 甲泼尼龙 视神经脊髓炎 视功能
中图分类号：R744.52； R452； R977.11 文献标识码：B 文章编号：1006-1533(2015)03-0035-03
, http://www.100md.com
ABSTRACT Objective： To discuss the effect of early glucocorticoid pulse therapy for the visual function of patients with neuromyelitis optica (NMO). Methods： Forty-two cases of patients with NMO from our hospital during October， 2011 to April， 2014 were selected and randomly divided into an observation group and a control group with 21 cases each. Patients were treated with the intravenous injection of both methylprednisolone and dexamethasone and the oral prednisone in the observation group while the intravenous injection of dexamethasone and the oral prednisone in the control group. Results： After treatment， the total efficiency was 80.77% in the observation group and 66.67% in the control group and their differences were statistically significant (P<0.05). The thickness of retinal nerve fiber layer (RNFL) was all significantly increased after treatment， which was significantly thicker in the observation group than in the control group (P<0.05). The total scores of Barthel index were significantly higher in the observation group than in the control group (P<0.05). Conclusion： Early glucocorticoid pulse therapy for patients with NMO can promote the recovery of visual acuity and daily living ability with obvious curative effect.
, 百拇医药
KEY WORDS methylprednisolone； neuromyelitis optica； visual function
视神经脊髓炎(neuromyelitis optica，NMO)又称德维克(Devic)综合征，是一种同时或相继累及视神经和脊髓的自身免疫性脱髓鞘疾病，临床表现为单眼或双眼视功能障碍[1]。该病肢体瘫痪发生率较高[2]，一旦确诊，应及时给予治疗。目前，临床对于NMO患者的治疗仍主要以糖皮质激素为主[3]。我院眼科采用早期糖皮质激素冲击疗法治疗42例NMO患者，并取得较满意的效果，现报道如下。
资料与方法
一般资料
选取2011年10月-2014年4月在我院住院治疗的视神经脊髓炎(NMO)患者42例，所有患者均符合视神经脊髓炎的诊断标准[4]，入院时视力均低于4.0，双下肢肌力0～4级，MRI见视神经和脊髓脱髓鞘病变，排除由脊髓血管畸形或脊髓压迫症所导致的NMO样临床表现或临床资料不全者。所有患者均自愿参加并签署书面知情同意书。将上述患者随机分为观察组和对照组，其中观察组患者21例，男7例，女14例；年龄21～47岁，平均年龄(32.76±5.62)岁；共26只眼睛视力障碍；对照组组患者21例，男8例，女13例；年龄19～46岁，平均年龄(33.08±5.54)岁；共24只眼睛视力障碍。两组患者性别、年龄、病程、入院时视力和双下肢肌力等一般资料比较差异均无统计学意义(P>0.05)，具有可比性。
治疗方法
观察组患者给予5%葡萄糖注射液500 ml+甲泼尼龙针1 g静脉滴注，1次/d，连续10 d，然后改用5%葡萄糖注射液500 ml+地塞米松10 mg静脉滴注，1次/d，连续5 d，随后给予泼尼松片1 mg/kg清晨顿服，1次/d，连续服用1周，然后每周减量5 mg，直至停药。对照组患者给予给予5%葡萄糖注射液500 ml+地塞米松10 mg静脉滴注，1次/d，连续10 d，随后改用泼尼松片口服，剂量、服药方法及减药方法同观察组。两组患者治疗过程中，均根据病情联合应用抗菌药、维生素、雷尼替丁、钙剂等对症支持药物。, http://www.100md.com(彭红)