视神经脊髓炎谱系疾病患者视觉诱发电位研究

摘要

Objective:To explore the characteristics of visual evoked potential in neuromyelitis optica spectrum disorders (NMOSD).Methods:The clinical features of 12 patients with NMOSD were analyzed.The study included blood AQP4-IgG,ophthalmic examination,visual evoked potential(VEP) examination,and cranial MR.The comparison between the groups was made by Fisher's exact probability method.Results:The cases had various clinical manifestations.All 12 patients were in conformity with the diagnostic criteria of NMOSD in which there were 10 cases with optic neuritis and 2 cases with positive AQP4-IgG who did not develop optic neuritis according to clinical and laboratory examinations.The incidence of optic neuritis in negative AQP4-IgG patients was similar to that in positive AQP4-IgG patients.The VEP of the patients with optic neuritis was mainly characterized by prolonged latency and abnormal wave amplitudes and shapes.VEP examination made up for the diagnosis of optic neuritis except intraocular segment.Conclusion:A variety of immune disturbances may be involved in the pathogenesis of optic neuritis in patients with NMOSD.VEP screening of optic neuritis in patients should be combined with clinical data,and comprehensive judge is important.It might be greatly helpful in the diagnosis of optic neuritis and clinical treatment by VEP examination of Optic nerves for the patients.%目的:探讨12例视神经脊髓炎谱系疾病(NMOSD)患者的视觉诱发电位(VEP)特征.方法:对12例中国NMOSD患者的临床数据进行分析,研究包括血中AQP4-IgG检查、眼科检查、VEP检查和头颅MRI检查;组间比较采用Fisher精确概率法进行统计学分析.结果:患者临床表型多样.所有患者符合NMOSD疾病诊断标准,通过临床及实验室检查证明在12例患者中有10例发生视神经炎,有2例未发生视神经炎,并且这2例患者均为AQP4-IgG阳性患者.AQP4-IgG阴性患者视神经炎发生比例与AQP4-IgG阳性患者相似.有视神经炎患者主要为VEP潜伏期延长,波幅、波形异常.VEP检查可弥补非眼内段视神经炎诊断.结论:NMOSD患者中神经炎的发生可能有多种免疫紊乱机制参与.VEP筛查神经炎患者,应结合临床,综合判断.患者通过VEP检查对本病视神经炎的诊断和临床治疗均有极大帮助.