[1]张　淼,张　鹏,田增春,等.大剂量甲泼尼龙冲击疗法对视神经脊髓炎患儿视力及视网膜神经纤维层厚度的影响[J].新乡医学院学报,2022,39(4):354-357.[doi:10.7683/xxyxyxb.2022.04.011]
　ZHANG Miao,ZHANG Peng,TIAN Zengchun,et al.Effects of high-dose methylprednisolone pulse therapy on visual acuity and retinal nerve fibre layer thickness in children with neuromyelitis optica[J].Journal of Xinxiang Medical University,2022,39(4):354-357.[doi:10.7683/xxyxyxb.2022.04.011]
点击复制

大剂量甲泼尼龙冲击疗法对视神经脊髓炎患儿视力及视网膜神经纤维层厚度的影响
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年4
页码:
354-357
栏目:
临床研究
出版日期:
2022-04-05

文章信息/Info

Title:
Effects of high-dose methylprednisolone pulse therapy on visual acuity and retinal nerve fibre layer thickness in children with neuromyelitis optica
作者:
张　淼1; 张　鹏2; 田增春1; 朱彩华1; 薛海蓉1
（1.南阳市中心医院儿科，河南　南阳　473000；2.南阳理工学院护理学院，河南　南阳　473000）
Author(s):
ZHANG Miao1; ZHANG Peng2; TIAN Zengchun1; ZHU Caihua1; XUE Hailong1
(1.Department of Pediatrics,Nanyang Central Hospital,Nanyang 473000,Henan Province,China;2.Nursing College of Nanyang Institute of Technology,Nanyang 473000,Henan Province,China)
关键词:
视神经脊髓炎; 甲泼尼龙; 冲击疗法; 视力; 视网膜神经纤维层厚度
Keywords:
neuromyelitis optica; methylprednisolone; pulse therapy; visual acuity; retinal nerve fiber layer thickness
分类号:
R774
DOI:
10.7683/xxyxyxb.2022.04.011
文献标志码:
A
摘要:
目的　探讨大剂量甲泼尼龙冲击疗法对视神经脊髓炎患儿视力及视网膜神经纤维层（RNFL）厚度的影响。方法　选择2016年3月至2020年12月南阳市中心医院收治的80例视神经脊髓炎患儿为研究对象，根据治疗方法不同将患儿分为观察组（n=44）和对照组（n=36）。对照组患儿给予醋酸地塞米松注射液和泼尼松片治疗，观察组患儿给予大剂量注射用甲泼尼龙琥珀酸钠冲击疗法和泼尼松片治疗，2组患儿均治疗1个月。比较2组患儿的临床疗效、RNFL厚度、Kurtzke扩展残疾状态评定量表（EDSS）评分及不良反应。结果　观察组和对照组患儿治疗总有效率分别为93.18%（41/44）、72.22%（26/36），观察组患儿治疗总有效率显著高于对照组（χ2=6.391,P<0.05）。治疗前2组患儿RNFL厚度比较差异无统计学意义（P>0.05），2组患儿治疗后RNFL厚度显著大于治疗前（P<0.05）；治疗后，观察组患儿RNFL厚度显著大于对照组（P<0.05）。治疗前2组患儿EDSS评分比较差异无统计学意义（P>0.05）；2组患儿治疗结束和治疗后6个月时EDSS评分显著低于治疗前（P<0.05），2组患儿治疗后6个月EDSS评分显著低于治疗结束时（P<0.05）；治疗结束和治疗后6个月，观察组患儿EDSS评分显著低于对照组（P<0.05）。治疗期间，观察组和对照组患儿不良反应发生率分别为20.45%（9/44）、27.78%（10/36），2组患儿不良反应发生率比较差异无统计学意义（χ2=0.586,P>0.05）。结论　大剂量甲泼尼龙冲击疗法可有效改善视神经脊髓炎患儿的RNFL萎缩和神经功能，提高患儿视力。
Abstract:
Objective　To investigate the effect of high-dose methylprednisolone pulse therapy on visual acuity and retinal nerve fiber layer (RNFL) thickness in children with neuromyelitis optica.Methods　A total of 80 children with neuromyelitis optica admitted to Nanyang Central Hospital from March 2016 to December 2020 were selected as the research subjects,and the patients were divided into observation group (n=44) and control group (n=36) according to different treatment methods.The children in the control group were treated with dexamethasone acetate injection and prednisone tablets,and the children in the observation group were treated with high-dose injection of methylprednisolone sodium succinate pulse therapy and prednisone tablets,all children in the both groups were treated for one month.The clinical effect,RNFL thickness,Kurtzke expanded disability status scale (EDSS) score and adverse reactions of patients were compared between the two groups.Results　The total effective rate of children in the observation group and control group was 93.18% (41/44) and 72.22% (26/36),respectively.The total effective rate of children in the observation group was significantly higher than that in the control group (χ2=6.391,P<0.05).There was no significant difference in RNFL thickness of patients between the two groups before treatment (P>0.05).The RNFL thickness after treatment was significantly greater than that before treatment in the two groups (P<0.05).The RNFL thickness of patients in the observation group was significantly greater than that in the control group after treatment (P<0.05).There was no significant difference in the EDSS score between the two groups before treatment (P>0.05).The EDSS score at the end of treatment and 6 months after treatment was significantly lower than that before treatment in the two groups (P<0.05).The EDSS score at 6 months after treatment was significantly lower than that at the end of treatment in the two groups (χ2=0.586,P<0.05).The EDSS score of patients in the observation group was significantly lower than that in the control group at the end of treatment and 6 months after treatment (P<0.05).During the treatment,the incidence of adverse reactions in the observation group and the control group were 20.45% (9/44) and 27.78% (10/36),respectively.There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).Conclusion　High-dose methylprednisolone pulse therapy can effectively improve RNFL atrophy,neurological function and visual acuity in patients with neuromyelitis optica.

参考文献/References:

［1］　魏世辉，宋宏鲁.增强对视神经脊髓炎相关性视神经炎的认识，提高早期正确诊断及治疗水平［J］.中华眼底病杂志，2019，35（3）：215-218.
WEI S H,SONG H L.Enhance the awareness of neuromyelitis optica-related optic neuritis to improve early diagnosis and treatment outcomes［J］.Chin J Ocul Fundus Dis,2019,35(3):215-218.
［2］　WU Y,ZHONG L M,GENG J.Neuromyelitis optica spectrum disorder:pathogenesis,treatment,and experimental models［J］.Mult Scler Relat Disord,2019,27:412-418.
［3］　HOLROYD K B,MANZANO G S,LEVY M.Update on neuromyelitis optica spectrum disorder［J］.Curr Opin Ophthalmol,2020,31(6):462-468.
［4］　LI R,WANG J,LI C,et al.Rescue immunoadsorption treatment for neuromyelitis optica spectrum disorder attacks unresponsive to intravenous methylprednisolone［J］.J Neuroimmunol,2021,35(22):577-584.
［5］　SONGTHAMMAWAT T,SRISUPA-OLAN T,SIRITHO S,et al.A pilot study comparing treatments for severe attacks of neuromyelitis optica spectrum disorders:Intravenous methylprednisolone (IVMP) with add-on plasma exchange (PLEX) versus simultaneous ivmp and PLEX［J］.Mult Scler Relat Disord,2020,38:101506.
［6］　WINGERCHUK D M,BANWELL B,BENNETT J L,et al.International consensus diagnostic criteria for neuromyelitis optica spectrum disorders［J］.Neurology,2015,85(2):177-189.
［7］　孙传兴.临床疾病诊断依据治愈好转标准［M］.北京：人民军医出版社，2002：54-55.
SUN C X.Clinical disease diagnosis based on cure and improvement criteria［M］.Beijing:People′s Military Medical Press,2002:54-55.
［8］　COHEN R A,KESSLER H R,FISCHER M.The extended disability status scale (EDSS) as a predictor of impairments of functional activities of daily living in multiple sclerosis［J］.J Neurol Sci,1993,115(2):132-135.
［9］　冀美琦，秦亚丽，矫毓娟，等.视神经脊髓炎谱系疾病患者临床特点分析［J］.眼科新进展，2020，40（2）：184-187.
JI M Q,QIN Y L,JIAO Y J,et al.Clinical characteristics of patients with neuromyelitis optica spectrum disor-ders［J］.Rec Adv Ophthalmol,2020,40(2):184-187.
［10］　HUDA S,WHITTAM D,BHOJAK M,et al.Neuromyelitis optica spectrum disorders［J］.Clin Med (Lond),2019,19(2):169-176.
［11］　宋宏鲁，徐全刚，魏世辉.视神经脊髓炎谱系疾病相关性视神经炎的治疗研究进展［J］.中华眼科杂志，2020，56（7）：539-543.
SONG H L,XU Q G,WEI S H.Progress in the treatment of neuromyelitis optica spectrum disorders related optic neuritis［J］.Chin J Ophthalmol,2020,56(7):539-543.
［12］　CHIGANER E H,HRYB J P,CONTENTTI E C.Myelitis and lupus:clinical manifestations,diagnosis and treatment［J］.Reumatol Clin,2017,13(6):344-348.
［13］　董智慧.探讨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［J］.中国卫生标准管理，2017，8（3）：64-65.
DONG Z H.Objective the investigate effect of glucocorticoid therapy on the recovery of visual function in patients with neuro myelitis optica［J］.Chin Health Stand Manag,2017,8(3):64-65.
［14］　郭思彤，李众，姜利斌，等.AQP4抗体阳性视神经脊髓炎相关视神经炎糖皮质激素冲击治疗效果分析［J］.中华眼科杂志，2019，55（3）：180-185.
GUO S T,LI Z,JIANG L B,et al.Effects of intravenous methylprednisolone pulse therapy on optic neuritis associated with AQP4 antibody seropositive neuromyelitis optica［J］.Chin J Ophthalmol,2019,55(3):180-185.
［15］　覃丽娜.维持性泼尼松治疗视神经脊髓炎的效果及对血清水通道蛋白4抗体的影响［J］.中外医学研究，2021，19（1）：4-6.
QIN L N.Effect of maintenance prednisone in the treatment of optic neuromyelitis and its effect on serum aquaporin 4 antibody［J］.Chin Foreign Med Res,2021,19(1):4-6.

相似文献/References:

[1]秦小菀,高伟霞.阿奇霉素联合甲泼尼龙治疗儿童难治性支气管哮喘疗效观察[J].新乡医学院学报,2019,36(11):1070.[doi:10.7683/xxyxyxb.2019.11.015]
　QIN Xiao-wan,GAO Wei-xia.Effect of azithromycin combined with methylprednisolone in the treatment of refractory bronchial asthma in children[J].Journal of Xinxiang Medical University,2019,36(4):1070.[doi:10.7683/xxyxyxb.2019.11.015]
[2]张桂欣.甲泼尼龙联合阿奇霉素序贯疗法治疗儿童难治性肺炎支原体肺炎疗效观察[J].新乡医学院学报,2020,37(10):964.[doi:10.7683/xxyxyxb.2020.10.014]
　ZHANG Guixin.Effect of methylprednisolone combined with azithromycin sequential therapy in the treatment of refractory mycoplasma pneumoniae pneumonia in children[J].Journal of Xinxiang Medical University,2020,37(4):964.[doi:10.7683/xxyxyxb.2020.10.014]
[3]欧阳冰,唐林芬,戚胡敏,等.甲泼尼龙联合丙种球蛋白治疗川崎病疗效观察[J].新乡医学院学报,2018,35(10):907.[doi:10.7683/xxyxyxb.2018.10.014]
　OUYANG Bing,TANG Lin-fen,QI Hu-min,et al.Effect of methylprednisolone combined with gamma globulin in the treatment of Kawasaki disease[J].Journal of Xinxiang Medical University,2018,35(4):907.[doi:10.7683/xxyxyxb.2018.10.014]
[4]李天超,展效文,徐亚利,等.阿奇霉素联合甲泼尼龙治疗儿童重症肺炎支原体肺炎疗效观察[J].新乡医学院学报,2023,40(6):543.[doi:10.7683/xxyxyxb.2023.06.008]
　LI Tianchao,ZHAN Xiaowen,XU Yali,et al.Effect of azithromycin combined with methylprednisolone in the treatment of severe Mycoplasma pneumoniae pneumonia in children[J].Journal of Xinxiang Medical University,2023,40(4):543.[doi:10.7683/xxyxyxb.2023.06.008]

更新日期/Last Update: 2022-04-05