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目的了解儿童视神经炎(ON)患者的流行病学及临床特征,为ON患儿的早期诊疗提供科学依据。方法收集2010年11月~2014年1月就诊于全国17家医院的275例(414眼)儿童ON患者的临床资料,记录其人口学特征、病因分型、前驱病史、临床症状、眼科和影像学检查结果及预后情况,进行回顾性分析。结果 275例患者中男女性别发病比为1∶1.24。发病年龄为2~15岁,以6岁及以上为主(94.5%)。儿童ON发病主要集中在秋、冬季节(64.4%),夏季较少(11.6%)。216例(78.5%)患者符合特发性ON诊断标准。单眼发病者136例(49.5%),双眼同时或相继发病者139例(50.5%)。80例(29.1%)患者在发病前3个月内有前驱病史。270例(377眼)进行了视力检查,201眼(53.3%)视力<0.1;271例(406眼)进行了眼底镜检查,299眼(73.6%)出现视神经乳头炎。视神经、脊髓和头颅3个部位在MRI检查中出现异常的比例分别为55.0%、41.2%和25.4%,差异有统计学意义(χ~2=29.602,P<0.013)。随访82眼发病3个月后的最佳恢复情况,71眼(86.6%)的视力得到恢复。结论儿童ON好发于6岁及以上的女性,以特发性ON为最常见的病因类型,单眼和双眼发病比例接近,以视力下降严重、视神经乳头炎为主要的临床特征,预后效果较好。
Objective To understand the epidemiological and clinical features of children with optic neuritis (ON) and provide a scientific basis for the early diagnosis and treatment of ON children. Methods The clinical data of 275 patients (414 eyes) with ON in children from 17 hospitals in China from November 2010 to January 2014 were collected and their demographic characteristics, etiological types, prodromal history, clinical symptoms, ophthalmology and imaging were recorded School examination results and prognosis, a retrospective analysis. Results The incidence of male-female ratio in 275 patients was 1: 1.24. The age of onset was 2 to 15 years old, mostly aged 6 and over (94.5%). The incidence of ON was mainly in autumn and winter (64.4%) and less in summer (11.6%). 216 patients (78.5%) met the idiopathic ON diagnostic criteria. Monocular disease in 136 cases (49.5%), eyes simultaneously or in succession 139 cases (50.5%). Eighty patients (29.1%) had a history of prediabetes within 3 months before onset. Visual acuity was assessed in 270 eyes (377 eyes), visual acuity of <0.1 in 201 eyes (53.3%), ophthalmoscopy in 271 eyes (406 eyes), and optic neuritis in 299 eyes (73.6%). The abnormal proportions of optic nerve, spinal cord and skull in MRI examination were 55.0%, 41.2% and 25.4%, respectively, with statistical significance (χ ~ 2 = 29.602, P <0.013). Follow-up 82 eyes best 3 months after the onset of recovery, 71 eyes (86.6%) of eyesight restored. CONCLUSIONS: Children with ON predominantly in women aged 6 and over have idiopathic ON as the most common etiological type with a similar incidence of monocular and binocular disease, with a significant reduction in visual acuity and optic neuritis as the main clinical features, with a better prognosis .