中等剂量糖皮质激素治疗眉弓内侧型与颧骨型外伤性视神经病变的疗效分析

朱捷; 徐毅; 郭建; 丁宁

doi:10.13201/j.issn.1009-5918.2019.07.007

中等剂量糖皮质激素治疗眉弓内侧型与颧骨型外伤性视神经病变的疗效分析

- 首都医科大学附属北京同仁医院急诊科(北京, 100730)

详细信息

通讯作者: 丁宁,E-mail:dingningab@163.com

中图分类号: R774.6

收稿日期: 2019-04-17

Clinical effect of medium-dose glucocorticoid therapy in traumatic optic neuropathy patients of medial superciliary arch type and zygomatic type

- Department of Emergency, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, 100730, China

More Information

Corresponding author: DING Ning, E-mail: dingningab@163.com

Received Date: 17 April 2019

摘要

摘要: 目的: 评价中等剂量激素治疗眉弓内侧型与颧骨型外伤性视神经病变(traumatic optic neuropathy,TON)的疗效。方法: 收集2014-02—2016-10期间在我院收治的眉弓内侧型与颧骨型TON患者83例,根据是否采用激素治疗分为试验组和对照组,试验组39例给予中等剂量甲泼尼龙琥珀酸钠(500mg/d)治疗3d后,减量至40mg/d治疗4d并辅以改神经营养等药物治疗,对照组44例除外激素其余相同方法治疗,疗程均为7d,所有患者行视觉诱发电位检查。采用单因素和多因素分析的方法比较疗效,随访至2019年2月,分析所有患者视力维持情况。结果: 单因素分析显示:组别(P=0.023)、视力情况(P=0.001)、视觉诱发电位(visual evoked potential,VEP)(P=0.001)和就诊时间(P=0.044)对治疗效果有影响。患者所处的组别和就诊时间是治疗效果的独立影响因素,与对照组比,试验组可获得更好的疗效(OR=3.351,95%CI:1.186~9.473),与就诊时间>24h的患者比,就诊时间≤24h的患者能获得更好的治疗效果(OR=3.270,95%CI:1.117~9.575)。两组随访28~40个月,随访中位数为34个月,试验组中23例视力有效者视力无明显变化,其余13例中视力提高者1例,下降者3例,视力无明显变化9例。对照组中15例视力有效者视力无明显变化,其余29例中视力提高者2例,下降者4例,视力无明显变化23例。结论: 中等剂量激素治疗眉弓内侧型和颧骨型TON可获得较好的疗效,但仍需增加样本量和延长随访时间进行观察。
- 视神经损伤 /
- 眉弓内侧型 /
- 颧骨型 /
- 糖皮质激素 /
- 视觉诱发电位
Abstract: Objective: To observe the clinical effect of medium-dose glucocorticoid therapy in traumatic optic neuropathy(TON)patients of medial superciliary arch type and zygomatic type.Method: A total of 83 TON patients who met the entry criteria at our hospital from February 2014 to October 2016 were enrolled in this study,and divided into the treatment group and the control group.39 cases of the treatment group were treated with medium-dose corticosteroids(500 mg/d for 3 days,then 40 mg/d for 4 days),combined with neurotrophic drugs.44 cases of the control group were treated with neurotrophic drugs for 7 days.Visual evoked potential(VEP)measurement was carried out in all cases.We evaluated the therapeutic effect with single factor analysis and multiple factors analysis.All patients were followed in Feberary 2019.Result: Single factor analysis revealed:group(P=0.023),vision situation(P=0.001),VEP(P=0.001)and clinic time(P=0.044)had impacts on treatment effect.After revising patients' group,vision situation,VEP and clinic time,OR(95%CI)of vision improved rate of treatment group is 3.351(1.186,9.473)compared with control group;compared to patients with clinic time>24 h,patients with clinic time≤24 hcould get better vision improved rate(OR=3.270,95%CI:1.117-9.575).The follow-up time of 2 groups ranged from 28 to 40 months.The median follow-up was 34 months.In the experimental group,there were no significant changes in visual acuity in 23 patients with visual acuity.Among the other 13 patients,1 had visual acuity improved,3 cases descended,9 cases had no change in visual acuity.In the control group,there were no significant changes in visual acuity in 15 patients with visual acuity.Among the other29 patients,2 patients had improved visual acuity,4 patients had decreased and 23 patients had no significant changes in visual acuity.Conclusion: TON patients of medial superciliary arch type and zygomatic type received medium-dose glucocorticoid could get better vision improved rate.However,it is still necessary to increase the sample size and extend the follow-up time for further observation.
- optic nerve injuries /
- medial superciliary arch type /
- zygomatic type /
- glucocorticoid /
- visual evoked potential

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