CAJ | 학술논문

目的探讨多发性硬化(MS)患者在视神经炎发作早期的视网膜神经纤维层(RNFL)、黄斑区节细胞复合体层(GCC)及视神经乳头的改变.方法前瞻性系列病例研究.2007年2月至2010年11月中国医学科学院北京协和医学院北京协和医院眼科疑似视神经炎急性发作的MS患者22例,在其急性视神经炎发作1周内,应用相干光断层扫描技术(OCT)对其进行检查,测量RNFL平均厚度、GCC平均厚度,对RNFL地形图和视神经乳头三维重建进行分析.结果 MS患者视神经炎发作1周内,首次发作的视神经炎早期眼的RNFL平均厚度为(141.55±53.73)μm,其中有75％( 12/16)的受检眼RNFL平均厚度增加,GCC平均厚度范围为91.54～118.45μm,其中64％(7/11)的受检眼G CC平均厚度增加；复发的视神经炎早期眼的RNFL平均厚度为(59.71±8.98)μm,其中有91.7％(11/12)的RNFL平均厚度变薄,GCC平均厚度范围为58.92 ～91.76 μm,其中62.5％(5/8)的受检眼GCC平均厚度较正常薄；视神经炎发作早期眼的对侧眼的RNFL平均厚度为(125.45±26.16) μm,其中60％( 6/10)的受检眼RNFL平均厚度增加,GCC平均厚度范围为90.35～117.37μm,43％ (3/7)的受检眼GCC平均厚度增加；OCT较直接眼底镜检查可以更多发现视神经乳头水肿和RNFL增厚.结论 MS患者在视神经炎首次发作早期、复发早期具有不同程度的RNFL、GCC及视神经乳头改变.应用OCT可以检测到相关的变化.
목적 탐토다발성경화(MS)환자재시신경염발작조기적시망막신경섬유층(RNFL)、황반구절세포복합체층(GCC)급시신경유두적개변.방법 전첨성계렬병례연구.2007년2월지2010년11월중국의학과학원북경협화의학원북경협화의원안과의사시신경염급성발작적MS환자22례,재기급성시신경염발작1주내,응용상간광단층소묘기술(OCT)대기진행검사,측량RNFL평균후도、GCC평균후도,대RNFL지형도화시신경유두삼유중건진행분석.결과 MS환자시신경염발작1주내,수차발작적시신경염조기안적RNFL평균후도위(141.55±53.73)μm,기중유75％( 12/16)적수검안RNFL평균후도증가,GCC평균후도범위위91.54～118.45μm,기중64％(7/11)적수검안G CC평균후도증가；복발적시신경염조기안적RNFL평균후도위(59.71±8.98)μm,기중유91.7％(11/12)적RNFL평균후도변박,GCC평균후도범위위58.92 ～91.76 μm,기중62.5％(5/8)적수검안GCC평균후도교정상박；시신경염발작조기안적대측안적RNFL평균후도위(125.45±26.16) μm,기중60％( 6/10)적수검안RNFL평균후도증가,GCC평균후도범위위90.35～117.37μm,43％ (3/7)적수검안GCC평균후도증가；OCT교직접안저경검사가이경다발현시신경유두수종화RNFL증후.결론 MS환자재시신경염수차발작조기、복발조기구유불동정도적RNFL、GCC급시신경유두개변.응용OCT가이검측도상관적변화.
Objective To detect the changes in the retinal nerve fiber layer (RNFL) and ganglion cell complex ( GCC ) in the eyes of multiple sclerosis patients during the early stage of optic neuritis.Methods A prospective case series study.Suspected acute optic neuritis of multiple sclerosis (MS) patients who attended the department of ophthalmology in Peking Union Medical College hospital from Feb.2007 to Nov.2010 were collected.Twenty two MS patients were evaluated within the first week of the attack of acute optic neuritis.The average thickness of RNFL and GCC was measured and a three dimensional image of optic disk was reconstructed using optical coherence tomography (OCT).Results Within the first week of onset,the average thickness of RNFL and G CC of first attack eyes increased 75％ and 64％,respectively.The average thickness of RNFL and GCC in relapsed eyes decreased 91.7％ and 62.5％ respectively.The average thickness of RNFL and G CC of the fellow eyes also increased 60％ and 43％ respectively,within the first week of onset.More cases of optic disk edema and thickening of RNFL were found by OCT than by direct ophthalmoscopy.Conclusions Different changes of the thickness of RNFL and G CC and morphology of the optic disk were detected during the early stage of the initial attack or relapsed optic neuritis in MS patients.OCT could detect such diffferences.