CAJ | 학술논문

目的：回顾性分析脱髓鞘性视神经病变的临床特征。方法：收集我院特发性视神经炎（IDON）患者71例（IDON 组）、视神经脊髓炎（NMO）患者69例（NMO 组）、有视神经病变的多发性硬化（MS）患者64例（MS 组）共204例患者的临床资料。结果：本组中有17例 MS、26例 NMO 由 IDON 转化而来，但脱髓鞘性视神经病变也可发生在中枢神经系统脱髓鞘事件之后或者同时发生。 NMO 容易合并血清免疫学异常，MS 容易累及双侧视神经且以球后视神经病变多见，IDON 和 NMO 视功能障碍更为严重。随访生存分析表明，合并颅内病灶或血清免疫学异常的 IDON 患者转化为 MS 或 NMO 的风险明显高于其他正常患者。结论：脱髓鞘性视神经病变的诊断要严格遵循诊断流程，正确鉴别这3种疾病对制定治疗方案延缓疾病进展、降低致残率及判断预后具有重要意义。
목적：회고성분석탈수초성시신경병변적림상특정。방법：수집아원특발성시신경염（IDON）환자71례（IDON 조）、시신경척수염（NMO）환자69례（NMO 조）、유시신경병변적다발성경화（MS）환자64례（MS 조）공204례환자적림상자료。결과：본조중유17례 MS、26례 NMO 유 IDON 전화이래，단탈수초성시신경병변야가발생재중추신경계통탈수초사건지후혹자동시발생。 NMO 용역합병혈청면역학이상，MS 용역루급쌍측시신경차이구후시신경병변다견，IDON 화 NMO 시공능장애경위엄중。수방생존분석표명，합병로내병조혹혈청면역학이상적 IDON 환자전화위 MS 혹 NMO 적풍험명현고우기타정상환자。결론：탈수초성시신경병변적진단요엄격준순진단류정，정학감별저3충질병대제정치료방안연완질병진전、강저치잔솔급판단예후구유중요의의。
Objective: To retrospectively analyze clinical features of demyelinating optic neuropathy. Methods:The data of 204 cases with demyelinating optic neuropathy were reviewed, including 71 patients with idiopathic optic neuritis (IDON), 69 cases with neuromyelitis optica (NMO), and 64 multiple sclerosis (MS) patients. Seven-teen cases of MS and 26 cases of NMO were transformed from IDON. Results: Demyelinating optic neuropathy occurred after the CNS demyelinating events or at the same time. Bilateral and retrobulbar optic neuritis were commonly seen in MS while the visual dysfunction in the ON and NMO patients were more severe than that in the MS cases. Follow-up survival analysis showed that the intracranial demyelinating lesions and abnormal serum immunological profiles in IDON were high risk factors for transforming into MS or NMO. Conclusion: Demyeli-nating optic neuropathy needs strict ophthalmological and neurological evaluation. Correct diagnosis is pivotal to the proper treatment and to predicting the outcome of demyelinating optic involvement.