【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(χ~2=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(χ~2=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。更多还原

【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(χ~2=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(χ~2=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.更多还原