18例乙胺丁醇中毒性视神经病变的临床特点

doi:10.13281/j.cnki.issn.1004-4469.2016.02.013

眼科

18例乙胺丁醇中毒性视神经病变的临床特点

曹珊珊彭春霞李晓明张晓慧魏世辉

100853 北京，解放军总医院眼科（曹珊珊、彭春霞、魏世辉）；130021 长春，吉林省人民医院眼科（李晓明）；100005 首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科研究所眼科学与视觉科学北京市重点实验室（张晓慧）

收稿日期:2015-12-29 出版日期:2016-03-25 发布日期:2016-03-24
通讯作者: 魏世辉，Email：weishihui706@hotmail.com
基金资助:
国家高技术研究发展计划（863计划）（2015AA 020511）

Clinical features of 18 cases of ethambutol-induced optic neuropathy

CAO Shan-shan¹, PENG Chun-xia¹, LI Xiao-ming², ZHANG Xiao-hui³, WEI Shi-hui¹

1. Department of Ophthalmology, Chinese PLA General Hospital, Beijing 100853, China; 2. Department of Ophthalmology, Jilin Province People’s Hospital, Changchun 130021, China; 3. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China

Received:2015-12-29 Online:2016-03-25 Published:2016-03-24
Contact: WEI Shi-hui, Email: weishihui706@hotmail.com

摘要/Abstract

摘要：

目的归纳乙胺丁醇中毒性视神经病变（EON）患者的临床特点，并探讨其预后。设计回顾性病例系列。研究对象 2011年6月至2015年6月解放军总医院EON患者18例36眼。方法分析所有入组患者的病例资料，记录其人口学特征、临床表现。跟踪随访6~50个月，进一步分析其预后。主要指标 人口学特征、矫正视力、色觉、视野、视网膜神经纤维层（RNFL）厚度、视觉诱发电位（VEP）、结核病侵袭部位及预后。结果平均发病年龄（40.56±12.57）岁，全部为双眼发病，其中男性11例（61.1%）。30眼（83.3%）色觉障碍。17例双眼视野缺损类型一致，23眼（63.9%）呈中心视野缺损。初诊时矫正视力0.09±0.59（手动~0.25）。乙胺丁醇每日剂量（17.06±5.62）mg/kg，服用时间（5.97±5.12）个月。随访时间（30.27±16.18）个月。停乙胺丁醇后，6例（33.3%）患者视力较前提高（初始视力0.17 ± 0.67 vs.治疗后视力0.33± 0.49），视力改善（6例）和视力未改善（12例）的两组患者之间的每日服药剂量分别为（13.31±3.98）mg/kg和（18.50±3.15）mg/kg（P=0.037）。随访中8例（16眼）复查相干光断层扫描，视盘颞侧、上方、鼻侧所对应的RNFL不同程度较前变薄。结论乙胺丁醇中毒性视神经病变多见于中老年男性，易累及双眼，约1/3的患者停药同时给予治疗后视力可好转。（眼科，2016, 25： 123-126）

关键词: , 乙胺丁醇/副作用, 视神经病变

Abstract:

Objective To investigate the clinical features and prognosis of ethambutol-induced optic neuropathy（EON）. Design Retrospective case series. Participants During June 2011 to June 2015, 18 patients were diagnosed as EON in People's Liberation Army (PLA) General Hospital. Methods A retrospective chart review of 18 patients diagnosed as EON was performed, collecting and analyzing their demographic characteristics, clinical features． The patients were followed for 6~50 months. Main Outcome Measures Demographic characteristics, best corrected visual acuity (BCVA), visual field, color vision, visual field and retinal nerve fiber layer (RNFL) thickness. Results The mean age of affected patients was 40.56±12.57 years. 11 of them were men, and all of them were presented with blurry vision in both eyes. 30 eyes (83.3%, 30/36) had dyschromatopsia. 23 eyes (63.9%) showed central scotoma. The mean BCVA was 0.09±0.59 at first sight. The mean dose and duration of ethambutol were (17.06±5.62) mg/kg over (5.97±5.12) months. The period of follow-up was (30.27±16.18) months. The visual function recovery after discontinuation of ethambutol was seen in 6 of the 18 patients. Between the vision improved group and non-improved group, there was a statistically significant difference of the ethambutol daily dose (P=0.037). During the follow-up, 16 eyes of 8 patients were examined by optical coherence tomography (OCT), which displayed RNFL thinning in temporal, superior and nasal side. Conclusions Ethambutol-induced optic neuropathy was more common in elderly men, and tended to involve both eyes. About 1/3 of the patients showed visual improvement after discontinuation of ethambutol. (Ophthalmol CHN, 2016, 25: 123-126)

Key words: ethambutol/side effect, optic neuropathy

曹珊珊彭春霞李晓明张晓慧魏世辉. 18例乙胺丁醇中毒性视神经病变的临床特点[J]. 眼科, doi: 10.13281/j.cnki.issn.1004-4469.2016.02.013.

CAO Shan-shan1, PENG Chun-xia1, LI Xiao-ming2, ZHANG Xiao-hui3, WEI Shi-hui1. Clinical features of 18 cases of ethambutol-induced optic neuropathy[J]. Ophthalmology in China, doi: 10.13281/j.cnki.issn.1004-4469.2016.02.013.

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18例乙胺丁醇中毒性视神经病变的临床特点

Clinical features of 18 cases of ethambutol-induced optic neuropathy

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