背景:视网膜光学相干断层扫描(OCT)可以区分一定的NMOSD(dNMOSD)和多发性硬化症(MS),但尚未在临床高度怀疑NMOSD且不符合当前共识诊断标准的患者中进行评估,本文称为“潜在”NMOSD(pNMOSD)。
目的:比较pNMOSD患者的视网膜OCT测量值,dNMOSD,MS,和参考健康对照(HC)。
方法:在这项横断面研究中,临床和人口统计学特征,以及视周视网膜神经纤维层(pRNFL)的OCT测量,内核层(INL),黄斑视网膜神经纤维层(mRNFL),外核层(ONL)神经节细胞/内丛状层(GCIPL),比较各组黄斑体积(MV)。混合效应回归模型调整患者眼间相关性,控制年龄,性别,研究了每只眼睛的疾病持续时间和视神经炎病史。对先前患有视神经炎的眼睛进行亚组分析。
结果:234眼(20pNMOSD,33dNMOSD,138MS,和43HC)被包括在内。控制年龄,性别,疾病持续时间,和每只眼睛的视神经炎病史,pNMOSD眼睛显示GCIPL降低,pRNFL,mRNFL和MV厚度,类似于dNMOSD的眼睛,但明显比MS和HC受试者的眼睛薄。对于pRNFL获得了类似的结果,mRNFL,GCIPL,亚组分析中的INL和MV厚度仅探索有视神经炎病史的眼睛(12pNMOSD,15dNMOSD,和27MS)。
结论:pNMOSD患者的视网膜OCT测量结果与dNMOSD相似,但明显低于MS患者和健康对照组。这表明视网膜OCT测量可能是支持NMOSD诊断的有用标志物,应在更大的研究中进行探索,作为当前共识诊断标准的有价值的补充。
BACKGROUND: Retinal optical coherence tomography (OCT) can differentiate definite NMOSD (dNMOSD) from multiple sclerosis (MS), but has not been evaluated in patients with a high clinical suspicion of NMOSD and not fulfilling the current consensus diagnostic criteria, referred in this paper as \"potential\" NMOSD (pNMOSD).
OBJECTIVE: To compare the retinal OCT measurements between patients with pNMOSD, dNMOSD, MS, and reference healthy controls (HC).
METHODS: In this cross-sectional study, clinical and demographic characteristics, as well as OCT measurements of peripapillary retinal nerve fiber layer (pRNFL), inner nuclear layer (INL), macular retinal nerve fiber layer (mRNFL), outer nuclear layer (ONL) ganglion cell/inner plexiform layer (GCIPL), and macular volume (MV) were compared between groups. Mixed-effects regression models adjusting for within-patient inter-eye correlations, controlling for age, gender, disease duration and history of optic neuritis per eye were explored. Subgroup analyses were performed on eyes with previous optic neuritis.
RESULTS: 234 eyes (20 pNMOSD, 33 dNMOSD, 138 MS, and 43 HC) were included. Controlling for age, gender, disease duration, and history of optic neuritis per eye, pNMOSD eyes showed decreased GCIPL, pRNFL, mRNFL and MV thicknesses, similar to eyes with dNMOSD, but significantly thinner than MS and HC subjects\' eyes. Similar results were obtained for the pRNFL, mRNFL, GCIPL, INL and MV thickness in the subgroup analysis exploring only eyes with history of optic neuritis (12 pNMOSD, 15 dNMOSD, and 27 MS).
CONCLUSIONS: Retinal OCT measurements in patients with pNMOSD were similar to dNMOSD, but significantly lower than patients with MS and healthy controls. This suggests that retinal OCT measures could be helpful markers supportive of NMOSD diagnosis and should be explored in larger studies as a valuable addition to the current consensus diagnostic criteria.