摘要目的 观察甲钴胺联合糖皮质激素治疗视神经炎的临床疗效.方法 回顾性研究.临床确诊为视神经炎的74例患者118只眼纳入研究.其中,视神经乳头炎38例55只眼,球后视神经炎36例63只眼.将患者按随机对照原则分为治疗组和对照组,分别为37例59只眼.治疗组给予半球后注射甲钴胺注射液500 μg/次,1次/d,10次为1个疗程；2～3个疗程后改口服甲钴胺500 μg/次,3次/d.全身静脉滴注地塞米松15mg/d,1周后改为强的松龙30 mg/d口服,每5天减量,每次减量5 mg,同时口服维生素B110 mg,3次/d,使用能量合剂、血管扩张剂.对照组除不使用甲钴胺外,其余治疗同治疗组.对比分析两组患者治疗后的疗效差异.结果 治疗组59只眼中,显效42只眼,占71.19％；有效15只眼,占25.42％；无效2只眼,占3.39％.其总有效率为96.61％.对照组59只眼中,显效30只眼,占50.85％;有效26只眼,占44.07％；无效3只眼,5.08％.其总有效率为94.92％.两组总有效率比较,差异无统计学意义(x2=1.10,P＞0.05)；显效率比较,差异有统计学意义(x2=5.65,P＜0.05).结论 甲钴胺联合糖皮质激素可有效治疗视神经炎.

abstractsObjective To observe the efficacy of glucocorticoid and Mecobalamin in the treatment of optic neuritis.Methods Seventy-four patients (118 eyes) with optic neuritis were enrolled in this study.There were 38 patients (55 eyes) with optic nerve papillitis,36 patients (63 eyes) with retrobulbar neuritis.The patients were divided into treatment and control group,37 patients (59 eyes) in each group.The treatment group received semi-retrobulbar injection of 500μg Mecobalamin per day,10 times for one course; after two to three courses changed oral 500 μg Mecobalamin,three times per day.Systemic intravenous injection of 15 dexamethasone mg per day for one week,then prednisolone 30 mg per day orally,the dosage was reduced every five days for 5 mg; oral administration of vitamin B1,10 mg three times per day,use of energy mixture,vasodilators.Control group underwent the same therapy as the treatment group without Mecobalamin.The efficacy differences between two groups were comparatively analyzed.Results Among 59 eyes in the treatment group,42 eyes (71.19％) were markedly effective,15 eyes (25.42％) were valid and two eyes (3.39％) were invalid.The total effective rate was 96.61％.Among 59 eyes in the control group,30 eyes (50.85％) were markedly effective,26 eyes (44.07％) were valid and three eyes (5.08％) were invalid.The total effective rate was 94.92 ％.The difference of total effective rate between two groups was not statistically significant (x2 =1.10,P＞0.05) ; but there was a difference in markedly effective ratebetween two groups (x2 =5.65,P＜0.05).Conclusion Mecobalamin combined with glucocorticoids was effective in the treatment of optic neuritis.