摘要目的 了解伴发病毒性肝炎的视神经炎的临床表现、治疗及预后.方法 回顾性系列病例研究.收集2003年9月至2010年6月北京同仁医院神经眼科20例伴发病毒性肝炎的视神经炎患者的临床资料,总结该组患者的临床特点、视野变化,并对治疗前后的视力采用Wingerchuk视力分级进行比较.结果 本组20例视神经炎患者,18例为慢性乙型肝炎,2例为慢性丙型肝炎.13例为单眼起病(65％),16例为单相病程(80％).视神经损害27只眼,视乳头水肿常见,共14只眼(52％)；视力损害最严重时最佳矫正视力≤0.1者共19只眼(70％)；视野损害以水平下半视野缺损最为常见,共10只眼(50％).经糖皮质激素治疗后3个月对所有患者进行随访,视力完全恢复3只眼(11％)、明显改善4只眼(15％)、好转12只眼(44％)、8只眼(30％)无变化.结论 本组伴发病毒性肝炎的视神经炎患者视力损害较重,糖皮质激素治疗后部分患者视力完全恢复,但多数患者视力恢复较差.应注意同期肝炎的抗病毒治疗.

abstractsObjective To investigate the clinical manifestation,management and prognosis of optic neuritis combined with viral hepatitis.Methods Retrospective study case series.Clinical data from twenty patients with optic neuritis combined with hepatitis who were hospitalized in Beijing Tongren Hospital neural eye wart from September 2003 to June 2010 were collected,the clinical characteristics and visual field changes in the group of patients were summarized,and comparison between the vision before and after treatment was made by the Wingerchuk vision classification.Results Among the twenty patients,eighteen patients had chronic hepatitis B and two patients had chronic hepatitis C.Thirteen (65％) patient were monocular,sixteen( 80％ ) patients were single-phase course.Twenty-seven eyes were affected.Disc edema was very common which was found in 14 eyes(52％ ),severe vision impairment ( Best corrected visual acuity worse than 20/200) were recorded in 19 eyes (70％).Lower altitudinal visual field impairment was more common which was found in 10 eyes (50％).All patients were followed for 3 months after steroid therapy,complete visual recovery or significant improvement was seen in only 3 eyes (1 1％ ) or 4 eyes (15％).Minor improvement was seen in 12 eyes (44％),while 8 eyes (30％) had no improvement.Conclusions In this study,optic neuritis combined with hepatitis usually showed severe visual impairment.Although the vision of some patients could completely recover after steroid therapy,most of the patients had poor recovery.Combination of steroid and anti-viral therapy should be considered in the management of optic neuritis combined with hepatitis.