抗アクアポリン4抗体陽性視神経炎の臨床像

Clinical features of optic neuritis positive for anti-aquaporin 4 antibody

要約　背景：抗アクアポリン4抗体陽性の視神経炎は，特発性視神経炎よりも予後が不良とされている。症例：抗アクアポリン4抗体陽性の視神経脊髄炎9例12眼を診療録の記録から解析した。男性2例，女性7例で，3例が両眼性，6例が片眼性であった。初発時の年齢は46～81歳（平均59歳）である。傍中心暗点，耳側半盲，水平半盲などがあった。平均6.5回の再発があり，最終視力は8眼が0.1以下，うち3眼が光覚なしであった。全例にステロイドパルス療法を行い，6例に免疫グロブリンの大量静注，4例に血漿交換，2例に免疫抑制薬投与を行った。結論：抗アクアポリン4抗体陽性の視神経炎は女性に多く，高齢での発症，両眼の罹患，視力転帰が不良な症例が多かった。

Abstract.　Purpose：To report the clinical features of optic neuritis positive for anti-aquaporin 4 antibody（AQP4）. Cases：This retrospective study was made on 12 eyes of 9 patients with AQP4-positive optic neuritis. The series comprised 2 males and 7 females. Three cases were bilaterally and 6 were unilaterally affected. The age at the onset ranged from 46 to 81 years,average 59 years. Perimetry showed paracentral scotoma,temporal hemianopia,or altitudinal hemianopia. Recurrence of optic neuritis averaged 6.5 times. Visual acuity at the last visit was less than 0.1 in 8 eyes including no light perception in 3 eyes. All the cases received corticosteroid pulse therapy. Intravenous immunoglobulin was given to 6 cases,plasmaphoresis in 4 cases,and immunosuppressive drugs to 2 cases. Conclusion：Optic neuritis positive for anti-AQP4 antibody was characterized by onset at advanced age,involvement of females,bilaterality,and poor visual outcome.