和歌山県立医科大学附属病院眼科における視神経炎治療と自己抗体との関連

Relation between autoantibody and therapeutic outcome of optic neuritis at Wakayama Medical School Hospital

要約　目的：和歌山県立医科大学附属病院眼科での視神経炎の治療と予後，および抗アクアポリン4（AQP4）抗体との関連の検討。

対象と方法：過去5年間に当科にて視神経炎として加療した37例〔男性16例，女性21例，平均年齢57.4歳（22〜85歳）〕を研究対象とした。血清抗AQP4抗体の有無，治療，視力予後について検討を行った。

結果：抗AQP4抗体は4例で陽性，33例で陰性であった。抗AQP4抗体陽性視神経炎は4例ともステロイドパルス療法への治療反応性が悪く，血漿交換を行った3例とも視力の改善は認めたものの3例中2例は最終視力0.1以下であった。抗AQP4抗体陰性視神経炎30例のうち24例はステロイドパルス療法で視力の改善が認められたが，最終視力予後の悪い症例も含まれた。

結論：ステロイドパルス療法無効例に対しては血漿交換療法が有効な例がみられた。また，抗AQP4抗体陰性視神経炎のなかにもステロイド無効例を認めており，抗AQP4抗体の偽陰性や，その他の因子の関与も考えられる。

Abstract　Purpose：To report the therapeutic outcome of optic neuritis as related to anti-aquasporin 4.

Cases：This retrospective study was made on 37 cases who were diagnosed with optic neuritis by us during the foregoing 5 years. The series comprised 16 males and 21 females. The age ranged from 22 to 85 years, average 57 years.

Results：Anti-aquasporin 4 antibody was positive in 4 cases（11％）and negative in 33（89％）. Outcome of systemic corticosteroid was insufficient in the 4 antibody-positive cases. Three out of the 4 cases received plasma-exchange therapy. The outcome was in two of these cases with final visual acuity of 0.1 or less. Visual acuity improved in 24 out of 30 cases who were negative for antibody and who received systemic corticosteroid.

Conclusion：Anti-aquasporin 4 antibody was positive in 4 cases of optic neuritis and negative in 33. Plasma-exchange therapy was effective in some cases of antibody-positive cases that failed to respond to systemic corticosteroid. Systemic corticosteroid was futile in some cases of antibody-negative cases, suggesting the presence of false-negative autoantibody and other factors.