{"title":"脱髓鞘性视神经炎与 Omicron 变异感染相关视神经炎的比较","authors":"Jing Zhang, Lian Wang, Chunli Chen, Haitao Ren, Miao Jin, Hongjuan Liu, Bentao Yang, Zhiqin Huang, Libin Jiang, Fred Kuanfu Chen","doi":"10.24976/Discov.Med.202436188.175","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The connection between viral infection and the onset of demyelination has garnered considerable attention. Omicron, the most recent prevalent strain of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has raised concerns. Optic neuritis (ON) associated with Omicron infection and spontaneous demyelinating ON may manifest distinct disease progressions. This study aims to contrast the features of these two distinct etiologies of ON.</p><p><strong>Methods: </strong>This case-control study comprised fifteen patients (21 eyes) diagnosed with Omicron infection-related ON and fifteen patients (24 eyes) with demyelinating ON serving as the control group. Clinical characteristics, cerebrospinal fluid (CSF) analysis, treatment protocols, and outcomes were compared between the two groups.</p><p><strong>Results: </strong>The Omicron-infected group exhibited a higher incidence of pain upon ocular movement (<i>p</i> = 0.023) and peripapillary hemorrhages (<i>p</i> = 0.046). In CSF analysis, there was an elevation in white cell counts (WCCs) (<i>p</i> = 0.004), with lymphocytes being the predominant cell type in the Omicron-related ON group. However, oligoclonal bands (OCBs), indicative of intrathecal synthesis, were significantly lower and lagged behind those of the demyelinating ON group (<i>p</i> = 0.021). SARS-CoV-2 RNA was not directly detected in the CSF of the Omicron-related ON group, and the degree of WCC elevation was closely linked with peripapillary hemorrhages (odds ratio = 0.029, <i>p</i> = 0.02). Additionally, the Omicron-related ON group displayed more pronounced ganglion cell loss following 3-month treatment (<i>p</i> = 0.02).</p><p><strong>Conclusion: </strong>Omicron-related ON is distinguished by more pronounced clinical symptoms and distinct CSF characteristics compared to spontaneous demyelinating ON. The absence of viral RNA sequence in the CSF of Omicron-associated ON supports the use of steroid monotherapy; however, varying treatment options and prognoses should be considered for these two types of ON.</p>","PeriodicalId":93980,"journal":{"name":"Discovery medicine","volume":"36 188","pages":"1891-1901"},"PeriodicalIF":0.0000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Comparison between Demyelinating and Omicron Variant Infection-Associated Optic Neuritis.\",\"authors\":\"Jing Zhang, Lian Wang, Chunli Chen, Haitao Ren, Miao Jin, Hongjuan Liu, Bentao Yang, Zhiqin Huang, Libin Jiang, Fred Kuanfu Chen\",\"doi\":\"10.24976/Discov.Med.202436188.175\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The connection between viral infection and the onset of demyelination has garnered considerable attention. Omicron, the most recent prevalent strain of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has raised concerns. Optic neuritis (ON) associated with Omicron infection and spontaneous demyelinating ON may manifest distinct disease progressions. This study aims to contrast the features of these two distinct etiologies of ON.</p><p><strong>Methods: </strong>This case-control study comprised fifteen patients (21 eyes) diagnosed with Omicron infection-related ON and fifteen patients (24 eyes) with demyelinating ON serving as the control group. Clinical characteristics, cerebrospinal fluid (CSF) analysis, treatment protocols, and outcomes were compared between the two groups.</p><p><strong>Results: </strong>The Omicron-infected group exhibited a higher incidence of pain upon ocular movement (<i>p</i> = 0.023) and peripapillary hemorrhages (<i>p</i> = 0.046). In CSF analysis, there was an elevation in white cell counts (WCCs) (<i>p</i> = 0.004), with lymphocytes being the predominant cell type in the Omicron-related ON group. However, oligoclonal bands (OCBs), indicative of intrathecal synthesis, were significantly lower and lagged behind those of the demyelinating ON group (<i>p</i> = 0.021). SARS-CoV-2 RNA was not directly detected in the CSF of the Omicron-related ON group, and the degree of WCC elevation was closely linked with peripapillary hemorrhages (odds ratio = 0.029, <i>p</i> = 0.02). Additionally, the Omicron-related ON group displayed more pronounced ganglion cell loss following 3-month treatment (<i>p</i> = 0.02).</p><p><strong>Conclusion: </strong>Omicron-related ON is distinguished by more pronounced clinical symptoms and distinct CSF characteristics compared to spontaneous demyelinating ON. The absence of viral RNA sequence in the CSF of Omicron-associated ON supports the use of steroid monotherapy; however, varying treatment options and prognoses should be considered for these two types of ON.</p>\",\"PeriodicalId\":93980,\"journal\":{\"name\":\"Discovery medicine\",\"volume\":\"36 188\",\"pages\":\"1891-1901\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Discovery medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.24976/Discov.Med.202436188.175\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Discovery medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.24976/Discov.Med.202436188.175","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景：病毒感染与脱髓鞘发病之间的联系引起了广泛关注。严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）的最新流行株 Omicron 引起了人们的关注。与Omicron感染相关的视神经炎（ON）和自发性脱髓鞘ON可能表现出不同的疾病进展。本研究旨在对比这两种不同病因引起的视神经炎的特征：这项病例对照研究包括 15 名被诊断为与奥米克龙感染相关的 ON 患者（21 只眼）和 15 名作为对照组的脱髓鞘性 ON 患者（24 只眼）。两组患者的临床特征、脑脊液（CSF）分析、治疗方案和结果进行了比较：结果：奥米克隆感染组眼球活动时疼痛（p = 0.023）和虹膜周围出血（p = 0.046）的发生率较高。在 CSF 分析中，白细胞计数（WCC）升高（p = 0.004），淋巴细胞是奥米克龙相关 ON 组的主要细胞类型。然而，表明鞘内合成的寡克隆带（OCBs）明显降低，落后于脱髓鞘ON组（p = 0.021）。欧米克隆相关性ON组的脑脊液中未直接检测到SARS-CoV-2 RNA，而WCC升高的程度与毛细血管周围出血密切相关（几率比=0.029，P=0.02）。此外，治疗 3 个月后，Omicron 相关性 ON 组显示出更明显的神经节细胞丢失（p = 0.02）：结论：与自发性脱髓鞘性ON相比，Omicron相关性ON具有更明显的临床症状和独特的CSF特征。奥米克龙相关性ON的脑脊液中没有病毒RNA序列，这支持使用类固醇单药治疗；然而，对于这两种类型的ON，应考虑不同的治疗方案和预后。
A Comparison between Demyelinating and Omicron Variant Infection-Associated Optic Neuritis.
Background: The connection between viral infection and the onset of demyelination has garnered considerable attention. Omicron, the most recent prevalent strain of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has raised concerns. Optic neuritis (ON) associated with Omicron infection and spontaneous demyelinating ON may manifest distinct disease progressions. This study aims to contrast the features of these two distinct etiologies of ON.
Methods: This case-control study comprised fifteen patients (21 eyes) diagnosed with Omicron infection-related ON and fifteen patients (24 eyes) with demyelinating ON serving as the control group. Clinical characteristics, cerebrospinal fluid (CSF) analysis, treatment protocols, and outcomes were compared between the two groups.
Results: The Omicron-infected group exhibited a higher incidence of pain upon ocular movement (p = 0.023) and peripapillary hemorrhages (p = 0.046). In CSF analysis, there was an elevation in white cell counts (WCCs) (p = 0.004), with lymphocytes being the predominant cell type in the Omicron-related ON group. However, oligoclonal bands (OCBs), indicative of intrathecal synthesis, were significantly lower and lagged behind those of the demyelinating ON group (p = 0.021). SARS-CoV-2 RNA was not directly detected in the CSF of the Omicron-related ON group, and the degree of WCC elevation was closely linked with peripapillary hemorrhages (odds ratio = 0.029, p = 0.02). Additionally, the Omicron-related ON group displayed more pronounced ganglion cell loss following 3-month treatment (p = 0.02).
Conclusion: Omicron-related ON is distinguished by more pronounced clinical symptoms and distinct CSF characteristics compared to spontaneous demyelinating ON. The absence of viral RNA sequence in the CSF of Omicron-associated ON supports the use of steroid monotherapy; however, varying treatment options and prognoses should be considered for these two types of ON.
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