视神经脊髓炎谱系疾病（neuromyelitis optica spectrum disorder, NMOSD）是一种罕见的中枢神经系统自身免疫性疾病，主要表现为视神经炎和纵向广泛性横贯性脊髓炎，复发率高，反复发作可导致不可逆的神经功能损害。文章报告了一例44岁女性的NMOSD患者，以反复发作的视神经炎为特征，经过长达11年的随访，共历经4次临床发作。患者首次发作时，因治疗过程中糖皮质（激素）减量过快和自行停药导致病情恶化，后续发作中采用了规范的急性期治疗和缓解期预防复发方案，包括大剂量激素冲击、免疫抑制剂（硫唑嘌呤、吗替麦考酚酯）和静脉注射免疫球蛋白（intravenous immunoglobulin, IVIG）等，显著延长了缓解期。最近一次复发中，患者首次使用了新型生物制剂伊奈丽珠单抗（CD19单克隆抗体）预防复发治疗。文章通过具体病例分析和文献综述，反映NMOSD急性期和缓解期预防复发治疗策略的时代变迁，并探索新型生物制剂使用过程中需要注意的问题。
Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disease that affects the central nervous system. It is predominantly characterized by optic neuritis and longitudinally extensive transverse myelitis. Given its high relapse rate, repeated attacks of NMOSD can result in irreversible nerve damage. The article details the case of a 44-year-old female patient with NMOSD, whose primary manifestion was recurrent optic neuritis.The patient was followed up over an 11-year span, during which she experienced a total of four clinical relapses. During the initial attack, the patient's condition deteriorated because of the rapid tapering of steroid therapy and her self-initiated discontinuation of medication. In subsequent attacks, standardized treatments for the acute phase and strategies for preventing relapses were implemented. These included high-dose steroid pulses, immunosuppressants (azathioprine, mycophenolate mofetil), and intravenous immunoglobulin (IVIG). These interventions significantly prolonged the remission period. During the most recent relapse, the patient received treatment with the novel biologic agent inebilizumab, which is a CD19 monoclonal antibody. Through a comprehensive case analysis and a review of relevant literature , this report sheds light on the evolving treatment strategies for managing the acute phase and preventing relapses during remission in NMOSD. It also highlights key considerations in the practical application of the new biologic therapies.
目的：分析慢性泪囊炎患者鼻内镜下泪囊鼻腔造瘘口术后的远期肉芽增生情况，评价物理清除联合曲安奈德（triamcinolone acetonide，TA）局部注射治疗慢性泪囊炎鼻内镜术后造瘘口肉芽组织增生的效果。方法：回顾性分析接受鼻内镜手术的慢性泪囊炎患者98例115眼。随访收集术后造瘘口肉芽组织增生发生情况，分析肉芽增生与无肉芽增生患者的临床特征。对有肉芽增生的患者26例31眼，根据治疗方式分为物理清除联合TA局部注射组13例16眼和单纯物理清除组13例15眼，比较2组间治疗有效率。结果：鼻内镜术后造瘘口肉芽增生病例共31眼（26.96%）。物理清除联合TA组的治愈率、好转率分别为93.75%、6.25%，物理清除组相应为60%、33.33%，组间比较差异有统计学意义（P < 0.05）。结论：物理清除联合TA局部注射治疗泪囊炎鼻内镜术后造瘘口肉芽组织增生安全、有效。
