目的：探讨静脉注射免疫球蛋白(IVIG)治疗糖皮质激素耐药的视神经脊髓炎相关性视神经炎(NMO-ON)复发患者的临床疗效。方法：前瞻性研究。选择2016-01/2018-01我院眼科住院部收治的79例对糖皮质激素耐药的NMO-ON复发患者，根据治疗方式将其分为两组，IVIG组42例57眼采用IVIG治疗，血浆置换(PE)组37例43眼采用PE治疗。比较两组患者疗效、不良反应和复发率，以及治疗前后裸眼视力、水通道蛋白4 抗体(AQP4-IgG)、髓鞘少突胶质细胞糖蛋白抗体(MOG-IgG)抗体变化。结果：IVIG组和PE组治疗有效率均为91%(P>0.05)； 两组患者治疗后裸眼视力分布情况较治疗前明显改善(P<0.01)，AQP4-IgG(+)、MOG-IgG(+)比例均较治疗前明显下降(P<0.001)，而以上指标两组间比较无差异(P>0.05)。两组患者中位随访40(29～50)mo，截止末次随访IVIG组、PE组复发率分别为10%、9%(P>0.05)。IVIG组治疗过程中不良反应发生率低于PE组(P<0.05)。结论：PE、IVIG均能改善糖皮质激素耐药的NMO-ON复发患者视力和症状，清除致病抗体，降低复发，但IVIG安全性相对较高。

AIM: To investigate the clinical efficacy of intravenous immunoglobulin(IVIG)in the treatment of neuromyelitis optica related optic neuritis(NMO-ON)patients with recurrent and glucocorticoid resistance. METHODS: A total of 79 NMO-ON patients with recurrent and glucocorticoid resistance admitted to the ophthalmic inpatient department of our hospital from January 2016 to January 2018 were retrospectively selected and divided into two groups according to the treatment mode. Forty-two patients(57 eyes)in the IVIG group were treated with IVIG, and 37 patients(43 eyes)in the PE group were treated with plasmapheresis. The differences in efficacy, adverse reactions and recurrence rates between the two groups were compared, as well as the changes and differences in uncorrected visual acuity, aquaporin-4 immunoglobulin G antibody(AQP4-IgG), and myelin oligodendrocyte glycoprotein antibody(MOG-IgG)antibody before and after treatment. RESULTS: The effective rates of IVIG group and PE group were 91% and 91% respectively(P>0.05). After treatment, the uncorrected visual acuity, photosensitive sense and number finger of the 2 groups were significantly improved(P<0.01), and the proportions of AQP4-IgG(+)and MOG-IgG(+)were significantly decreased(P<0.001)compared with those before treatment, while the proportions of visual acuity, photosensitive sense and number finger, AQP4-IgG(+)and MOG-IgG(+)in the 2 groups showed no statistical difference(P>0.05). The patients in the two groups were followed up for a median of 40(29-50)mo. By the last follow-up, the recurrence rates in IVIG group and PE group were 10% and 9%, respectively(P>0.05). The incidence of adverse reactions in IVIG group was lower than that in PE group(P<0.05). CONCLUSION: Both PE and IVIG can improve the vision and symptoms of patients with NMO-ON patients with recurrent and glucocorticoid resistance, clear the pathogenic antibodies, and reduce the recurrence. The clinical efficacy of two methods is significant, but IVIG is relatively safe.