大剂量甲泼尼龙冲击治疗Vogt-小柳-原田病的效果观察

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摘要目的观察大剂量甲泼尼龙冲击治疗Vogt-小柳-原田病的临床效果。方法回顾分析2013年1月~2016年1月上海市徐汇区中心医院确诊为Vogt-小柳-原田病的住院患者69例（135眼）。所有患者予以大剂量甲泼尼龙冲击治疗，即甲泼尼龙1 g/d静脉滴注，连续3 d，再根据患者临床表现改善情况正规逐渐减量至停药。观察比较患者治疗前及治疗3、7 d后的最佳校正视力（BCVA）、眼底、光学相干断层扫描（OCT）以及眼底荧光血管造影（FFA）的变化情况，并随访1年。结果经治疗，100眼（74.1%）1周内视力明显提高（≥0.6）、视网膜水肿消退，OCT示浆液性视网膜脱离消失，FFA荧光素渗漏减轻。视力提高缓慢的32眼（23.7%）发病时间均≥2周，用药2周视力方缓慢提高。3眼（2.2%）治疗无效后改免疫抑制剂治疗。BCVA转换为logMAR视力分析显示：与治疗前相比，治疗3 d及7 d后患眼视力明显改善，差异有高度统计学意义（P ＜ 0.01）；与治疗3 d后相比，治疗7 d后视力亦明显提高，差异有高度统计学意义（P ＜ 0.01）。OCT变化情况分析显示：与治疗前相比，治疗3 d及7 d后平均黄斑中心凹区ILM-RPE视网膜厚度、黄斑部视网膜容积以及黄斑部视网膜平均容积厚度均明显下降，差异有高度统计学意义（P ＜ 0.01）；与治疗3 d后相比，治疗7 d后平均黄斑中心凹区ILM-RPE视网膜厚度、黄斑部视网膜容积以及黄斑部视网膜平均容积厚度均明显下降，差异有高度统计学意义（P ＜ 0.01）。所有患者随访1年，未见严重不良反应，其中3例患者（6眼）于治疗后半年内复发，再次予以冲击治疗，随访稳定。结论大剂量甲泼尼龙冲击治疗Vogt-小柳-原田病疗效确切、视功能恢复快、复发率低、不良反应少，是一种安全有效的治疗方法。且发病时间越短，治疗效果越好。

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	朱茂丽黄亮薛敏董健鸿▲

关键词 ： Vogt-小柳-原田病, 甲泼尼龙, 糖皮质激素

Abstract：Objective To observe the effect of high-dose Methylprednisolone treatment on Vogt-Koyanagi-Harada disease. Methods Sixty-nine hospitalized patients (135 eyes) diagnosed with Vogt-Koyanagi-Harada disease from January 2013 to January 2016 in Xuhui District Central Hospital of Shanghai were analyzed retrospectively. All patients received high-dose Methylprednisolone treatment, with Methylprednisolone 1.0 g/d in early mornings for three consecutive days, and then the dosage was tapered based on the condition improvement. Before and after being treated for three and seven days, all patients underwent vision acuity examination, fundus examination, optical coherence tomography (OCT) and fundus fluorescein angiography (FFA). The changes were analyzed, and the patients were followed up for one year. Results After treatment for one week, there were 100 eyes (74.1%) whose vision acuity were improved significantly [best corrected vision acuity (BCVA)≥0.6], retina edema subsided, retinal detachment disappeared in OCT and fluorescence leakage reduced in FFA. All of the 32 eyes (23.7%) with vision acuity slowly improved were treated after an onset of no less than two weeks. The BCVA was improved slowly after treatment for two weeks. There were 3 eyes (2.2%) that showed no response to the high-dose methylprednisolone treatment and then received immunosuppressant therapy. Analysis of logMAR vision converted from BCVA, vision acuity of all patients was improved obviously after treatment for three days and seven days compared to before treatment, with statistically significant differences (P ＜ 0.01); moreover, vision acuity of all patients was improved markedly after treatment for seven days compared to that after treatment for three days, and the difference was of statistical significance (P ＜ 0.01). Analysis of OCT: compared to conditions before treatment, foveal thickness (ILM-RPE), macular retinal volume and average volume thickness were decreased greatly after treatment for three days and seven days, and the difference was of statistical significance (P ＜ 0.01). Compared to results after treatment for three days, macular foveal thickness (ILM-RPE), macular retinal volume and average volume thickness were decreased greatly after treatment for seven days, and the difference was of statistical significance (P ＜ 0.01). During the one-year follow-up, no serious corticosteroid complications occurred to all eyes. Three patients (6 eyes) had a relapse within six months after treatment, and were given high-dose Methylprednisolone treatment again, which ended well. Conclusion High-dose Methylprednisolone treatment can effectively control the Vogt-Koyanagi-Harada disease, with fast visual function recovery, low recurrence rate and rare adverse reaction. It is safe and effective. The earlier the treatment is given, the better the curative effect will be.

Key words： Vogt-Koyanagi-Harada disease Methylprednisolone Corticosteroid

通讯作者: ▲通讯作者

引用本文:

朱茂丽黄亮薛敏董健鸿▲. 大剂量甲泼尼龙冲击治疗Vogt-小柳-原田病的效果观察[J]. 中国医药导报, 2017, 14(18): 134-137.
ZHU Maoli HUANG Liang XUE Min DONG Jianhong▲. The effect observation of high-dose Methylprednisolone treatment on Vogt-Koyanagi-Harada disease. 中国医药导报, 2017, 14(18): 134-137.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2017/V14/I18/134

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