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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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

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	ZHU Maoli HUANG Liang XUE Min DONG Jianhong▲

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ZHU Maoli HUANG Liang XUE Min DONG Jianhong▲. The effect observation of high-dose Methylprednisolone treatment on Vogt-Koyanagi-Harada disease[J]. 中国医药导报, 2017, 14(18): 134-137.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2017/V14/I18/134

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