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摘要:
目的 探讨Vogt-小柳-原田病(Vogt-Koyanagi-Harada disease, VKH)初发病例的激素治疗方法及效果。 方法 对本院2008年1月至2012年1月收治的病程在1周之内的VKH初发患者21例(42只眼)应用泼尼松120~140 mg/d, 晨起顿服, 每3~5天依据病情好转情况减量20 mg; 减至80 mg/d时, 每5天减量10 mg; 减至60 mg/d时, 每周减量5 mg; 减至15 mg/d后维持1~2个月, 以后每周减量5 mg至停药。 结果 所有患者治疗后第2天头痛症状消失, 视力有所改善。3 d后视力明显提高, 眼底视网膜脱离情况明显好转。7 d后视力≥ 0.5者36只眼, 占85.7%, 视网膜脱离均消失。1个月后所有患者视力均恢复至发病前最佳水平。随诊观察12~36个月期间无复发病例, 治疗期间未见严重的激素并发症。 结论 对于VKH初发病例早期大剂量应用泼尼松口服及长期的泼尼松口服治疗可有效控制病情。 -
关键词:
- Vogt-小柳-原田病 /
- 糖皮质激素 /
- 视网膜脱离
Abstract:Objective To observe the application and effectiveness of corticosteroid therapy for the initial cases of Vogt-Koyanagi-Harada disease (VKH). Methods Totally 21 VKH cases (42 eyes) from January 2008 to January 2012 in our hospital with initial onset and duration within a week were administered with prednisone of 120-140 mg/d at early morning. The dosage was reduced 20 mg every 3 to 5 days based on the condition improved and reduced 10 mg every 5 days when the dosage reached 80 mg/d, then reduced 5 mg every week from 60 mg/d. When the dose reduced to 15 mg/d, it was maintained for 1-2 months. After that the dose should be gradually reduced by 5 mg per week until zero. Results One day after treatment, headache disappeared and visual acuity improved in all patients. On the third day, the visual acuity improved significantly and retinal detachment improved remarkably. On the seventh day, there were 36 eyes (85.7%) with visual acuity ≥ 0.5 and retinal detachments disappeared in all eyes. One month later, the visual acuity returned the optimal levels before the onset in all patients. No serious corticosteroid complications occurred during the treatment. During the 12to 36month follow-up, no recurrence was noted. Conclusion Initial treatment with high-dose corticosteroids followed by prolonged corticosteroid therapy can effectively control the VKH. -
Key words:
- Vogt-Koyanagi-Harada disease /
- corticosteroid /
- retinal detachment
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图 1 患者男性, 38岁, 双眼视力急剧下降5d, 视力:双眼0.08, 入院时眼底图像显示:双眼视盘鼻侧充血、边界模糊, 视网膜静脉轻度扩张, 后极部及盘周视网膜浅脱离
A.右眼; B.左眼
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[1] 杨培增, 王红, 周红颜, 等. Vogt-Koyanagi-Harada综合征的临床表现及诊断[J].中华眼科杂志, 2002, 38:736-739. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhyk200212009 [2] 王梦华, 侯习武, 魏丽萍, 等. Vogt-小柳-原田综合征的临床治疗[J].中国实用眼科杂志, 2011, 29:1283-1286. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsyykzz201112021 [3] 杨培增, 李绍珍.葡萄膜炎[M].北京:人民卫生出版社, 1998:317-324. [4] 张美芬, 刘勤, 闵寒毅, 等. Vogt-Koyanagi-Harada综合征的治疗与预后[J].中华眼科杂志, 2002, 38:200-203. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhyk200204003 [5] Pan D, Hirose T. Vogt-Koyanagi-Harada syndrome:review of clinical features[J]. Semin Ophthalmol, 2011, 26:312-315. doi: 10.3109/08820538.2011.588654 [6] Moorthy RS, Inomata H, Rao NA. Vogt-Koyanagi-Harada syndrome[J]. Surv Ophthalmol, 1995, 39:265-292. doi: 10.1016/S0039-6257(05)80105-5 [7] Read RW, Yu F, Accorinti M, et al. Evaluation of the effect on outcomes of the route of administration of corticosteroids in acute Vogt-Koyanagi-Harada disease[J]. Am J Ophthalmol, 2006, 142:119-124. doi: 10.1016/j.ajo.2006.02.049 -
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