甲强龙治疗Vogt-小柳原田综合征的疗效分析

摘要

目的 分析静脉甲强龙冲击治疗Vogt-小柳原田综合征(VKH)患者的光学相干断层扫描(OCT)图像特征.方法 将16例急性期VKH患者32只眼根据年龄采用分层随机法分成观察组和对照组,观察组采用甲强龙500 mg·d-1静脉滴注治疗,3 d后改为口服强的松1 mg·kg-1·d-1治疗;对照组直接采用口服强的松1 mg·kg-1·d-1,此后两组患者强的松剂量均根据病情逐渐减量.治疗前,治疗后5、15、30、90 d予以OCT检查,观察两组后极部视网膜脱离形态和视盘水肿程度.结果 所有急性期患者OCT图像均表现为多灶性神经上皮层脱离,部分患者脱离灶有膜样结构.视盘边界模糊,视杯容积较正常减少,视神经纤维层增厚.两组患者视网膜最大脱离高度和视杯容积在治疗后5、15、30、90 d与治疗前相比差异有统计学意义(P<0.05).观察组与对照组视网膜最大脱离高度和视杯容积仅在治疗后5 d比较差异有统计学意义(t=2.83,P=0.008;t=-8.95,P<0.001).治疗前,治疗后15、30、90 d观察组与对照组比较,视网膜最大脱离高度和视杯容积均差异无统计学意义(P>0.05).结论 静脉甲强龙冲击和单纯口服强的松均能有效治疗VKH,两者长期疗效无差异,但甲强龙冲击联合口服强的松能在早期更有效地减轻视乳头水肿,促进视网膜下液吸收.%Objective To observe the clinical effect of intravenous methylprednisolone in treating Vogt-Koyanagi-Harada(VKH) syn-drome patients by analyzed optical coherence tomography(OCT) features. Methods Thirty-two eyes with 16 patients were assigned into two groups. 16 eyes with 8 patients in observation group were treated with 500 mg intravenous methylprednisolone per day. Three days later 1 mg·kg - 1 prednisone were given orally per day. The control group(16 eyes with 8 patients) received prednisone 1 mg·kg - 1 o-rally per day. The dose of prednisone in two groups was reduced according to the patient′s condition. All patients were evaluated before treatments and 5 d,15 d,30 d,90 d after treatment. The maximum heightof retinal detachment and cup volume were measured by using OCT. Results All patients′ OCT images revealed multifocal neurosensory detachment areas,some of them have membrane structure in detachmentarea. Both cup volume reduction and RNFL thickening could be observed in all patients. On cup volume and maximum height of retinal detachment have statistical significant differences between the two groups 5 d,15 d,30 d,90 d after treatments(P < 0. 05), and that in observation groups improved further(t = 2. 83,P = 0. 008;t = - 8. 95,P < 0. 001) than in control groups five days after treatments. Compared with the control group,the maximum height of retinal detachment and cup volume in observation group was no sta-tistical significance 15 d,30 d,90 d after treatments(P > 0. 05). Conclusions Intravenous methylprednisolone and single oral predni-sone can both effectively treat Vogt-Koyanagi-Harada syndrome,there was no difference between them in long-term effect. However,in-travenous methylprednisolone canreduce papilledema more effectively and promote the absorption of subretinal fluid at an early stage.