Vogt-小柳-原田综合征的临床分析

Clinical analysis of Vogt-Koyanagi-Harada syndrome

目的:探讨Vogt-小柳-原田综合征(Vogt-Koyanagi-Harada sydrome,VKH)的临床特点、治疗方法及治疗效果。方法:收集2004-04/2012-04在我院就诊的20例39眼VKH患者的临床资料,对其眼部表现、全身症状、眼底荧光素血管造影(fundus fluorescein angiograghy,FFA)和治疗进行回顾性分析。结果:该组病例中20例39眼均为初发患者,19例双眼发病,1例单眼发病。发病前有前驱症状者14例(70%),主要为头痛,恶心,呕吐。就诊时有眼外症状和体征者16例(80%),包括中枢神经系统异常、听力障碍、脱发和白癜风。FFA检查表现为斑驳状高荧光、视盘色染和多湖样荧光积存。所有患者给予大剂量糖皮质激素治疗,疗程9～12mo。20例患者的视力均显著提高。随访3mo后,3例复发。结论:前驱症状、临床病程、眼外表现及FFA等有助于Vogt-小柳-原田综合征的诊断,早期给予大剂量糖皮质激素治疗,绝大部分患者可控制炎症,改善视力。但有复发倾向,严密观察,应长期随访。

· AIM ： To investigate the clinical characteristic, treatment and treatment effect of Vogt- Koyana - Harada （VKH syndrome. · METHODS： A retrospective study was conducted based on the clinical data of 20 patients 39 eyes with VKH syndrome who were admitted to the First Affiliated Hospital of the Medical College of the Shihezi University from April 2004 to April 2012. The clinical data were analyzed, including ocular symptoms, ocular symptoms, fundus fluorescein angiography （ FFA）, and treatment method. · RESULTS： All of the 20 patients 39 eyes were initial patients, simultaneous involvement of both eyes occurred in 19 cases, only one case had the unilateral disease. Prior to the onset of the disease, 14 patients （70%） had prodromal symptoms such as headache, nausea, vomiting. External ocular symptoms were noted in 80% of the patients, including neurologic symptoms, auditory problems, poliosis, alopecia and vitiligo. The specific performances of FFA were irregular punctate hyperfluorescent dots, disc leakage and multiple hyperfluorescent pool in the subretina. All patients were treated with high-dose corticosteroids for 9-12 months. The vision of the patients improved differently. After 3 months＇ following-up, 3 cases relapsed. · CONCLUSION： Prodrome, clinical course, external ocular symptoms and FFA are helpful to the diagnosis of VKH syndrome. Early and aggressive systemic treatment with corticosteroids has greatly improved the visual outcome in VKH patients. But there is a tendency of recurrence, and long-term follow-up should be closely observed.