Vogt-小柳-原田病初发病例的激素治疗

Corticosteroid Therapy in the Initial Cases of Vogt-Koyanagi-Harada Disease

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120～140mg/d,晨起顿服,每3～5天依据病情好转情况减量20mg;减至80mg/d时,每5天减量10mg;减至60mg/d时,每周减量5mg;减至15mg/d后维持1～2个月,以后每周减量5mg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。3d后视力明显提高,眼底视网膜脱离情况明显好转。7d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。

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 im- proved and reduced 10 mg every 5 days when the dosage reached 80 rag/d, then reduced 5 mg every week from 60 mg/d. When the dose reduced to 15 rag/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 vis- ual acuity improved in all patients. On the third day, the visual acuity improved significantly and retinal detach- ment improved remarkably. On the seventh day, there were 36 eyes （85.7%） with visual acuity 〉i 0.5 and reti- nal 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 12- to 36- month follow-up, no recurrence was noted. Conclusion Initial treatment with high-dose corticosteroids followed by prolonged corticosteroid therapy can effectively control the VKH.