Vogt-Koyanagi-Harada综合征的治疗

Therapeutic regimen in Vogt-Koyanagi-Harada syndrome

目的 分析观察Vogt Koyanagi Harada(VKH)综合征患者的治疗方法和效果 ,寻找理想的治疗方案。方法 对 1996年 1月至 2 0 0 0年 12月在中山眼科中心葡萄膜炎专科确诊为VKH综合征 ,并经系统治疗及随访≥ 1年的 82例 (16 4只眼 )患者的资料进行分析。其中 2 8例 (5 6只眼 )为初发性患者 ,糖皮质激素治疗≥ 1年 ;5 4例 (10 8只眼 )为复发性患者 (外院间断性糖皮质激素治疗 ) ,用苯丁酸氮芥治疗≥ 1年 ;所有患者均联合中药治疗 ;将外院间断性糖皮质激素治疗的 5 4例患者与本院系统性治疗的 2 8例初发性患者资料进行对比分析。结果 2 8例初发性葡萄膜炎患者经系统的糖皮质激素治疗≥ 1年 ,视力均显著提高 ;96 4 %患者的葡萄膜炎完全控制。 5 4例复发性患者经苯丁酸氮芥治疗≥ 1年后 ,视力有不同程度增加者 95只眼 (88 0 % ) ;葡萄膜炎完全控制者 5 1例 (94 4 % ) ;5 4例外院间断性大剂量行糖皮质激素治疗者 ,葡萄膜炎均有复发或炎症持续存在 ,且其视力明显低于系统应用糖皮质激素或苯丁酸氮芥治疗后的视力。结论 初发性VKH综合征患者应给予足量及长期的糖皮质激素治疗 ;对复发患者 ,苯丁酸氮芥是一种有效的药物 ;

Objective To compare the effectiveness of therapeutic regimen in Vogt Koyanagi Harada (VKH) syndrome and determine the reasonable regimen for different patients Methods Data of 82 patients with VKH syndrome, coming from all over China and referred to Zhongshan Ophthalmic Center from January 1996 to December 2000 were retrospectively analyzed Twenty eight patients (56 eyes) with first attack of the intraocular inflammation were treated with oral prednisone for more than one year, whereas 54 patients (108 eyes) with recurrent episodes were treated with chlorambucil for more than one year All patients were treated with a combination of these immunosuppressives with traditional Chinese medicine herbs, and followed up more than one year after systemic treatment The previous treatment for these 54 patients was also analyzed in an attempt to compare these results with those presented here Results Uveitis was completely controlled in 96 4% of the patients treated with oral prednisone, and all of these patients showed improved vision after treatment A complete control of uveitis was achieved in 94 4% and improved vision was seen in 88 0% of the patients treated with chlorambucil All of these 54 patients, although treated with longer but intermittent systemic corticosteroids before installation of chlorambucil, showed a chronic or recurrent uveitis and most cases had markedly decreased vision as compared with those treated by us with regular systemic corticostroids Conclusions Intensive and prolonged systemic treatment with corticosteroids is recommended for the patients with first attack of VKH symdrome, wherase regular treatment with chlorambucil is useful for control of chronic and recurrent uveitis seen in VKH syndrome Traditional Chinese medicine herbs may be helpful in amelioration of uveitis and reduction of side effects of immunosuppressives