抗结核药物联合激素治疗结核性匐行样脉络膜炎的短期疗效

Short-term efficacy of combined antitubercular and corticosteroids therapy for tubercular serpiginous-like choroiditis

目的 观察抗结核药物联合糖皮质激素治疗结核性匐行样脉络膜炎的短期效果,探讨可能影响治疗效果的因素.设计回顾性病例系列.研究对象2016年1月至2019年6月就诊于北京同仁医院的结核性匐行样脉络膜炎患者16例(20眼).方法 抗结核治疗方案为前2个月应用异烟肼、利福平、乙胺丁醇、吡嗪酰胺四联一线药物,后4个月合用异烟肼和利福平;抗结核开始2周后联合口服糖皮质激素(泼尼松龙)治疗,初始剂量为1 mg/kg/日,根据病情逐渐减量,维持6个月;开始用药后1、2、3、6个月进行随访复查.随访时记录彩色眼底照相、眼底自发荧光照相(FAF)、相干光断层扫描(OCT)以及是否有玻璃体细胞,以判断治疗效果.主要指标治疗有效及复发的眼数,并发症.结果 11例13眼(68.8%)经抗结核联合糖皮质激素治疗后6个月病灶稳定,其中8例(72.7%)严格遵循治疗方案.10例在抗结核之前有全身糖皮质激素应用史,其中5例(50%)在6个月时病情未稳定,1眼(5%)出现脉络膜新生血管(CNV).6例抗结核之前未用糖皮质激素,随访6个月时病情均稳定(100%).结论 抗结核药物联合糖皮质激素治疗结核性匐行样脉络膜炎在6个月时多数患者病灶稳定,抗结核前有全身糖皮质激素应用史者预后较差.

Objective To observe the short-term efficacy of antitubercular drugs combined with corticosteroids in the treatment of tubercular serpiginous-like choroiditis,and explore the factors that may affect the treatment.Design Retrospective case series.Participants 16 patients(20 eyes)with tubercular serpiginous-like choroiditis presented to Beijing Tongren Hospital from January 2016 to June 2019.Methods First-line 4-drug antitubercular therapy(isoniazid,rifampicin,ethambutol,pyrazinamide)were given initially for 2 months.Thereafter,rifampicin and isoniazid were continued for another 4 months.Oral corticosteroids(prednisolone 1 mg/kg/day initially)were administered 2 weeks later than antitubercular therapy,then gradually tapered off depending on the clinical response and last for 6 months.Following-up was conducted 1,2,3,and 6 months after the combined therapy.During the follow-up,color fundus photography,fundus autofluorescence(FAF),optical coherence tomography(OCT)and vitreous cells were recorded.Main Outcome Measures Numbers of eyes with effectiveness or recurrence,complication.Results 11 patients with 13 eyes(68.8%)had stable lesions after antitubercular drugs combined with corticosteroids therapy,and 8 patients(72.7%)strictly followed the dosing regimen.Ten people were administered corticosteroids systemically before anti-tuberculosis,of which 5(50%)patients had active lesions at 6 months,1 eye(5%)developed choroidal neovascular(CNV).6 patients who were without corticosteroids history before antitubercular all showed stable fundus at the end of the follow-up.Conclusion The lesions of tubercular serpiginous-like choroiditis in most patients responded well to combined antitubercular and corticosteroids therapy.Patients who were administered large amounts of corticosteroids systemically before the antitubercular had a poor prognosis.