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目的 观察Vogt Koyanagi Harada(VKH)综合征患者采用糖皮质激素的治疗效果 ,并探讨VKH综合征治疗的有效方案。方法 对 136例确诊为VKH综合征患者中 5 1例初诊葡萄膜炎期患者 ,采用大剂量方案治疗 ,首次泼尼松剂量为 2mg·kg-1·d-1,顿服 ,逐渐减量然后改为隔日顿服 ,疗程约为 8个月。 85例为外院转诊患者 ,均曾经糖皮质激素治疗 ,治疗时间均≥ 2个月 ,总量均≥ 2 0 0 0mg(等效剂量泼尼松 ) ;采用调整方案治疗 ,根据患者眼部情况调整泼尼松的剂量 ,疗程 6～ 10个月。同时对大剂量治疗组 11例患者及调整方案组 14例患者的 2 4h尿游离皮质醇 (urinefreecortisol,UFC)进行检测 ,以观察VKH综合征患者肾上腺皮质功能。结果 5 1例患者经大剂量方案治疗后 ,炎性反应稳定、缓解 ,94 1%的视力≥ 0 5 ,79 4 %的视力≥ 0 8,炎症复发率及眼部并发症发生率低 ;2 4hUFC水平正常。 85例经调整方案治疗后 ,炎症缓解 ,5 8 8%的视力≥ 0 5 ,4 2 9%的视力≥ 0 8为。并发症的发生率为 4 9 4 %。 2 4hUFC水平由 (5 35± 5 8) μg升至 (2 1 9± 7 2 ) μg (正常值 2 0～ 78μg/2 4h) ;结论VKH综合征患者经大剂量方案治疗效果满意 ,调整方案可作为补救性措施
Objective To observe the effect of glucocorticoid treatment in Vogt Koyanagi Harada (VKH) syndrome and explore the effective treatment of VKH syndrome. Methods A total of 51 cases of newly diagnosed uveitis in 136 patients with VKH syndrome were treated with high-dose regimen. The first dose of prednisone was 2 mg · kg-1 · d-1, Day after tomorrow to change clothes, treatment is about 8 months. 85 patients were referred to the outpatient hospital, were treated with glucocorticoid, the treatment time were ≥ 2 months, the total amount ≥ 200 mg (equivalent dose of prednisone); treatment regimen, according to the patient’s eye condition Adjust the dose of prednisone, treatment of 6 to 10 months. At the same time, 24 hours urinary free cortisol (UFC) was measured in 11 patients in the high-dose treatment group and in 14 patients in the adjustment program group to observe adrenocortical function in patients with VKH syndrome. Results 51 patients were treated with high-dose regimen, and the inflammatory response was stable and relieved. The visual acuity of 94 1% was ≥ 0 5, the visual acuity of 79 4% ≥ 0 8, the recurrence rate of inflammation and the incidence of ocular complications were low; 2 4hUFC normal level. Eighty-five patients were treated with the adjusted regimen. Inflammation was relieved. Visual acuity of 58.8% was ≥0.5, and visual acuity of 42.9% was ≥0.8. The complication rate was 494%. The levels of 4UUFC increased from (5 35 ± 5 8) μg to (2 1 9 ± 7 2) μg (normal 2 0 ~ 78 μg / 2 4h). Conclusion The treatment of VKH syndrome patients with high-dose regimen was satisfactory. Can be used as a remedial measure