Vogt-小柳-原田病诊治分析  

Analysis of the diagnosis and treatment of Vogt-Koyanagi-Harada disease

作　　者：裴锦云 郑曰忠[1] 

机构地区：[1]天津市三潭医院眼科,300193 [2]天津市眼科医院,300020

出　　处：《中国实用眼科杂志》2015年第9期1013-1017,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的 通过分析Vogt-小柳-原田病（Vogt-Koyanagi-Harada disease,VKH）患者的临床特征、诊治效果和复发相关因素,旨在提高对VKH的诊治水平.方法 临床病例对照研究.自2006年1月至2014年6月,在天津市三潭医院及天津市眼科医院收治VKH患者96例（192只眼）,其中男52例,女44例;发病时平均年龄（38.4±11.7）岁.根据就诊时间和病程分为两组：（1）初发组：发病14 d内在本院首诊的初诊患者59例,给与口服泼尼松治疗,病情好转后递减.（2）转诊组：发病后在外院已治疗6个月以上患者37例,给与环孢素或硫唑嘌呤联合泼尼松治疗.分析两组患者的临床特征、视力预后和复发相关因素.结果 96例患者中,有头痛或耳鸣前驱症状者61例（63.5％,61/96）.初发组患者均主诉双眼视力骤降,初诊时双眼矫正视力分别为0.24±0.16和0.22±0.14,眼底表现为后极部视网膜水肿、视乳头水肿或渗出性视网膜脱离.经糖皮质激素治疗10～18个月后病情稳定,视力逐渐恢复,末次随诊矫正视力分别为0.79±0.22和0.78±0.21;停药6～12个月后有3例患者复发,未见盲或低视力患者.转诊组患者表现为反复发作的全葡萄膜炎症,首诊时双眼矫正视力分别为0.21±0.11和0.20±0.11,经系统治疗12～24个月后炎症得以控制,末次随诊矫正视力分别为0.32±0.26和0.30± 0.28.单眼盲（最佳矫正视力低于0.05）发生率为11.5％ （22/196）,双眼盲为3.1％ （6/196）.结论 及时确诊和合理治疗,可使VKH患者恢复良好视力和减少盲目发生率,误诊或延误治疗可造成病情反复发作和视力损害。Objective To improve the levels of treatment of Vogt-Koyanagi-Harada （VKH） disease, through analysis of the clinical characters, treatment outcomes and recurrent factors of the VKH patients.Methods From January 2006 to June 2014, 96 cases of VKH patients were collected continuously in our hospital.The male was 52 cases and were classified by the times of diagnosis： group A of 59 patients were initial diagnosis and the female was 44 cases.The average onset age was 38.4±11.7 years old.Two groups of patients were treated in our hospital after onset of disease less than two weeks, group B of 37 patients were transferred by other hospitals after onset of six months or more.All the patients in Group A were treated with oral prednisolone and withdrawal with recovery of the disease.The transferred patients were treated with oral corticosteroids and combined with other immunosuppressive agents （cyclosporine or azathioprine）.The clinical characters,treatment outcomes and the recurrent factors of two group patients were compared.Results All 96 cases of patients had both eyes involved.The prodromal symptoms included meningism, tinnitus vitiligo and poliosis were seen in 61 patients （63.5%, 61/96）.All the patients had sudden decreased vision on both eyes, the best corrected visual acuity （BCVA） at the first visit in Group A patients was 0.24±0.16 and 0.22±0.14 for right eyes and left eyes.The retinal edema, optic disc swelling or exudative retinal detachment was seen in most of patients.The disease was controlled and the visual acuity was improved after treatment with systemic corticosteroids for 10 to 18 months.The BCVA at last visit was 0.79±0.22 and 0.78±0.21 for right and left eye.After the follow-up for 6～12 months, 3 cases were recurrent.No patient had blind or low vision.The transferred patients were presented with recurrent panuveitis.The BCVA at the first visit was 0.21±0.11 and 0.20±0.11 for right eyes and left eyes.After the treatment for 12～24 months, the inflammation was controlled, t

关 键 词：葡萄膜炎 VOGT-小柳-原田病 诊断 治疗 

分 类 号：R742[医药卫生—神经病学与精神病学]