儿童Vogt-小柳-原田综合征临床特征分析  

Clinical characteristics of Vogt-Koyanagi-Harada syndrome in children

作　　者：胡亭 彭晓燕[2] 黄志 王红[2] 刘敬花[2] 麻婧[2] Hu Ting;Peng Xiaoyan;Huang Zhi;Wang Hong;Liu Jinghua;Ma Jing(Department of Ophthalmology,Beijing Yanqing District Hospital(Peking University Third Hospital Yanqing Hospital),Beijing 102100,China;Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology&Visual Sciences,Beijing 100730,China;Beijing MEM Eye Hospital,Beijing 100036,China)

机构地区：[1]北京市延庆区医院(北京大学第三医院延庆医院)眼科,北京102100 [2]首都医科大学附属北京同仁医院、北京同仁眼科中心、眼科学与视觉科学北京市重点实验室,北京100730 [3]北京美尔目眼科医院,北京100036

出　　处：《眼科》2024年第5期350-355,共6页Ophthalmology in China

摘　　要：目的分析儿童Vogt-小柳-原田(VKH)综合征的临床特征。设计回顾性病例系列。研究对象9例(18眼)儿童VKH综合征患者。方法回顾患者的病历资料。主要指标症状、体征及治疗结果。结果9例患者平均年龄(10.8±2.4)岁,平均随访(8.1±6.1)个月。7例(77.8%)发病前有前驱症状,其中感冒样症状3例(42.8.%),头痛耳鸣者2例(28.6%),仅头痛2例(28.6%)。2例合并有关节症状及反复发作口腔溃疡。3例合并结核分枝杆菌感染。1例发生于麻疹疫苗接种后。所有患者均口服糖皮质激素治疗,2例联合阿达木单抗(ADA)治疗,其中1例为早期联合使用,另1例是治疗5个月后炎症控制不佳再联合应用。末次随访时14眼(77.8%)视力≥0.6;4眼(22.2%)<0.3,主要为全身用糖皮质激素治疗距症状出现>30天者,其中2眼炎症反复发作,1眼因玻璃体混浊、全周视网膜脱离伴广泛视网膜下增殖行玻璃体切除术。9例患者中,3例未发生并发症,其中1例为早期联合应用ADA者。结论感染及疫苗接种可能是儿童VKH综合征的发病诱因,治疗前要重视结核感染的排查,糖皮质激素联合ADA治疗可改善治疗效果。Objective To analyze the clinical features of Vogt-Koyanagi-Harada(VKH)syndrome in children.Design Retrospective case series.Participants 9 children(18 eyes)with VKH syndrome.Methods The medical records data were analyzed retrospectively.Main Outcome Measures symptoms,signs,and treatment effects.Results The mean age of onset was(10.8±2.4)years in 9 patients.The average follow-up was(8.1±6.1)months.7 cases(77.8%)had prodromal symptoms before the onset of the disease,including 3 cases(42.8%)of cold-like symptoms,2 cases(28.6%)of tinnitus headache,and 2 cases(28.6%)of headache.2 cases were combined with joint symptoms and recurrent oral ulcers.3 cases were infected with mycobacterium tuberculosis.One case occurred after measles vaccination.Two cases were treated with adalimumab(ADA),one of which was used in the early stage,and the other was used after 5 months of treatment because of the abnormal choroidal thickness.At the end of follow-up,the uncorrected visual acuity of 14 eyes(77.8%)was≥0.6 and 4 eyes(22.22%)<0.3,mainly in children whose symptoms appeared more than 30 days after the first systemic corticosteroid treatment.Of the 9 patients,3 had no complications,and one of them was observed in the early combination treatment with ADA.Conclusion Infection and vaccination may be the inducing factors of VKH syndrome in children.Attention should be paid to the screening of tuberculosis infection before treatment,and the combination of ADA can improve the treatment response.

关 键 词：VOGT-小柳-原田综合征 儿童 

分 类 号：R773.9[医药卫生—眼科]