CAJ | 학술논문

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.
목적 통과분석Vogt-소류-원전병(Vogt-Koyanagi-Harada disease,VKH)환자적림상특정、진치효과화복발상관인소,지재제고대VKH적진치수평.방법 림상병례대조연구.자2006년1월지2014년6월,재천진시삼담의원급천진시안과의원수치VKH환자96례(192지안),기중남52례,녀44례;발병시평균년령(38.4±11.7)세.근거취진시간화병정분위량조:(1)초발조:발병14 d내재본원수진적초진환자59례,급여구복발니송치료,병정호전후체감.(2)전진조:발병후재외원이치료6개월이상환자37례,급여배포소혹류서표령연합발니송치료.분석량조환자적림상특정、시력예후화복발상관인소.결과 96례환자중,유두통혹이명전구증상자61례(63.5％,61/96).초발조환자균주소쌍안시력취강,초진시쌍안교정시력분별위0.24±0.16화0.22±0.14,안저표현위후겁부시망막수종、시유두수종혹삼출성시망막탈리.경당피질격소치료10～18개월후병정은정,시력축점회복,말차수진교정시력분별위0.79±0.22화0.78±0.21;정약6～12개월후유3례환자복발,미견맹혹저시력환자.전진조환자표현위반복발작적전포도막염증,수진시쌍안교정시력분별위0.21±0.11화0.20±0.11,경계통치료12～24개월후염증득이공제,말차수진교정시력분별위0.32±0.26화0.30± 0.28.단안맹(최가교정시력저우0.05)발생솔위11.5％ (22/196),쌍안맹위3.1％ (6/196).결론 급시학진화합리치료,가사VKH환자회복량호시력화감소맹목발생솔,오진혹연오치료가조성병정반복발작화시력손해.
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, the BCVA at the last visit was 0.32±0.26 and 0.30±0.28 for right and left eyes.The blindness (BCVA less than 0.05) rate for one eye was 11.5％ (22/196), and the blind rate for both eyes was 3.1％ (6/ 196).Conclusions The better visual outcomes would be achieved and the blindness or visual damage would be prevented in most VKH patients with early diagnosis and proper treatment with high-dose corticosteroids.The incorrect diagnosis and delayed treatment were associated with recurrence and visual damage.