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大剂量静脉激素冲击治疗白塞眼病

作者：Mohammadi M 译者：姚中强来源：中国风湿病公众论坛日期：2017-07-03

导读

大剂量静脉激素冲击治疗对白塞眼病视力改善更好复发更少

关键字：白塞眼病

目的：评估静脉大剂量甲级强的松龙冲击治疗白塞眼病的疗效。

方法：这是一个双盲对照试验，我们随机把有后色素膜炎和/视网膜血管炎的白塞病患者分为两组。他们或者接受静脉甲级强的松龙冲击治疗(1000 mg 甲强龙)或者空白药物连续3天。两组均接受静脉环磷酰胺、硫唑嘌呤和泼尼松龙联合治疗6个月。计算每一个患者的视敏度、基于每只眼睛每一段的炎症状态的病情活动性评分(DAI) 、总炎症活动性评分 (TIAI) 和调整后的病情活动性评分。用配对t检验和Mann-Whitney U检验来进行统计分析。

结果：每组各17名患者完成了试验。试验组平均视敏度从0.5增加到0.8 (P < 0.000001)，空白对照组视敏度从0.6增加到0.7 (P < 0.02) ，两组间有显著统计学差异 (P = 0.01)。两组病情活动性评分的改善无显著差异 (P > 0.2): 后色素膜炎：1.9 降低到 0.5 (P < 0.0006) vs 2.3 降到0.8 (P < 0.0002); 视网膜血管炎: 4.0 降到 1.1 (P < 0.0004) vs 3.1降到1.1 (P < 0.0005); 总炎症活动性评分: 23 降到5.7 (P < 0.0002) vs 24.8降到 8.4 (P < 0.003); 调整后的总病情活动性评分: 24.1降到 7.3 (P < 0.0002) vs25.9 降到 7.9 (P < 0.004)。试验组1例复发，对照组7例 (P < 0.005)。

结论：对严重白塞眼病来说，在常规联合治疗基础上增加大剂量激素冲击治疗，可能治疗6月之内视力改善更好，复发更少。

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附原文：

AIM: To evaluate the efficacy of intravenous high-dose pulses of methylprednisolone (IVPM) for treatment of ocular involvement in Behcet's disease (BD).

METHODS:In a double-blind control study, we randomized BD patients with posterior uveitis (PU) and/or retinal vasculitis (RV) into two groups. They received either IVPM (1000 mg methylprednisolone) or placebo for 3 consecutive days. Both groups received combination therapy with IV cyclophosphamide, azathioprine and prednisolone for 6 months. Visual acuity (VA), DiseaseActivity Index (DAI) based on the inflammatory state of each section of each eye, total inflammatory (TIAI) and adjusted DAI (TADAI) for each patient were calculated. The comparisons were done by paired t- and Mann-Whitney U-test.

RESULTS:Seventeen patients in each group completed the treatment. The mean VA improved from 0.5 to 0.8 (P < 0.000001) for the study and from 0.6 to 0.7 (P < 0.02) for the placebo group. The difference was significant (P = 0.01). The comparison showed no significant difference regarding DAI improvement in other items (P > 0.2): PU, 1.9 to 0.5 (P < 0.0006) versus 2.3 to 0.8 (P < 0.0002); RV: 4.0 to 1.1 (P < 0.0004) versus 3.1 to 1.1 (P < 0.0005); TIAI: 23 to 5.7 (P < 0.0002) versus 24.8 to 8.4 (P < 0.003); TADAI: 24.1 to 7.3 (P < 0.0002) versus 25.9 to 7.9 (P < 0.004). We had one flare in the study versus seven in the placebo group (P < 0.005).

CONCLUSION:Adding high-dose intravenous steroid pulse therapy to conventional combination therapy for severe ocular lesions of BD may cause better improvement on VA and fewer flares during the first 6 months of treatment.

引自：Mohammadi M, Shahram F, Shams H, Akhlaghi M, Ashofteh F, Davatchi F.High-dose intravenous steroid pulse therapy in ocular involvement ofBehcet's disease: a pilot double-blind control study.Int J Rheum Dis. 2017 May 19. doi: 10.1111/1756-185X.13095. [Epub ahead of print]