脉冲式与半脉冲式类固醇疗法治疗Vogt-小柳-原田病的疗效与安全性比较研究

Comparative study of efficacy and safety of pulse versus half-pulse steroid therapy for Vogt-Koyanagi-Harada Disease.

作者信息

Tsubota Kinya, Goto Hiroshi, Asakage Masaki, Kinoshita Yuto, Nonaka Ryota, Wakatsuki Kei, Sugawara Risa, Fukai Ryosuke, Usui Yoshihiko

机构信息

Department of Ophthalmology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.

出版信息

Jpn J Ophthalmol. 2025 May 26. doi: 10.1007/s10384-025-01213-3.

DOI:10.1007/s10384-025-01213-3

PMID:40418489

Abstract

PURPOSE

High-dose steroid therapy is commonly used for Vogt-Koyanagi-Harada (VKH) disease in Japan, but the optimal initial dose remains uncertain. This study investigated the efficacy and safety of conventional steroid pulse therapy (pulse group) and half-dose steroid pulse therapy (half-pulse group) for the initial treatment of VKH disease.

STUDY DESIGN

This was a single-center, retrospective observational study based on a review of medical records.

SUBJECTS AND METHODS

Seventy-two patients with initial-onset VKH disease treated at Tokyo Medical University Hospital were analyzed. The pulse group (44 patients) received 1000 mg/day of intravenous methylprednisolone (MPSL), while the half-pulse group (28 patients) received 500 mg/day of MPSL. In both groups, steroids were tapered according to ocular findings, and the minimum follow-up period was eight months.

RESULTS

Recurrence rate during follow-up period (pulse group: 41%, half-pulse group: 34%, p = 0.48), mean number of recurrences (pulse group: 1.9 ± 1.2, half-pulse group: 1.5 ± 0.9, p = 0.42), and type of recurrence (anterior uveitis: pulse group: 11%, half-pulse group: 17%, p = 0.33; posterior inflammation: pulse group: 34%, half-pulse group: 22%, p = 0.14) were not significantly different between the two groups. The proportion of patients requiring cataract surgery during the follow-up period tended to be higher in the pulse group (pulse group: 10%, half-pulse group: 3%, p = 0.12), although not significantly different. The incidence of sunset glow fundus was not significantly different between the two groups (pulse group: 23%, half-pulse group: 10%, p = 0.22).

CONCLUSIONS

No significant difference in clinical efficacy for VKH disease was observed between conventional steroid pulse therapy and half-pulse therapy, and by reducing the total steroid dose, half-pulse therapy potentially lowers the risk of adverse effects related corticosteroid.

摘要

目的

在日本，高剂量类固醇疗法常用于治疗葡萄膜大脑炎（VKH），但最佳初始剂量仍不确定。本研究调查了传统类固醇脉冲疗法（脉冲组）和半剂量类固醇脉冲疗法（半脉冲组）对VKH疾病初始治疗的疗效和安全性。

研究设计

这是一项基于病历回顾的单中心回顾性观察研究。

对象与方法

分析了东京医科大学医院收治的72例初发性VKH疾病患者。脉冲组（44例患者）接受每日1000毫克静脉注射甲基泼尼松龙（MPSL），而半脉冲组（28例患者）接受每日500毫克MPSL。两组均根据眼部情况逐渐减少类固醇剂量，最短随访期为8个月。

结果

随访期间的复发率（脉冲组：41%，半脉冲组：34%，p = 0.48）、平均复发次数（脉冲组：1.9±1.2，半脉冲组：1.5±0.9，p = 0.42）以及复发类型（前葡萄膜炎：脉冲组：11%，半脉冲组：17%，p = 0.33；后部炎症：脉冲组：34%，半脉冲组：22%，p = 0.14）在两组之间无显著差异。随访期间需要进行白内障手术的患者比例在脉冲组中倾向于更高（脉冲组：10%，半脉冲组：3%，p = 0.12），尽管差异不显著。两组落日征眼底的发生率无显著差异（脉冲组：23%，半脉冲组：10%，p = 0.22）。