目的：評(píng)估靜脈大劑量甲級(jí)強(qiáng)的松龍沖擊治療白塞眼病的療效。
方法：這是一個(gè)雙盲對(duì)照試驗(yàn),，我們隨機(jī)把有后色素膜炎和/視網(wǎng)膜血管炎的白塞病患者分為兩組,。他們或者接受靜脈甲級(jí)強(qiáng)的松龍沖擊治療(1000 mg 甲強(qiáng)龍)或者空白藥物連續(xù)3天,。兩組均接受靜脈環(huán)磷酰胺、硫唑嘌呤和潑尼松龍聯(lián)合治療6個(gè)月,。計(jì)算每一個(gè)患者的視敏度,、基于每只眼睛每一段的炎癥狀態(tài)的病情活動(dòng)性評(píng)分(DAI) 、總炎癥活動(dòng)性評(píng)分 (TIAI) 和調(diào)整后的病情活動(dòng)性評(píng)分,。用配對(duì)t檢驗(yàn)和Mann-Whitney U檢驗(yàn)來(lái)進(jìn)行統(tǒng)計(jì)分析,。
結(jié)果：每組各17名患者完成了試驗(yàn)。試驗(yàn)組平均視敏度從0.5增加到0.8(P < 0.000001),，空白對(duì)照組視敏度從0.6增加到0.7(P < 0.02) ,，兩組間有顯著統(tǒng)計(jì)學(xué)差異(P = 0.01)。兩組病情活動(dòng)性評(píng)分的改善無(wú)顯著差異(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); 視網(wǎng)膜血管炎:4.0 降到1.1 (P < 0.0004) vs 3.1降到1.1(P < 0.0005); 總炎癥活動(dòng)性評(píng)分:23 降到5.7(P < 0.0002) vs 24.8降到8.4 (P < 0.003); 調(diào)整后的總病情活動(dòng)性評(píng)分:24.1降到7.3 (P < 0.0002) vs 25.9 降到7.9 (P < 0.004),。試驗(yàn)組1例復(fù)發(fā),，對(duì)照組7例 (P < 0.005)。
結(jié)論：對(duì)嚴(yán)重白塞眼病來(lái)說(shuō),，在常規(guī)聯(lián)合治療基礎(chǔ)上增加大劑量激素沖擊治療,，可能治療6月之內(nèi)視力改善更好，復(fù)發(fā)更少,。
附原文：
AbstractAIM:To evaluate the efficacy ofintravenous high-dose pulses of methylprednisolone (IVPM) for treatment ofocular involvement in Behcet's disease (BD).METHOD:In adouble-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 groupsreceived combination therapy with IV cyclophosphamide, azathioprine andprednisolone 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. Thecomparisons were done by paired t- and Mann-Whitney U-test.RESULTS:Seventeenpatients in each group completed the treatment. The mean VA improved from 0.5to 0.8 (P < 0.000001) for the study and from 0.6 to 0.7 (P < 0.02) forthe placebo group. The difference was significant (P = 0.01). The comparisonshowed 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 to5.7 (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 studyversus seven in the placebo group (P < 0.005).
CONCLUSION:Adding high-doseintravenous steroid pulse therapy to conventional combination therapy forsevere ocular lesions of BD may cause better improvement on VA and fewer flaresduring the first 6 months of treatment.
引自：
Mohammadi M, Shahram F, Shams H, Akhlaghi M, Ashofteh F, Davatchi F.High-doseintravenous steroid pulse therapy in ocular involvementofBehcet'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]
