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) vs 25.9 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。
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]
