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要約 目的:Vogt-小柳-原田病(以下,原田病)では,メラノサイト抗原特異的T細胞が主に病態を形成すると想定されており,シクロスポリンによる同T細胞の活性化抑制が期待される。早期からの免疫抑制薬の併用が視力予後に有効であるとの報告があるが,ステロイドパルス療法直後からシクロスポリンを併用した場合における,① 早期の治療効果,② 寛解期の再発について十分に検討されていないため,今回の後ろ向き研究を実施した。
対象と方法:2014年10月以降に当院眼科を受診し,未治療の原田病と診断された患者25名において,ステロイド単独群11名(男性8名,女性3名:46.7±11.1歳),シクロスポリン併用群14名(男性5名,女性9名:46.8±11.9歳)に分類し,2年間の治療効果を比較検討した。
結果:併用群の治療開始1か月後のlogMAR視力改善値は,単独群よりも0.24良好であった。中心窩下脈絡膜厚の変化量は,治療開始前と比較しておおむね50〜200μm程度の範囲であり,観察期間のすべてにおいて有意な差はなかった。また再発率に差はなかったが,単独群は男性のみ,併用群は女性のみ再発し,再発時の中心窩下脈絡膜厚は単独群では増加する一方,併用群では必ずしも増加しなかった。
結論:シクロスポリンの効能に性差がある可能性,そして2群間の再発時の所見の特徴は異なる可能性がある。
Abstract Purpose:Cyclosporine is a calcineurin inhibitor that selectively inhibits intracellular signaling in T cells. Since melanocyte antigen-specific T cells are assumed to be the main pathological factor in Harada disease, cyclosporine is expected to suppress the activation of these T cells. Although it has been reported that early concomitant use of immunosuppressive drugs is effective in improving prognosis and visual acuity, we conducted this study because 1)the efficacy of early treatment and 2)relapse during remission have not been sufficiently investigated when cyclosporine is used immediately after steroid pulse therapy.
Subjects and methods:Twenty-five patients diagnosed with untreated Harada's disease who had visited our ophthalmology clinic since October 2014 were divided into the steroid only group(8 males, 3 females, mean age 46.7±11.1 years)and the cyclosporine combination group(5 males, 9 females, mean age 46.8±11.9 years). The treatment efficacy over 2 years was compared.
Results:The logMAR visual acuity improvement of the combination group was 0.24 greater than that of the monotherapy group after one month of treatment. The magnitude of change in the subcentral choroid was generally in the range of 50 to 200 μm compared to that before the start of treatment, and there were no significant differences during the observation period. There was no difference in the recurrence rate, but only males in the monotherapy group and only females in the combined therapy group had recurrence. Subfoveal choroidal thickening, at the time of recurrence, occurred in the monotherapy group, but not in the combined therapy group.
Conclusions:There are sex-related differences in the efficacy of cyclosporine, and the characteristics of the findings at recurrence between the two groups differed.
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