原田病の遷延例に関する統計的観察

Statistic evaluation of protracted cases of Vogt-Koyanagi-Harada disease

　1968年から1987年に原田病と診断し，治療を開始した86症例を，初発病変部位から，後極部剥離型，乳頭周囲浮腫型，前眼部病変型の各病型に分け，それぞれ遷延例を治癒例と比較検討した。遷延例は全症例の36.0％で，後極部剥離型に比べ乳頭周囲浮腫型で有意に多く認められた。患者は20,30歳代に最も多かったが，20歳代は遷延例が16.7％と低値であった。眼外症状は各病型とも遷延例の方が高頻度で，特に白髪，脱毛，皮膚白斑は有意に遷延例に多く認められた。夕焼け状眼底は，後極部剥離型，乳頭周囲浮腫型の遷延例の約90％，治癒例の約70％に出現し，全体で遷延例のほうが治癒例よりも有意に高頻度に出現した。ステロイド療法に関しては，後極部剥離型の遷延例12例中9例が10日以前に治療を開始し，600mg未満でも以上でも，遷延化率は余り変わらなかったことから，ステロイド大量療法については，病変の程度により再検討する必要があると思われる。

We evaluated a series of 86 new cases of Vogt-Koyanagi-Harada disease seen at Tokushima and Osaka Universities during the foregoing 20-year period. We classified the cases into three types according to the site of predominant initial lesion: posterior retinal detachment type, peripapillary edema type and anterior uveitis type. The disease followed a protracted course in 31 cases (36%). The incidence of protracted cases were significant-ly higher in peripapillary edema type than in poste-rior retinal detachment type. Extraocular symp-toms and diffuse fundus depigmentation in the late stage were more frequent in the protracted cases than in those with early cure.

Among posterior retinal detachment type with early cure, 60% of the cases received less than 600 mg of prednisolone during the first month. Among peripapillary type with protracted course, 78% of the cases received less than 600 mg of prednisolone. High-dose corticosteroid therapy appeared to be redundant in some cases of posterior retinal detach-ment type because of the inherent favorable prog-nosis.