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Article(id=1209139835365880764, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1209139833285505965, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2021.07.06, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1615392000000, receivedDateStr=2021-03-11, revisedDate=1621094400000, revisedDateStr=2021-05-16, acceptedDate=null, acceptedDateStr=null, onlineDate=1766211001482, onlineDateStr=2025-12-20, pubDate=1627401600000, pubDateStr=2021-07-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766211001482, onlineIssueDateStr=2025-12-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766211001482, creator=13701087609, updateTime=1766211001482, updator=13701087609, issue=Issue{id=1209139833285505965, tenantId=1146029695717560320, journalId=1189873630562394117, year='2021', volume='46', issue='7', pageStart='637', pageEnd='742', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766211000986, creator=13701087609, updateTime=1766212174313, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1209144754630168707, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1209139833285505965, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1209144754630168708, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1209139833285505965, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=673, endPage=677, ext={EN=ArticleExt(id=1209139835667870658, articleId=1209139835365880764, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Efficacy and safety of golimumab in the treatment of refractory non-infectious uveitis, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To explore the short-term efficacy and safety of golimumab (GLM) for treatment of refractory non-infectious uveitis. Methods Nonrandomized retrospective case series. Forty-six patients in Department of Ophthalmology Beijing Chaoyang Hospital from October 2018 to December 2019 with different types of uveitis that were resistant to treatment with previous immunosuppressors were included in this study. All the patients were treated with GLM (50 mg every four weeks) during at least 3 months. Clinical evaluation and treatment-related side effects were assessed in all included patients. Results At the end of follow up, ocular inflammation was controlled or relieved in 34 patients, the response rate was 73.91%.There was a statistically significant improvement in mean best corrected visual acuity (0.22 vs. 0.26, P=0.002). GLM therapy achieved complete control of inflammation in 9 patients (19.57%). GLM was continuously used in 17 patients (36.96%) without inflammation recurrence, including single GLM treatment in 14 patients, and combination with conventional immunosuppressors in 3 patients. The types of conventional immunosuppressors [M(Q1, Q3)] decreased from 2(2, 3) to 1(1, 2) (P<0.001) after GLM treatment. The dosage of prednisone decreased from 38 mg/d [(30, 45) mg/d] at baseline to 8 mg/d [(5, 15) mg/d](P<0.001). The systemic adverse effects associated with GLM therapy were observed in 4 patients, including bacterial pneumonia in 1 patient, anaphylactic reaction in 2 patients, and transaminase elevation in 1 patient. Conclusion GLM can effectively reduce the recurrence of non-infectious refractory uveitis, improve patients' vision, and reduce the combined use of glucocorticoid and immunosuppressors.

, correspAuthors=Yong Tao, authorNote=null, correspAuthorsNote=
*E-mail:
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目的 探讨戈利木单抗(GLM)治疗非感染性难治性葡萄膜炎的初步疗效。方法 回顾性分析2018年10月—2019年12月于首都医科大学附属北京朝阳医院眼科使用GLM治疗(50 mg/月，持续3个月)的46例非感染性难治性葡萄膜炎患者的临床资料，记录随访及预后情况，以及主要不良反应的发生情况。结果 46例非感染性难治性葡萄膜炎患者均对传统免疫抑制剂反应不佳。34例在GLM治疗后病情控制或缓解，总有效率为73.91%。86只受累眼治疗后视力logMAR值降低，与治疗前比较差异有统计学意义(0.22 vs. 0.26，P=0.002)。9例(19.57%)停药后至随访截止时无复发，17例(36.96%)在随访截止时仍维持用药，炎症无复发。维持GLM用药的患者中，13例单用GLM维持，4例仍需联合原有的免疫抑制剂治疗。联合用药的种类[M(Q1，Q3)]由治疗前的2(2，3)种减少为随访末期的1(1，2)种(P<0.001)；泼尼松维持用药量由治疗前的38(30，45) mg/d减量为治疗后的8(5，15) mg/d(P<0.001)。应用GLM后，发生细菌性肺炎1例，过敏反应2例，转氨酶升高1例。结论 GLM可有效减少非感染性难治性葡萄膜炎的复发次数，改善患者视力，减少激素和免疫抑制剂的联合使用种类及剂量。

, correspAuthors=陶勇, authorNote=null, correspAuthorsNote=
陶勇，E-mail：
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周强，医学博士，副主任医师，主要从事复杂性眼底病，葡萄膜炎的药物及手术治疗方面的研究

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周强，医学博士，副主任医师，主要从事复杂性眼底病，葡萄膜炎的药物及手术治疗方面的研究

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周强，医学博士，副主任医师，主要从事复杂性眼底病，葡萄膜炎的药物及手术治疗方面的研究

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GLM. 戈利木单抗；A. 视力；B. 用药种类；C. 泼尼松维持剂量；与治疗前比较，(1)P=0.002，(2)P<0.001。

, figureFileSmall=r8Zq+lqBDvxW090hqr1Mkg==, figureFileBig=0V/uaPay09lysmqcP+hfiA==, tableContent=null), ArticleFig(id=1209197925708731364, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139835365880764, language=EN, label=Tab.1, caption=

Efficacy of golimumab in treatment of patients with different disease types of refractory uveitis (n)

, figureFileSmall=null, figureFileBig=null, tableContent=
疾病类型有效无效
白塞病葡萄膜炎(n=16)133
幼年关节炎相关葡萄膜炎(n=8)71a
强直性脊柱炎相关葡萄膜炎(n=5)50
小柳原田综合征(n=2)20
特发性视网膜血管炎(n=2)11
交感性眼炎(n=1)01
可疑白塞病葡萄膜炎(n=3)03
非肉芽肿性葡萄膜炎(n=4)22
肉芽肿性葡萄膜炎(n=3)30
后巩膜炎(n=2)11a
合计(n=46)3412
), ArticleFig(id=1209197925780034533, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139835365880764, language=CN, label=表1, caption=

不同疾病类型难治性葡萄膜炎患者GLM治疗效果(例)

, figureFileSmall=null, figureFileBig=null, tableContent=
疾病类型有效无效
白塞病葡萄膜炎(n=16)133
幼年关节炎相关葡萄膜炎(n=8)71a
强直性脊柱炎相关葡萄膜炎(n=5)50
小柳原田综合征(n=2)20
特发性视网膜血管炎(n=2)11
交感性眼炎(n=1)01
可疑白塞病葡萄膜炎(n=3)03
非肉芽肿性葡萄膜炎(n=4)22
肉芽肿性葡萄膜炎(n=3)30
后巩膜炎(n=2)11a
合计(n=46)3412
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戈利木单抗治疗非感染性难治性葡萄膜炎的初步疗效
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周强 , 陶勇 *
解放军医学杂志 | 临床研究 2021,46(7): 673-677
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解放军医学杂志 | 临床研究 2021, 46(7): 673-677
戈利木单抗治疗非感染性难治性葡萄膜炎的初步疗效
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周强, 陶勇*
作者信息
  • 首都医科大学附属北京朝阳医院眼科，北京 100020

    • 周强，医学博士，副主任医师，主要从事复杂性眼底病，葡萄膜炎的药物及手术治疗方面的研究

通讯作者:

陶勇，E-mail：
Efficacy and safety of golimumab in the treatment of refractory non-infectious uveitis
Qiang Zhou, Yong Tao*
Affiliations
  • Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
出版时间: 2021-07-28 doi: 10.11855/j.issn.0577-7402.2021.07.06
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摘要
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目的 探讨戈利木单抗(GLM)治疗非感染性难治性葡萄膜炎的初步疗效。方法 回顾性分析2018年10月—2019年12月于首都医科大学附属北京朝阳医院眼科使用GLM治疗(50 mg/月，持续3个月)的46例非感染性难治性葡萄膜炎患者的临床资料，记录随访及预后情况，以及主要不良反应的发生情况。结果 46例非感染性难治性葡萄膜炎患者均对传统免疫抑制剂反应不佳。34例在GLM治疗后病情控制或缓解，总有效率为73.91%。86只受累眼治疗后视力logMAR值降低，与治疗前比较差异有统计学意义(0.22 vs. 0.26，P=0.002)。9例(19.57%)停药后至随访截止时无复发，17例(36.96%)在随访截止时仍维持用药，炎症无复发。维持GLM用药的患者中，13例单用GLM维持，4例仍需联合原有的免疫抑制剂治疗。联合用药的种类[M(Q1，Q3)]由治疗前的2(2，3)种减少为随访末期的1(1，2)种(P<0.001)；泼尼松维持用药量由治疗前的38(30，45) mg/d减量为治疗后的8(5，15) mg/d(P<0.001)。应用GLM后，发生细菌性肺炎1例，过敏反应2例，转氨酶升高1例。结论 GLM可有效减少非感染性难治性葡萄膜炎的复发次数，改善患者视力，减少激素和免疫抑制剂的联合使用种类及剂量。

葡萄膜炎  /  戈利木单抗  /  生物制剂  /  肿瘤坏死因子拮抗剂

Objective To explore the short-term efficacy and safety of golimumab (GLM) for treatment of refractory non-infectious uveitis. Methods Nonrandomized retrospective case series. Forty-six patients in Department of Ophthalmology Beijing Chaoyang Hospital from October 2018 to December 2019 with different types of uveitis that were resistant to treatment with previous immunosuppressors were included in this study. All the patients were treated with GLM (50 mg every four weeks) during at least 3 months. Clinical evaluation and treatment-related side effects were assessed in all included patients. Results At the end of follow up, ocular inflammation was controlled or relieved in 34 patients, the response rate was 73.91%.There was a statistically significant improvement in mean best corrected visual acuity (0.22 vs. 0.26, P=0.002). GLM therapy achieved complete control of inflammation in 9 patients (19.57%). GLM was continuously used in 17 patients (36.96%) without inflammation recurrence, including single GLM treatment in 14 patients, and combination with conventional immunosuppressors in 3 patients. The types of conventional immunosuppressors [M(Q1, Q3)] decreased from 2(2, 3) to 1(1, 2) (P<0.001) after GLM treatment. The dosage of prednisone decreased from 38 mg/d [(30, 45) mg/d] at baseline to 8 mg/d [(5, 15) mg/d](P<0.001). The systemic adverse effects associated with GLM therapy were observed in 4 patients, including bacterial pneumonia in 1 patient, anaphylactic reaction in 2 patients, and transaminase elevation in 1 patient. Conclusion GLM can effectively reduce the recurrence of non-infectious refractory uveitis, improve patients' vision, and reduce the combined use of glucocorticoid and immunosuppressors.

uveitis  /  golimumab  /  biological agents  /  anti-TNF drugs
周强, 陶勇. 戈利木单抗治疗非感染性难治性葡萄膜炎的初步疗效. 解放军医学杂志, 2021 , 46 (7) : 673 -677 . DOI: 10.11855/j.issn.0577-7402.2021.07.06
Qiang Zhou, Yong Tao. Efficacy and safety of golimumab in the treatment of refractory non-infectious uveitis[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (7) : 673 -677 . DOI: 10.11855/j.issn.0577-7402.2021.07.06
正文
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非感染性葡萄膜炎是一组免疫介导的眼病，及时有效的治疗对于视力预后至关重要。糖皮质激素和免疫抑制剂是目前主要的治疗手段[1-2]。但部分非感染性葡萄膜炎患者应用激素/传统免疫抑制剂治疗的疗效不佳(包括治疗失败或低剂量治疗时复发)，或存在激素/传统免疫抑制剂使用禁忌或不耐受，导致治疗困难[3]。2001年首次报道抗肿瘤坏死因子类药物治疗免疫介导的难治性非感染性葡萄膜炎效果明显[4]，2008年Cordero-Coma等[5]报道，戈利木单抗(golimumab，GLM)治疗非感染性葡萄膜炎有效，但国内未见相关报道。本研究回顾性分析在首都医科大学附属朝阳医院眼科接受GLM治疗的非感染性葡萄膜炎患者的临床资料，初步探讨其临床疗效。
1 资料与方法
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1.1 研究对象
收集2018年10月—2019年12月在首都医科大学附属朝阳医院眼科应用GLM治疗的难治性非感染性葡萄膜炎46例患者的临床资料。非感染性葡萄膜炎包括白塞病葡萄膜炎、幼年关节炎相关葡萄膜炎、强直性脊柱炎相关葡萄膜炎、Vogt-小柳原田综合征(VKH)、特发性视网膜血管炎、特发性葡萄膜炎等。诊断标准依据葡萄膜炎分类标准。所有患者在接受GLM治疗之前均接受过常规糖皮质激素和(或)免疫抑制剂的全身和局部治疗，若存在以下情况，则为难治性非感染性葡萄膜炎：(1)患者在全身使用糖皮质激素3个月后，在口服泼尼松15 mg/d及以下剂量时，无法控制眼部炎症；(2)患者有强烈意愿拒绝继续使用全身/局部糖皮质激素，希望进行替代；(3)患者希望减少葡萄膜炎复发，减少全身/局部使用糖皮质激素的并发症，减少反复就医次数。所有患者除眼部受累外，均不伴有其他重要器官如胃肠道、心血管或神经系统活动性受累，均除外肿瘤及全身性传染病，包括乙型肝炎或丙型肝炎、梅毒、艾滋病等；行T淋巴细胞干扰素释放试验及X线胸片检查，排除活动性结核。本研究获首都医科大学附属北京朝阳医院伦理委员会批准。
1.2 治疗及随访
患者改用GLM治疗后，每4周皮下注射GLM 50 mg 1次，至少维持3次以上连续治疗。所有患者对药物使用的必要性及可能的不良反应知情同意。所有患者治疗启动后每月常规检查血常规、尿常规及肝肾功能，并定期进行眼科门诊随访。随访在起始3个月内至少每月1次，随后依据病情逐渐延长随访时间，随访截止日期为2020年9月。治疗后随访时间最短不小于9个月。眼科相关检查(最佳矫正视力、眼压、眼前节及眼底检查)的评判均由北京朝阳医院眼科一位资深医师完成，如有疑问，则由另一位上级医师复核判断(后期因疫情原因，外地患者均在当地三级医院眼科进行复诊完成基本眼科检查和全身化验，并电话联系记录病情变化)。
1.3 观察指标
主要观察指标为患者视力改善程度和病情控制情况，次要观察指标为激素和免疫抑制剂的节约效应以及GLM的不良反应。
1.4 相关定义
本研究依据患者眼内炎症控制情况以及对具体药物的使用情况进行归类分组以便于对药物的使用分析。(1)维持：持续用药，眼内炎症未复发；(2)稳定：停药至少3个月眼内炎症未复发；(3)趋于稳定：用药期间控制，停药后眼内炎症复发但程度轻，仅局部用药控制；(4)有效换药：用药期间控制，因停药后眼内炎症复发，或经济/身体等原因，改用其他药物控制；(5)无效换药：用药期间眼内炎症加重或仍复发，改其他药物控制。其中，维持、稳定、趋于稳定、有效换药定义为治疗有效，无效换药定义为治疗无效。
1.5 统计学处理
采用 SPSS 17.0 软件进行统计分析。正态分布的计量资料采用$\bar{x}±s$表示，非正态分布的计量资料采用M(Q1，Q3)表示；计数资料以例(%)表示。将标准对数视力转换为logMAR视力(考虑到双眼患者大多两眼先后发病，且两眼存在病情严重程度的差异，本研究纳入所有患眼)。治疗前后视力和泼尼松剂量的比较采用重复测量资料的方差分析，治疗前后用药种类对比采用单因素方差分析。P<0.05为差异有统计学意义。
2 结果
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2.1 一般资料
46例患者年龄(27.8±14.8)岁，其中男22例，占47.8%。46例中双眼受累者共40例，包括白塞病葡萄膜炎13例，幼年关节炎相关葡萄膜炎8例，强直性脊柱炎相关葡萄膜炎4例。受累眼共计86眼。
2.2 既往治疗
应用GLM之前，33例(71.7%)长期使用中等以上糖皮质激素为主的多种免疫抑制剂(环孢素/吗替麦考酚酯/氨甲蝶呤/他克莫司/沙利度胺)治疗，葡萄膜炎反复发作。每天糖皮质激素最低维持用量：16例(48.5%)采用泼尼松20~30 mg/d，17例(51.5%)采用泼尼松>30 mg/d。13例(28.3%)应用1种或1种以上非糖皮质激素类免疫抑制剂治疗，29例(63.0%)联合应用两种以上免疫抑制剂，2例(4.3%)应用英夫利西单抗，1例(2.2%)应用阿达木单抗，疗程3~5个月，疗效均不佳。
2.3 GLM治疗及随访结果
接受GLM治疗后，34例病情控制或缓解，总有效率73.9%(34/46，表1)。86只受累眼经GLM治疗后logMAR值降低，与治疗前比较差异有统计学意义(0.22 vs. 0.26，P=0.002，图1A)。应用GLM治疗后，患者联合用药种类明显减少，由治疗前的2(2，3)种减少为1(1，2)种，差异有统计学意义(P<0.001，图1B)。泼尼松维持用药量由治疗前的38(30，45) mg/d降低至治疗后的8(5，15) mg/d，差异有统计学意义(P<0.001，图1C)。截至2020年9月，46例均完成最后一次临床/电话随访，其中11例完全停药，4例在治疗期间仍需联合原有免疫抑制剂治疗以控制病情。
2.3.1 维持患者
17例(37.0%)在随访截止时仍维持用药，炎症无复发，其中13例(28.3%)单独使用GLM维持用药，炎症无复发，占维持用药患者总数的76.5%。4例(8.7%)在治疗期间仍需联合原有的免疫抑制剂治疗以控制病情，但服用剂量均降低到最低耐受程度。
2.3.2 稳定患者
9例(19.6%)停药后随访期间无复发，用药次数为7(6，9)次，停药后随访时间为8(6，12)个月。
2.3.3 趋于稳定患者
2例(4.4%)停药后趋于稳定，偶有复发但程度较轻，经局部用药后缓解，未再进行全身免疫抑制剂或GLM治疗。
2.3.4 有效换药患者
6例(13.0%)初始治疗有效，但因各种原因非计划停药。其中2例患者用药期间无复发，但因经济原因改换其他免疫抑制剂维持治疗。3例患者用药期间仍有复发，但频次和程度均较用药前改善，局部用药不能控制，外地就诊改用中药或阿达木单抗维持治疗。1例患者5次治疗期间无复发，停药2个月后病情复发，外地就诊改用阿达木单抗维持治疗。
2.3.5 无效换药患者
12例(26.1%)考虑治疗无效。其中10例(21.7%)在用药5(3，8)个月的过程中，原发病仍频繁发作未控制，改用其他免疫抑制剂或联合中药治疗。2例(4.4%)因首次治疗时发生严重不良反应停药，亦归入无效患者。
2.4 不良反应
1例幼年关节炎相关葡萄膜炎患者在注射第1针后1周发生细菌性肺炎，经抗感染治疗后好转并停药，疗效分组为无效。1例双眼弥漫性巩膜炎患者在注射第1针后出现皮肤过敏症状，经抗过敏治疗后好转并停药，疗效分组为无效。1例幼年关节炎相关葡萄膜炎患者在使用GLM维持治疗12次后转氨酶明显升高，停药后恢复正常，改小剂量糖皮质激素联合环孢素维持，疗效分组为有效。1例幼年关节炎相关葡萄膜炎患者在使用GLM 5次后出现皮疹伴瘙痒，经抗过敏治疗后消退，推迟GLM用药2周，重新启用后未再出现不良反应，疗效分组为有效。
3 讨论
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非感染性葡萄膜炎多伴随严重的眼部并发症，包括黄斑水肿、周边网膜增殖膜、白内障及高眼压等，导致视力严重受损，治疗更加困难[6]。糖皮质激素是治疗的主要手段之一，但患者可能因长时间高剂量应用糖皮质激素而发生全身不良反应，部分患者因对激素不敏感而选择使用其他免疫抑制剂。
研究显示，抗肿瘤坏死因子类药物可用于治疗免疫介导的难治性葡萄膜炎[4]。2018年中国台湾专家共识中也推荐对于难治性非感染性葡萄膜炎患者使用阿达木单抗等抗肿瘤坏死因子类药物[7]。尽管英夫利西单抗和阿达木单抗已被认为是治疗免疫介导的葡萄膜炎的一线或二线免疫调控剂[8-9]，但仍有25%~60%的患者对这两种药物无反应或出现不良反应[10-11]。2009年，美国FDA批准GLM与氨甲蝶呤(MTX)联合使用治疗中度及重度活动期类风湿关节炎，以及活动性银屑病关节炎或活动性强直性脊柱炎[12]。也有其他报道显示，GLM治疗葡萄膜炎有效[5,13-14]，尤其是风湿病相关葡萄膜炎[15-16]。
肿瘤坏死因子-α(TNF-α)被认为是免疫介导的葡萄膜炎病理过程中的主要炎性因子[17]。TNF-α可促进白细胞浸润、树突细胞成熟和巨噬细胞激活并驱动辅助性T淋巴细胞的反应，在启动和维持炎症过程中起到关键作用[18]。与传统的免疫抑制剂比较，抗肿瘤坏死因子类药物具有一些潜在优势，如对于顽固病例具有显著疗效[19]、较低的免疫抑制负荷[20]、快速起效的临床效果[21]、使用相对安全[8]、可改善生活质量等[22]。尽管抗肿瘤坏死因子类药物治疗非感染性葡萄膜炎有效，但也有研究提示其可能会诱导新的葡萄膜炎发作，主要考虑与药物的免疫原性有关[23]。GLM是兼具阿达木单抗和英夫利西单抗特性的一种全人免疫球蛋白IgG1的单克隆抗体，与其他TNF-α抑制剂相比，其免疫原性更低，人体耐受性更高[24]。
本研究是国内首次探讨GLM对于难治性葡萄膜炎疗效的小规模研究，结果显示总有效率为73.9%，并发现GLM可有效控制难治性非感染性葡萄膜炎的炎症反应，改善患者视力，避免或减少其他免疫抑制剂的使用或依赖，从而减少免疫抑制剂的不良反应。
既往研究表明，GLM的不良反应主要包括感染(尤其是结核病)、过敏反应及自身抗体的出现等。本研究46例中，有4例出现不良反应，包括1例细菌性肺炎、1例肝功能异常、2例皮肤过敏反应，以上均为可逆性变化，经积极治疗后控制。4例中，仅有2例因急性不良反应(肺炎、过敏)而直接换药无法评估药效，另外2例均显示对GLM治疗有效。4例中，3例为幼年关节炎相关葡萄膜炎患者，年龄均小于16岁，不排除为儿童免疫系统与成人免疫系统存在差异所致。本研究所有患者均未出现抗核抗体阳性。总体而言，GLM具有良好的耐受性。
本研究的不足之处在于为回顾性分析，缺乏对照组，且因疫情影响，房水闪辉、中央黄斑厚度的资料后期收集不完整。尽管本研究结果显示不同疾病亚组GLM治疗的有效率不同，但由于各疾病亚组纳入患者数有限，纳入最多的白塞病葡萄膜炎组仅16例患者，其他疾病亚组患者数量均小于10例，所以，尚不能判定GLM对各亚组疾病的疗效区别。
综上所述，对于激素联合多种免疫抑制剂治疗无效的难治性非感染性葡萄膜炎患者，可以尽早规范联合应用GLM，以减少葡萄膜炎的反复发作，降低视力损害等眼部并发症的风险，同时应当密切监测感染、肝功能等全身指标，以降低GLM的全身不良反应。GLM治疗难治性葡萄膜炎的短期效果显示有效、可耐受。但由于难治性非感染性葡萄膜炎病因复杂，全身使用各种药物仍然存在交互因素，可能干扰最终疗效的观察，因此该结果仍需未来的前瞻性大样本对照研究加以明确。
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  • 国家自然科学基金面上项目(82070948)
  • 北京市教育委员会科研计划资助项目(KM202010025020)
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2021年第46卷第7期
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doi: 10.11855/j.issn.0577-7402.2021.07.06
  • 接收时间：2021-03-11
  • 首发时间：2025-12-20
  • 出版时间：2021-07-28
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  • 收稿日期：2021-03-11
  • 修回日期：2021-05-16
基金
National Natural Science Foundation of China(82070948)
国家自然科学基金面上项目(82070948)
Scientific Research Program of Beijing Municipal Commission of Education(KM202010025020)
北京市教育委员会科研计划资助项目(KM202010025020)
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    首都医科大学附属北京朝阳医院眼科，北京 100020

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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