糖皮质激素在艾滋病免疫重建炎性综合征中的应用分析

目的探讨分析糖皮质激素在艾滋病（AIDS）免疫重建炎性综合征（IRIS）中的应用价值。方法回顾性分析AIDS高效抗逆转录病毒治疗（HAART）过程中发生IRIS而使用糖皮质激素治疗的19例患者的临床资料。结果 IRIS并发肺结核10例、结核性胸膜炎4例、颈淋巴结结核2例、结核性脑膜炎1例、隐球菌脑膜炎2例。表现为持续发热19例（100%）,头痛呕吐3例（15.8%）。使用激素治疗前均给予非甾体类抗炎药物对症处理无效,经糖皮质激素治疗后好转。结论糖皮质激素可改善IRIS并发结核病、隐球菌脑膜炎的临床症状,提高患者治疗的依从性。     

The development of bone microstructure,metabolism and biomechanics in lumbar vertebra under short-term glucocorticoid exposure

Abstracts

Objective: This study investigated the characteristics of bone microstructure, metabolism, and biomechanics in rat’s lumbar vertebra undergoing short-term glucocorticoid administration.

Methods: Forty 4-month-old female Sprague–Dawley rats were treated with either vehicle (Cont) or prednisone acetate (Pre) at 3.5?mg/kg/day, respectively for periods of 7 days and 21 days. The lumbar vertebras were processed for MicroCT scan, histomorphometry analysis, mechanical compression test, in addition to Dual-Energy X-ray absorptiometry scan, respectively.

Results: The connective density (Conn. D) along with trabecular connection nodes decreased while trabecular termini increased in Pre at day 21 when compared to Cont at day 21 as well as Pre at day 0. The mineralizing surface (MS/BS), mineral apposition rate (MAR), bone formation rate (BFR), osteoblast surfaces (Ob.S/BS) were lower in Pre at day 21 than that in Cont at day 21, Pre at day 0 and Pre at day 7. Only the bending stiffness of compression test decreased in Pre group at day 21 compared to age-matched control.

Conclusion: The results suggested that excess prednisone significantly inhibited bone formation and slightly depressed bone resorption in the lumbar vertebra of intact rats for the duration of 21 days. Accordingly, the trabecular spatial microstructure made an adjustment yet failed to maintain the anti-compression mechanical property.     

Effects of glucocorticoid receptor antagonist on CAPs threshold shift due to short-term sound exposure in guinea pigs

OBJECTIVE: The steroid drugs are used for the standard treatment of sudden sensorineural hearing loss. However, clinical results on the effect of glucocorticoids in acoustic trauma have not yet been understood well. The effects of glucocorticoid receptor (GR) antagonist, mifepristone, on the cochlea sensitivity loss due to short-term sound exposure were studied in the guinea pig. METHODS: Mifepristone (20 mg/kg) was injected subcutaneously immediately after the noise exposure to 4 kHz pure tone of 100 or 120 dB SPL for 10 min and also at 1 day and 3 days later. Seven days after the sound exposure, the compound action potentials (CAPs) of the cochlear nerve and the 2f(1)-f(2) distortion product oto-acoustic emissions (DPOAEs) were recorded. RESULTS: No significant CAP threshold losses were observed in either mifepristone or saline administration after the exposure at 100 dB SPL. After the exposure at 120 dB SPL, administration of mifepristone elevated the CAP threshold at 5-8 kHz significantly as compared with the saline administration. The DPOAE output shifts of both saline and mifepristone groups were similar to each other. CONCLUSION: Mifepristone may influence inner hair cells (IHCs) and afferent nerve fibers beneath the IHC without having influence on outer hair cells (OHCs). It is suggested that glucocorticoid plays an important role in the improvement of hearing impairment after loud sound exposure.     

Evans综合征12例临床分析

目的分析Evans综合征的临床表现及治疗经验。方法回顾性分析12例Evans综合征患者的临床资料。结果12例Evans综合征患者中8例为原发性,起始用激素治疗有效率75％（6例）,其中4例复发,加用免疫抑制剂后有效,其他2例单用激素治疗无效的病例联合免疫抑制剂缓解。3例是继发于系统性红斑狼疮,用甲强龙冲击联合免疫抑制治疗均有效,1例继发于B细胞淋巴瘤,用化疗有效。结论Evans综合征要警惕淋巴肿瘤的可能性．在治疗上加用免疫抑制剂是必要的。     

亚急性甲状腺炎临床分析

目的探讨亚急性甲状腺炎的临床表现及治疗方法.方法回顾性分析我院50例亚急性状腺炎患者的临床资料.结果50例亚急性甲状腺炎患者中,以30—50岁女性多见,占88%;临床症状主要为颈部不适及甲状腺局部的疼痛及触痛(90%);50例血沉均明显升高,45例血清游离三碘甲腺原氨酸(FT3)、血清游离甲状腺素(FT4)明显增高,促甲状腺激素(TSH)水平降低,所有患者予非甾体类及肾上腺糖皮质激素治疗有效.结论绝大部分亚急性甲状腺炎有典型的临床表现,非甾体类及糖皮质激素治疗疗效确切.     

Effects of methoxychlor and its metabolite 2,2-bis(p-hydroxyphenyl)-1,1,1-trichloroethane on 11β-hydroxysteroid dehydrogenase activities in vitro

Methoxychlor (MXC) is primarily used as a pesticide and widely present in the environment. The objective of the present study is to investigate the direct effects of MXC and its metabolite 2-bis(p-hydroxyphenyl)-1,1,1-trichloroethane (HPTE) on two isoforms of 11β-hydroxysteroid dehydrogenase (11β-HSD1 and 11β-HSD2) in vitro. Human liver microsome, rat testis microsome and adult Leydig cells were used for the measurement of 11β-HSD1 activity. Human placental and rat kidney microsomes were used for 11β-HSD2 activity. The IC₅₀ values on human 11β-HSD1 by MXC and HPTE were 1.91 ± 0.07 and 8.88 ± 0.08 μM, respectively. HPTE inhibited rat 11β-HSD1 with IC₅₀ of 9.15 ± 0.05 μM, while MXC did not inhibit the enzyme. MXC and HPTE were competitive inhibitors of 11β-HSD1. HPTE also inhibited human and rat 11β-HSD2 with IC₅₀ values of 55.57 ± 0.08 and 12.96 ± 0.11 μM, respectively, while MXC did not inhibit 11β-HSD2. In summary, our results showed that MXC and its metabolite HPTE inhibited both isoforms of 11β-HSD in a species- and chemical structure-dependent manner.     

小剂量糖皮质激素与雷公藤多甙联合治疗IgA肾病蛋白尿患者的疗效观察

目的观察小剂量糖皮质激素与雷公藤多甙联合治疗对IgA肾病蛋白尿患者的临床疗效。方法选择2010年10月至2012年10月,纳入的IgA肾病继发蛋白尿患者86例,随机将所有观察对象分为研究组和对照组,各43例,两组均给予少盐、低脂、适量优质蛋白饮食,服用氯沙坦钾片1片/(d.次),研究组增加口服雷公藤多甙片(TWP)1mg/kg,3次/d,强的松0.6 mg/kg,清晨顿服,6月后调整药量为TWP 0.5 mg/kg,强的松0.3 mg/kg,3月后复查,调整药量为TWP 10 mg/d,强的松5 mg/d,根据病情可酌情减量至停药。对照组不服用强的松,给予TWP治疗,其疗程与研究组TWP治疗方案相同。比较两组治疗前及治疗后3个月时血常规、肝功能、肾功能、血脂、尿常规、24 h尿蛋白沉淀定量等指标。结果治疗后3个月时,研究组血肌酐、尿素氮、尿酸均明显低于对照组,且研究组治疗后显著低于治疗前(均P<0.01)。研究组24 h尿蛋白沉淀定量及尿红细胞计数均显著低于对照组(均P<0.05)。研究组疗效总有效率明显高于对照组(矫正χ2=9.06,P<0.05)。结论小剂量糖皮质激素与雷公藤多甙联合用药较雷公藤单药具有明显改善IgA肾病患者临床症状、提高疗效、减少不良反应事件等作用。     

Salivary cortisol and administration of concentrated oral glucose in newborn infants: improved detection limit and smaller sample volumes without glucose interference

Newborn infants are subject to repetitive painful and stressful events during neonatal intensive care. When the baby attempts to cope with a stressful situation the hypothalamus‐pituitary‐adrenal axis is activated, releasing cortisol. The free cortisol response is optimally measured in saliva and saliva samples can be taken easily and without pain. However, saliva is very scarce in infants and saliva stimulants can interfere with analytical methods. Nowadays, sweet solutions are frequently administered to neonates prior to a disturbing procedure in order to reduce pain. The possible interference of sweet solutions with the measurement of salivary cortisol has not yet been documented. The aims of the present study were to further improve the detection limit of the radioimmunoassay used for cortisol analysis and to determine the degree of interference of high concentrations of glucose with the analytical method. By decreasing incubation temperature and prolonging the incubation time it was possible to improve the detection limit of the radio immunoassay (RIA) to 0.5?nmol/L at the same time as the sample volume was decreased to 10?μL saliva. Saliva was collected from full‐term and preterm babies and was sufficient for analysis in 113 out of 116 (97%) samples. Glucose in the concentrations and amounts commonly used for pain relief did not interfere with the RIA method. In conclusion, it is feasible to collect microlitre volumes of saliva and analyse even very low concentrations of cortisol in newborns. It is also possible to offer the baby oral glucose prior to a painful procedure and still reliably measure salivary cortisol.     

糖皮质激素联合泛昔洛韦治疗带状疱疹的疗效观察

目的 探讨早期小剂量应用糖皮质激素治疗带状疱疹的最佳疗程及安全性.方法 选择145例带状疱疹患者,随机分为观察组75例和对照组70例,两组均常规口服泛昔洛韦、甲钴胺;肌注维生素B1、B12;外用炉甘石洗剂,疗程为9d.观察组在此基础上口服小剂量泼尼松,观察其最佳有效疗程及安全性.结果 观察组在止痛、止疱、结痂、皮损痊愈时间明显优于对照组(P＜0.05);观察组和对照组相比疼痛缓解积分及后遗神经痛的发生率明显降低(P＜0.05).但9天时两组的疼痛缓解积分则无差异性(P＞ 0.05).安全性方面两组均无明显的不良反应(P＞ 0.05).结论 早期应用糖皮质激素治疗带状疱疹安全有效,疗程以6天内为最佳.     

抗神经生长因子与糖皮质激素干预对哮喘大鼠肺神经生长因子表达的影响

目的 探讨糖皮质激素与抗神经生长因子（NGF）干预对哮喘大鼠肺内NGF表达的影响.方法 建立哮喘模型,将48只SD大鼠按随机数字法分为对照组、哮喘组、糖皮质激素干预组和抗NGF干预组,每组12只.用免疫组织化学方法检测哮喘大鼠肺内NGF表达水平.结果 NGF的表达与呼吸道平滑肌厚度呈正相关.哮喘组呼吸道平滑肌厚度及NGF的表达均显著高于对照组、抗NGF干预组及糖皮质激素组（P〈0.05）;抗NGF干预组及糖皮质激素组NGF表达显著高于对照组（P〈0.05）.结论 在实验哮喘大鼠中,肺内NGF表达水平显著增高,糖皮质激素与抗NGF干预后肺内NGF表达水平有所减少.