中西医结合治疗多发性硬化相关视神经炎疗效观察

目的:观察在激素常规治疗的基础上加用针刺治疗多发性硬化相关视神经炎(multiple sclerosis optic neuritis,MS-ON)的临床疗效。方法:所有病例均给予激素及针刺治疗,针刺治疗每天1次,10天为1个疗程,连用3个疗程。结果:10例(12眼)治疗效果满意,视力恢复至0.8以上7眼,0.25~0.6者5眼,视野较发病初改善;1眼治疗不满意,视力提高小于1行。11例患者随访8~34个月,未见复发。结论:在激素常规治疗的基础上加用针刺治疗MS-ON疗效显著。     

氨茶碱联合甲基强的松龙治疗支气管哮喘的临床疗效观察

目的比较静脉滴注氨茶碱联合甲基强的松龙和静脉滴注氨茶碱治疗支气管哮喘急性期的疗效。方法选择138例轻、中度支气管哮喘患者,随机分为两组。观察组72例,应用氨茶碱0.25g加入5%葡萄糖注射液250ml静滴,每日1次,甲基强的松龙40mg加入5%葡萄糖注射液100ml静滴,每日2次;对照组66例,应用氨茶碱0.25g加入5%葡萄糖注射液250ml静滴,每日1次。结果观察组显效时间及疗程明显小于对照组（P〈0.05）,总有效率高于对照组（P〈0.05）。结论静脉滴注氨茶碱加甲基强的松龙治疗支气管哮喘急性期疗效显著,是有效的治疗方法之一。     

Methylprednisolone induces activation of the contact system in a dose-dependent manner. An in vitro study

The effect of methylprednisolone sodium succinate (MP) on the contact system of plasma was studied in human citrated pool plasma. Contact activation was demonstrated by the presence of plasma kallikrein (KK) activity and activated Hageman factor (FXIIa) and/or KK in complex with Cl inhibitor (Clinh), detected by chromogenic peptide substrates or radio immunoassays, using monoclonal antibodies directed to neodeterminants exposed on complexed Clinh, respectively.

When plasma and different doses of MP were incubated for a period of 24 hours, the highest dose of MP (10 mg/ml) gave rapid and marked increases in KK activities and concentrations of Clinh complexes. MP at 5 mg/ml plasma also induced activation of the contact system, although this activation was less pronounced. Even the lower dose of MP (1 mg/ml), which is equivalent to doses used in humans, increased plasma concentrations of KK-Clinh complexes.

In conclusion, this study shows that MP in a dose-dependent way activates the contact system of plasma.     

Effects of high-dose methylprednisolone on Na+-K+ ATPase and lipid peroxidation after experimental subarachnoid hemorrhage

The production of oxygen-free radicals and their subsequent peroxidative action on membrane unsaturated fatty acids could be enhanced after subarachnoid hemorrhage. High-dose methylprednisolone (30 mg/Kg i.v.) treatment can antagonize acute SAH-induced brain hypoperfusion and protect the ultrastructural integrity of endothelial cell membranes. Experimental subarachnoid hemorrhage (SAH) was induced in anesthesized rats by slow injection of 0.3 ml of autologous arterial blood into cisterna magna. Tissue lipid peroxidation, quantified as thiobarbituric acid reactive material (TBAR) and Na(+)-K+ ATPase activity were assayed in three different rat brain areas (cerebral cortex, hippocampus and brain stem) of controls (without any surgical manipulation), sham-operated (0.3 ml. of mock CSF into cisterna magna) and after SAH induction, at 1 h, 6 h and 48 h. Na(+)-K+ ATPase activity decreased in the cerebral cortex at 1 h and 6 h and in brain stem at 1 h after SAH, while the same enzymatic activity was unchanged in the hippocampus. High-dose methyl-prednisolone treatment (started immediately after SAH induction) enhanced the Na(+)-K+ ATPase activity until control levels. There was no significant difference in lipid peroxide content between sham-operated and hemorrhagic animals; however, the injection itself induces a transient increase of TBAR (1 h after injection) and methylprednisolone treatment decreases the products of lipid peroxidation in all brain areas.     

Effect of Chengzai Pill on the L-Type Ca^2＋ Channel Currents of Osteoblasts Pretreated with Methylprednisolone

Objective: To observe the effect of the serum containing Chengzai Pill on the L-type voltage-sensitive calcium channels current (L-VSCCsC) of osteoblastic MC3T3-E1 cells pretreated with methylprednisolone (mPSL). Methods: A control group, a model group, a low dose group and a high dose group were set up. The whole cell patch clamp technique was used to record L-VSCCsC of 10 osteoblastic MC3T3-E1 cells in each group and their peak currents were determined. Results: The peak current of the control group was 0.2284±0.0209 nA; the peak current of the model group was 0.1839±0.0179 nA; decreased by 19.5% as compared with the control group (P<0.01); the peak current of the low and high dose groups was 0.2526± 0.0093 nA and 0.2671±0.0120 nA respectively, increased by 37.4% and 45.2% as compared with the model group (P<0.01); the difference between the low and high dose groups was P<0.05. Conclusion: 1. mPSL inhibits L-VSCCsC of osteoblasts; and 2. The serum containing Chengzai Pill increases L-VSCCsC of osteoblasts pretreated with mPSL.     

甲基强的松龙在脊髓型颈椎病外科治疗中的预防保护作用

目的探讨分析手术前使用甲基强的松龙（MP）在脊髓型颈椎病（CSM）外科治疗中对颈脊髓的预防保护作用。方法脊髓型颈椎病患者37例，随机分成实验组（A组）和对照组（B组）。A组：颈椎前路手术减压前即开始使用大剂量甲基强的松龙，19例。B组：颈椎前路手术过程中未使用甲基强的松龙，18例。术前、术后第1天及术后2周按颈椎病脊髓功能状态评分法（40分法）计算2组患者的脊髓功能恢复率。结果A组在术后第1天、术后2周的脊髓症状改善情况较B组有显著性差异（P〈0．01）。结论预防使用大剂量甲基强的松龙可提高脊髓型颈椎病手术的安全性，在治疗过程中起到预防性脊髓、神经保护作用。     

Efficacy of Methylprednisolone Acetate Versus Triamcinolone Acetonide Intra-articular Knee Injection in Patients With Chronic Inflammatory Arthritis: A 24-Week Randomized Controlled Trial

Purpose

Triamcinolone hexacetonide (TH), triamcinolone acetonide (TA), and methylprednisolone acetate (MPA) are commonly used intra-articular steroid preparations. Studies suggest that intra-articular TH is more efficacious than MPA and TA in chronic inflammatory arthritis. However, it is unclear which of the latter two preparations has better efficacy. Thus, we compared intra-articular knee injections of MPA and TA in patients with chronic inflammatory arthritis.

甲泼尼龙抑制神经干细胞并诱导其凋亡的研究

目的：研究甲泼尼龙对体外培养的神经干细胞的直接作用，为有效的结合这两种治疗方法提供依据和指导。方法：体外培养神经干细胞，加入MP培养12h、24h和48h后，用细胞活性检测试剂CCK-8，检测其对神经干细胞活性的影响，用Hoeehst 33258染色观察细胞凋亡，用Annexin V／PI双染色法检测神经干细胞凋亡比率。结果：甲泼尼龙对体外培养的活性有抑制作用，而且可以诱导体外培养的神经干细胞的发生凋亡。结论：甲泼尼龙不利于神经干细胞的生长，不宜在进行甲泼尼龙冲击疗法的同时进行神经干细胞移植。     

血浆交换丙种球蛋白甲基强的松龙治疗重症肌无力

目的探讨依次采用少量血浆交换、大剂量丙种球蛋白、大剂量甲基强的松龙治疗重症肌无力 (MG)Ⅱ b或Ⅲ型的临床疗效及安全性.方法对符合 Osserman 分型为Ⅱ b或Ⅲ型的 37例 MG患者,按住院先后顺序随机分成两组.治疗组 18例,依次采用少量血浆交换、大剂量丙种球蛋白、大剂量甲基强的松龙治疗.对照组 19例,采用传统的大剂量地塞米松治疗.观察两组近期的临床疗效及安全性.结果治疗组症状缓解快,激素治疗过程中发生呼吸肌瘫痪、使用呼吸机现象少,住院时间短,死亡率低 (均 p<0.05).结论依次采用少量血浆交换、大剂量丙种球蛋白、大剂量甲基强的松龙治疗Ⅱ b或Ⅲ型 MG效果好,安全性高,值得临床推广应用.     

1352例急性脊柱脊髓损伤早期救治分析

目的 分析急性脊柱脊髓损伤的伤情、合并伤和并发症，提出早期治疗原则。方法 对1352例急性脊柱脊髓损伤病例进行回顾性分析。结果 脊髓完全性损伤875例、不完全性损伤477例；合并症有肺部感染、泌尿系感染、褥疮等；合并伤有颅脑损伤、四肢骨盆骨折、血气胸等。保守治疗包括大剂量甲基强的松龙冲击疗法、高压氧治疗、脱水剂、神经营养药物等；对存在脊柱不稳、脱位和脊髓压迫者，进行减压内固定手术；合并伤均给予专科处理。结论 应重视急性脊柱脊髓损伤的现场急救，进行及时正确的早期处理；应重视处理合并伤，预防脊髓继发性损伤和并发症；早期康复指导是提高救治水平的关键。