三七通舒胶囊治疗60例急性面神经炎患者的临床研究

目的比较三七通舒胶囊加西药基础治疗与单用西药治疗面神经炎的疗效差异。方法将60例面神经炎患者按门诊顺序分为治疗组和对照组各30例,对照组采用口服强的松20mg＋非特异性抗炎治疗,隔日1次,1周后停药;配合口服维生素B1、维生素B12改善神经代谢,30天为1疗程。而治疗组则在前述治疗基础上加用三七通舒胶囊（每粒含三七三醇皂苷100mg）。结果治疗组治疗4周后,20例痊愈,5例显效,2例有效,总有效率达90％;而对照组10例痊愈,3例显效,2例有效,总有效率仅为50．0％;两组间总有效率差异有统计学意义（P〈0．05）。结论 三七通舒胶囊加激素治疗面神经炎的疗效较好．优于单用激素治疗。     

醋酸泼尼松龙纳米乳的制备

目的制备醋酸泼尼松龙纳米乳,并观察其稳定性。方法聚乙二醇,醋酸泼尼松龙和卵磷脂的氯仿溶液在氮气流下减压成膜,加入经水化超声处理的大豆油,进一步处理后使其微乳化。结果粒径50~100nm,包封率≥90%。结论该工艺制备了粒径小于100nm的醋酸泼泥松龙纳米乳,有较好的稳定性。     

Low-dose prednisolone in first-line docetaxel for patients with metastatic castration-resistant prostate cancer: Is there a clinical benefit?

BackgroundRandomized studies have shown improved survival with the combination of docetaxel (D) and prednisone in patients with metastatic castration-resistant prostate cancer (mCRPC). We retrospectively investigated whether coadministration of low-dose glucocorticoids has clinical benefits.Material and methodsRecords from 358 patients with metastatic castration-resistant prostate cancer treated consecutively with either D 75 mg/m² every 3 weeks (n = 124) (Rigshospitalet) or D and prednisolone (P) 10 mg daily (n = 234) (Herlev Hospital) given as first-line chemotherapy were reviewed. Of these, 15 patients treated with glucocorticoids at initiation of D at Rigshospitalet were excluded. Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 was used to register any grade of peripheral edema, grade ≥2 sensory neuropathy, and grade ≥3 nonhematological toxicity. Background clinical data, rates of toxicity, hospital admissions, dose reductions, and post−D treatments were analyzed by the Chi-squared test or Mann-Whitney U test. Progression-free survival and overall survival were calculated by the Kaplan-Meier method.ResultsPatients treated with D alone had a higher incidence of peripheral edema (32% vs. 15%, P<0.001) and grade 3 nonhematological toxicity (56% vs. 43%, P = 0.022). Patients treated with D alone were also more frequently hospitalized (53% vs. 41%, P = 0.035), mainly owing to a higher incidence of febrile neutropenia in this group (25% vs. 10%, P<0.001). P did not influence progression-free survival (P = 0.692, log-rank test) or overall survival when adjusting for baseline levels of hemoglobin, alkaline phosphatase, lactate dehydrogenase, prostate-specific antigen, and Eastern Cooperative Oncology Group performance status (hazard ratio_P = 0.98, 95% CI: 0.76–1.26, P = 0.89, Cox proportional hazard regression model).ConclusionsCoadministration of low-dose P reduced the incidence of peripheral edema, grade 3 nonhematological toxicity, and the risk of being admitted owing to febrile neutropenia during treatment with D. Adjusted survival analysis did not indicate that P affected prognosis.     

泼尼松及其醋酸酯片剂的生物利用度比较研究

本文报道了体外溶出速度有显著差异的泼尼松与醋酸泼尼松片剂的体内比较试验。结果表明:醋酸泼尼松片剂之间及泼尼松与醋酸泼尼松片剂之间均无体内外相关关系。由于三个样品体内血峰浓度、曲线下面积、峰时均表示有相等的生物利用度,因此,作者认为目前采用的泼尼松片溶出速度技术一般地还不能用来充分预示体内生物利用度参数。     

The assessment of the systemic effects of inhaled glucocorticosteroids

Summary In a randomized, double-blind crossover study, the effects of 0.8, 1.6 and 3.2 mg/day inhaled budesonide and 5, 10 and 20 mg/day oral prednisolone on mineral metabolism were compared. Twelve healthy subjects (4 m, 8 f) were treated for 1 week at each dosage level, the graduated dosages being given in ascending order. Budesonide and prednisolone were given twice daily and once daily, respectively, which reflects the schedules common in clinical practice.Serum calcium and the regulatory hormones of calcium metabolism (parathyroid hormone, vitamin D metabolites and calcitonin) were not changed either by prednisolone or budesonide. Prednisolone significantly increased 24 h and 08.00 h fasting urinary calcium excretion and decreased renal calcium reabsorption, while budesonide had little or no effect on urinary calcium loss and increased renal reabsorption at the highest dose level. Both drugs significantly increased renal phosphate reabsorption and serum phosphate levels, but prednisolone caused greater increases than budesonide.In conclusion, during short-term treatment with the dosages used, inhaled budesonide had less effect on calcium and phosphate metabolism than oral prednisolone, and so it may have a lesser action on the skeleton of the type contributing to osteoporosis during long-term treatment.     

Fast track clinic for early diagnosis of polymyalgia rheumatica: Impact on symptom duration and prednisolone initiation

ObjectivesTo evaluate the efficacy of a fast track clinic (FTC) for patients suspected of polymyalgia rheumatica (PMR) regarding symptom duration, prednisolone initiation before rheumatological assessment, number of hospital contacts before diagnosis, and cancer diagnosis.MethodsIt is a retrospective cohort study with a one year follow-up period. Patients referred to the FTC (1st August 2016 to 25th June 2019) were compared to a historical cohort of PMR patients (1st August 2014 to 1st August 2016). Referral criteria are: age over 50, symptoms of PMR but not cranial GCA, and increased C-reactive protein. Data were obtained from patient journals.ResultsNinety-seven PMR patients in the historical cohort and 113 FTC patients, of whom 83 patients had PMR, were included. The median (interquartile range) number of days from symptom onset until PMR diagnosis were 53 (31–83) days in the FTC versus 80 (58–132) days in the historical cohort (P < 0.001). Prednisolone was prescribed before rheumatological assessment to 11% in the FTC versus 42% in the historical cohort (P < 0.001). Patients in the FTC had significantly fewer contacts with the hospital before the diagnosis compared with the historical cohort. Four patients in the FTC were diagnosed with a cancer, all of which were found by imaging.ConclusionThe FTC reduced the time from symptom onset until diagnosis, lowered prednisolone initiation before rheumatological assessment, and resulted in fewer hospital visits. The frequency of cancers was low in patients suspected of PMR and cancers were discovered by imaging.     

Pharmacodynamic modelling of the drug-induced downregulation of a β2-adrenoceptor mediated response and lack of restoration of receptor function after a single high dose of prednisone

Changes in ₂-adrenoceptor function by chronic dosing of ₂-mimetics and the possible influence of a single dose of prednisone have been studied as changes over time in the concentration-effect relationship of the ₂-adrenoceptor agonist terbutaline. Hypokalaemia was used as the specific ₂-adrenoceptor mediated effect.8 healthy volunteers were given subcutaneous terbutaline 0.01 mg·kg^–1 BW on 3 occasions over a 10-day experimental protocol: 1 Control experiment on Day 1; 2 After 7 days of oral terbutaline 5 mg t.i.d. (Day 8); and 3 After 8 days on oral terbutaline and 12 h after prednisone 100 mg orally (Day 10). The time course of the terbutaline concentrations and hypokalaemia was related using a pharmacokinetic-pharmacodynamic model. A sigmoid and a threshold E_max model were used to relate drug concentrations to effects.The oral terbutaline treatment caused a 35% increase in the distribution volume of SC terbutaline. After one week on oral terbutaline the concentration-effect relationship was shifted to the right and was steeper, with a higher EC₅₀ of terbutaline and higher values for the apparent threshold concentration. These observations are compatible with a decrease in receptor numbers after 7 days of terbutaline in a system characterised by the presence of spare receptors. The data after prednisone pretreatment showed an apparent decline in the baseline plasma potassium concentrations that could be included in the E_max model.There was no change in the concentration-effect relationship 12 hours after prednisone.     

坦索罗辛联合泼尼松龙治疗Ⅲ型前列腺炎的疗效及对B7-H3、IFN-γ、IL-10表达的影响

目的:探讨坦索罗辛联合泼尼松龙治疗Ⅲ型前列腺炎的疗效及对共刺激分子(B7-H3)、γ-干扰素(interferon-γ,IFN-γ)、白细胞介素(interleukin-10,IL-10)表达的影响。方法:采用回顾性分析法,选取Ⅲ型前列腺炎患者120例,按照治疗方案的不同分为两组:单独坦索罗辛治疗为对照组,坦索罗辛联合泼尼松龙治疗为观察组,每组各60例。比较给药前、后两组前列腺炎的疗效。采用酶联免疫吸附剂测定(enzyme linked immunosorbent assay,ELISA)检测两组患者给药前、后B7-H3、IFN-γ、IL-10的变化情况。将治疗前、后两组患者的慢性前列腺炎症状评分(NIH-CPSI)与前列腺液中的B7-H3、IFN-γ、IL-10水平作线性回归。结果:(1)与给药前相比,两组患者疗效均有显著改善,且观察组优于对照组,差异均有统计学意义(P<0.05);(2)与给药前相比,两组患者B7-H3、IFN-γ、IL-10水平均显著降低,且观察组优于对照组,差异均有统计学意义(P<0.05);(3)治疗前、后两组患者的NIH-CPSI评分与IFN-γ、IL-10水平呈良好的相关性,但与B7-H3水平的相关性较差。结论:坦索罗辛联合泼尼松龙治疗Ⅲ型前列腺炎的疗效显著,其抗炎作用可能与降低前列腺中IFN-γ、IL-10的表达有关。     

枕大神经痛诊治的解剖学基础

目的 介绍枕大神经痛的诊断与局部注射的治疗方法。方法 选择门诊确诊为枕大神经痛的患者30余例，采用强的松龙混悬液加局部麻药的局部注射神经通过第二颈椎横突上方一段的治疗方法。结果 所有病例皆在注射后短时完全止痛，多数病例一周后痊愈，少数经2－3次注射后痊愈，少数病人失访。结论 对诊断明确的病例，采用强的松龙注射法，可以获得满意的效果。