血浆置换及大剂量甲泼尼龙治疗蜂螫伤致溶血性贫血的疗效分析

目的比较血浆置换(PE)与大剂量甲泼尼龙治疗蜂螫伤致溶血性贫血的疗效。方法蜂螫伤导致溶血性贫血患者35例,入院后除常规的对症处理外,拒绝行PE治疗的患者分为大剂量甲泼尼龙治疗组(n=13),其余的22位患者采用PE方法治疗,比较两组的溶血控制时间、并发症发生率、死亡率、平均住院天数。结果与大剂量甲泼尼龙治疗组相比,PE治疗组溶血控制的时间相当,差异没有统计学意义,但该组患者的并发症发生率、死亡率、平均住院天数均低于前者,差异有统计学意义(P0.05)。结论 PE治疗能够有效治疗蜂螫伤所致溶血性贫血,且降低并发症的发生率,从而减低死亡率,缩短病程,减少平均住院天数,是早期治疗蜂螫伤中毒的有效手段。     

A Chinese adolescent girl with Fechtner-like syndrome

We describe a 15-y-old girl with Fechtner-like syndrome, who is the first Chinese reported to have this rare syndrome. She presented with left homonymous hemianopia and neuroimaging revealed haemorrhage in both parietal and occipital lobes. Peripheral blood smear showed macrothrombocytopenia and intracytoplasmic inclusion bodies inside leucocytes. Thrombocytopenia and proteinuria responded to intravenous immunoglobulin and pulsed methylprednisolone. This case illustrates that life-threatening haemorrhage can occur in patients with Fechtner syndrome. Although there was no effective treatment reported in the literature, high dose steroid and immunoglobulin seemed to be useful in our patient. Our patient also had nephritic-nephrotic syndrome with renal insufficiency, which is unusual in adolescent female patients.     

甲基强的松龙对低温保存大鼠肝脏的保护作用

应用Ｗｉｓｔａｒ大鼠肝脏离体灌流模型，用ＣＭＵ—１号液，含有甲基强的松龙的ＣＭＵ—１号液，以及缺血前预用甲基强的松龙后再用ＣＭＵ—１号液分别对肝脏进行灌洗保存。检测ＬＤＨ、ＡＬＴ、肝组织匀浆ＳＯＤ活性和ＭＤＡ含量，并观察肝组织结构。结果表明：甲基强的松龙对低温保存的离体大鼠肝脏具有保护作用     

甲基强的松龙治疗实验性变态反应性脑脊髓炎的作用机制

目的:研究细胞因子、T细胞凋亡和淋巴细胞增殖在实验性变态反应性脑脊髓炎(EAE)形成中的作用及甲基强的松龙(MP)治疗EAE的作用机制。方法:采用人脑纯化的髓鞘碱性蛋白(MBP)与完全福氏佐剂免疫Lewis大鼠,建立EAE动物模型。用双抗体夹心ELISA法检测各组大鼠血清中IL-10、TNF-α、IFN-γ的含量:流式细胞仪检测外周血T细胞凋亡;3H-TdR释放法检测外周血淋巴细胞转化率。结果:与对照组比较,EAE组的外周血IFN-γ、TNF-α水平明显增高,IL-10水平明显降低,MP治疗后IFN-γ和TNF-α水平下降,IL-10浓度上调。MP还诱导外周血T细胞凋亡和抑制MBP致敏淋巴细胞增殖并呈剂量依赖性。结论:应用人MBP成功建立EAE大鼠模型,MP可能通过调节Th细胞因子格局、促进Th2细胞因子分泌、抑制MBP致敏淋巴细胞增殖及外周血T细胞凋亡而发挥治疗多发性硬化的作用。     

Eye movement quantitative evaluation before and after high-dose 6-methylprednisolone in multiple sclerosis

We studied saccadic and smooth pursuit eye movements in 24 patients suffering from multiple sclerosis during disease worsening, before and after high-dose 6-methylprednisolone infusions. Quantitative evaluation of saccades was based on amplitude/duration and amplitude/peak velocity relationships, precision (i.e. the ratio of actual to desired saccade amplitude) and the latency, whereas smooth pursuit eye movements were studied using target velocity/performance index relationship. At basal recordings, 22/24 (91.7%) of the patients showed at lest one abnormality. Eleven of the 24 patients (45.8%) showed modification of one or several parameters: improvement in 6 patients, worsening in 2, coexistence of both trends in 3. Latency improvement was the only significant modification when patients were considered as a group. Neurophysiological modifications did not correspond to clinical changes.     

A simplified method for the preparation of EAC14 intermediate cells using human serum treated with methylprednisolone

The inhibitory effect of methylprednisolone 21-succinate ester (MPS) on the activities of complement components in human serum was studied by incubating human serum with various concentrations of MPS at 37 degrees C for 30 min and then measuring the residual activity of each component in human serum. The formation of EAC1 and EAC14 by C1 and C4 respectively, were only weakly inhibited by MPS at a final concentration of 10 mg/ml. In contrast, the same concentration of MPS completely inhibited the capacity of C2, C3, C5 and C6-9 to induce respective succeeding intermediates. On the basis of these findings a simplified method was devised for the preparation of EAC14 intermediates using human serum pretreated with MPS.     

脂多糖对大鼠肺微血管内皮细胞Gsα和Giα蛋白亚型的影响*

目的：观察脂多糖（LPS）对大鼠肺微血管内皮细胞（RPMVECs)G蛋白的影响及甲基强的松龙的干预作用。方法：用流式细胞技术（FCM）检测G蛋白亚型的变化。结果：①10μg/ml LPS作用于RPMVECs30和90min后,Gsα蛋白水平较对照组显著下降。甲基强的松龙干预30和90min后,对LPS致RPMVECs膜Gsα蛋白水平的变化有显著抑制作用。②10μg/ml LPS作用于RPMVECs30和90min后,Giα蛋白水平较对照组显著下降。甲基强的松龙干预30和90min后,对LPS致RPMVECs膜Giα蛋白水平的变化有显著抑制作用。结论：①LPS诱导RPMVECS Gsα和Giα蛋白水平的变化可能是LPS诱导RPMVECs单层通透性增加的机制之一。②甲基强的松龙参与抑制LPS诱导RPMVECs单层通透性增加的作用。     

七叶皂苷钠治疗喘息患者的研究

目的　评价七叶皂苷钠注射液治疗慢性喘息型支气管炎和支气管哮喘的有效性与安全性。方法　将 84例慢性喘息型支气管炎和支气管哮喘患者随机分为 2组 :观察组用七叶皂苷钠 2 0mg加入生理盐水 4 0mL中缓慢静脉注射 ,每日 2次 ;对照组用甲基强的松龙 4 0mg加入生理盐水 4 0mL中静脉注射 ,每日 1次。 2组疗程均为 5d。结果　 2组肺功能改善情况、临床疗效和综合疗效均无显著性差异 (P均 >0 .0 5 ) ,观察组和对照组不良反应发生率分别为12 %和 2 1% ,经相应对症处理后不影响治疗。结论　七叶皂苷钠治疗喘息患者安全、有效。     

清开灵和甲基强的松龙注射液联合用药对油酸型急性肺损伤家兔的治疗作用

目的:观察静脉注射清开灵、甲基强的松龙(MP)注射液及其联合用药对油酸型急性肺损伤(ALI)家兔的影响。方法:家兔随机分为11组:对照组,油酸组,治疗组分别包括清开灵和MP注射液以及清开灵+MP注射液小、中、大剂量组。iv油酸(0.05mL·kg^-1)复制家兔ALI模型后,立即iv上述药液,观察给予油酸前及以后30,60,120min时的呼吸频率和幅度,于各时间点测定动脉血气含量;实验后处死家兔取肺组织,测定肺组织LDH,CAT和MDA的含量,及观察病理变化。结果:与油酸组比较,清开灵和MP注射液小、中、大剂量组的呼吸幅度显著升高、呼吸频率显著降低(P<0.05);治疗30min时,清开灵+MP注射液小、大剂量组的PaO₂显著升高(P<0.05),120min时,清开灵、MP及清开灵+MP注射液小、中和大剂量组的PaCO₂显著降低(P<0.05);清开灵、MP注射液中、大剂量组的LDH显著升高、CAT和MDA显著降低(P<0.05);清开灵+MP小、中剂量组可以减轻由油酸引起的病理改变。结论:清开灵+MP小剂量对油酸型肺损伤家兔的疗效优于同剂量下 的单独用药;而清开灵或MP大剂量单独给药的疗效优于同剂量下的联合用药。     

Peroperative cardiovascular stability during brainstem surgery. The use of high-dose methylprednisolone compared to dexamethasone. A retrospective analysis

BACKGROUND: In neurosurgical procedures within brainstem structures, corticosteroids are routinely administered to prevent oedema and to reduce intraoperative trauma. After replacing the routine administration of dexamethasone (DX) by high-dose methylprednisolone (MP) during surgery for tumours within brainstem structures, a decreased incidence of intraoperative haemodynamic instability events was observed. To test this hypothesis, a retrospective analysis was performed. METHODS: Peroperative data of 62 surgical procedures of brainstem tumours were retrospectively analysed with respect to haemodynamic instability requiring changes in surgical strategy and/or emergence medication with vasoactive drugs. Severe changes in haemodynamic parameters were defined as a significant increase or decrease in heart rate and/or mean arterial blood pressure greater than 30% compared to baseline values. From 1988 to 1994, intravenous dexamethasone was given peroperatively in 33 patients. After a bolus of 1 mg kg(-1) body weight (BW) 30 min preoperatively, 0.2 mg kg(-1) were given every 4 h. From 1994 until now, methylprednisolone was administered instead of dexamethasone in 29 patients. After an initial bolus of 30 mg kg(-1) BW immediately before surgery, 5.4 mg kg(-1) h(-1) were given 23 h postoperatively. RESULTS: The results of this retrospective analysis suggest that the number of operations with episodes of bradycardia, arterial hypotension (P<0.05), tachycardia and arterial hypertension (P<0.005) was significantly decreased in the group of patients treated with high-dose methylprednisolone. CONCLUSION: The retrospective analysis of the clinical data showed that the routine use of high-dose methylprednisolone was associated with a decreased incidence of haemodynamic instability in a selected group of patients undergoing brainstem surgery. This finding has to be proven in prospective double-blind controlled studies.