新肩三针穴位注射为主治疗肩手综合征的临床研究

目的评价新肩三针穴位注射治疗脑卒中后肩手综合征的临床疗效。方法采用随机对照的方法,将72例符合纳入标准的患者分为治疗组(针刺 新肩三针穴位注射)和对照组(单纯用针刺)。用脑卒中临床神经功能缺损程度评分量表,肩关节疾患治疗成绩判定标准和手掌手指功能评价进行临床疗效评定。结果治疗组疗效明显优于对照组,差异有统计学意义(P<0.05)。结论新肩三针穴位注射是治疗脑卒中后肩手综合征的有效治疗方法。     

Pharmacokinetics of prednisolone in children with the nephrotic syndrome

The aim of this study was to establish whether the criteria for the clinical effectiveness of steroids are correlated with the pharmacokinetics of prednisolone in children treated with prednisone during an attack of idiopathic nephrotic syndrome (INS). Thirteen patients with nephrosis were included. Prednisolone, prednisone and cortisol levels were measured using a specific high-performance liquid chromatography assay after an oral dose of 1 mg/kg body weight of prednisone taken at the onset of the disease. All the pharmacokinetic parameters, including the conversion of prednisone to prednisolone were similar to the data already published in children with INS. No correlation was found between the values of pharmacokinetic parameters and criteria of clinical effectiveness. Hypo-albuminaemia was significantly correlated with the area under the plasma-concentration curve but not with the elimination half-life of prednisolone. Moreover, the prednisolone elimination half-life correlated with the urinary exretion of 17-hydroxycorticosteroids achieved in the first 6h. The present study suggests that routine measurements of prednisolone kinetics do not help when assessing the treatment of children with INS.     

Short-Term Effect of Vitamin K Administration on Prednisolone-Induced Loss of Bone Mineral Density in Patients with Chronic Glomerulonephritis

Glucocorticoid-induced osteoporosis has been reported to be caused by enhanced bone resorption and suppressed bone formation. To clarify whether administration of vitamin K, which enhances bone formation, prevents prednisolone-induced loss of bone mineral density (BMD), a randomized, prospective, controlled study was conducted on 20 patients with chronic glomerulonephritis scheduled for treatment with prednisolone. All patients were initially treated with 0.8 mg/kg body weight/day of prednisolone (maximum of 40 mg) for 4 weeks, tapering to 20 mg/day over approximately 6 weeks. Ten patients received prednisolone alone (Group 1), and the other 10 patients received prednisolone plus 15 mg of menatetrenone, vitamin K, three times per day (Group 2). BMD of the lumbar spine measured by dual-energy X-ray absorptiometry (DXA) and biochemical markers of bone metabolism in blood and urine were evaluated before and 10 weeks after administration of prednisolone alone or with menatetrenone. In Group 1, treatment with prednisolone significantly reduced BMD of the lumbar spine from 1.14 ± 0.12 to 1.10 ± 0.11 g/cm² (P= 0.0029). Serum intact osteocalcin and procollagen type I C-peptide (PICP) concentrations, biochemical markers of bone formation, were markedly reduced. A biochemical marker of bone resorption, urinary excretion of deoxypyridinoline, was significantly reduced. In Group 2, prednisolone-induced reduction of BMD was prevented by menatetrenone administration (1.09 ± 0.09 to 1.07 ± 0.07 g/cm², P= 0.153). Menatetrenone prevented reduction of PICP concentration by prednisolone but not in serum intact osteocalcin concentration and urinary excretion of deoxypyridinoline. Thus, treatment with prednisolone resulted in loss of BMD of the lumbar spine associated with suppression of both bone formation and bone resorption. Menatetrenone is a useful agent in preventing prednisolone-induced loss of BMD. Received: 7 July 1998 / Accepted: 13 August 1999     

HPLC梯度洗脱法同时测定鼻炎喷剂中3种组分的含量

目的:建立同时测定鼻炎喷剂中盐酸麻黄碱、环丙沙星、醋酸泼尼松龙3种组分含量的方法。方法:采用高效液相色谱梯度洗脱法。色谱柱为SHIMADZU Shim-pack VP-ODS,流动相为甲醇-乙腈-0.05 mol/L磷酸二氢钾(含0.25%三乙胺,pH 3.0),流速为1.0 ml/min,变换紫外检测波长分别为207、278、247 nm,柱温为40℃。结果:盐酸麻黄碱、环丙沙星、醋酸泼尼松龙检测质量浓度线性范围分别为99.93⁷99.44、46.38799.44、46.38³71.00、5.39371.00、5.39⁴3.12μg/ml(r=0.999 643.12μg/ml(r=0.999 6⁰.999 8),平均回收率为100.4%(RSD=1.2%,n=3)、101.1%(RSD=1.3%,n=3)和101.0%(RSD=1.5%,n=3)。结论 :建立的方法简便、灵敏、准确,可用于制订鼻炎喷剂的质量标准并为产品质量控制提供支持。     

丹墨胶囊对泼尼松在大鼠体内药动学的影响

目的:研究丹墨胶囊对泼尼松在大鼠体内药动学的影响。方法:12只SD大鼠随机均分为单用丹墨胶囊(864 mg/kg)组、联合用药(864 mg/kg丹墨胶囊+42 mg/kg醋酸泼尼松)组。采用高效液相色谱(HPLC)法检测血浆中泼尼松、泼尼松龙的质量浓度。色谱柱为CC 250/4.6 NUCLEODUR 100-5C18(250 mm×4.6 mm,5μm),流动相为甲醇-水(A,含0.2%H3PO4,55∶45,V/V)-乙腈(B),梯度洗脱,检测波长为240 nm,柱温为40℃,流速为1.0 ml/min。用WinNonlin4.2程序计算主要药动学参数,并进行统计分析。结果:泼尼松、泼尼松龙回归方程分别为y=2.092x-0.042 6(r=0.999 8)、y=1.730 9x+0.005 5(r=0.999 5)。泼尼松、泼尼松龙质量浓度均在10⁵ 000 ng/ml范围内与其峰面积和内标峰面积比值呈良好线性关系。联合用药组泼尼松的AUC05 000 ng/ml范围内与其峰面积和内标峰面积比值呈良好线性关系。联合用药组泼尼松的AUC0².5 h和cmax均明显小于单用丹墨胶囊组(P<0.01或P<0.05);联合用药组泼尼松龙的cmax明显大于单用丹墨胶囊组(P<0.05)。结论:864 mg/kg丹墨胶囊能加快泼尼松向泼尼松龙转化,提高泼尼松的疗效。     

Severe Hepatic Injury Caused by Imatinib Mesylate Administered for the Treatment of Chronic Myeloid Leukemia and the Efficacy of Prednisolone for its Management

Imatinib mesylate is a specific inhibitor of BCR-ABL tyrosine kinase, which is now widely used for the treatment of chronic myeloid leukemia (CML) with a high efficacy. Although severe hepatic injury caused by imatinib mesylate is rare, such a side effect may force patients to discontinue taking imatinib mesylate. In the present paper, we report on the case of a 51-year-old woman with CML who experienced hepatic injury with severe hyperbilirubinemia caused by imatinib mesylate. The findings from a liver biopsy specimen and her clinical course suggested the hepatic injury to presumably have been caused by an allergic mechanism. The co-administration of prednisolone was thus tried, and she has been able to continue imatinib mesylate administration without any liver dysfunction and finally was able to obtain a complete cytogenetic response.We therefore recommend that prednisolone should be tried when severe hepatic injury caused by imatinib mesylate is observed, since it might enable such patients to continue imatinib mesylate treatment and thereby improve the prognosis in such cases.     

A favourable response to surgical intervention and hyperbaric oxygen therapy in pyoderma gangrenosum

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterised with ulcerations. Inflammatory bowel diseases (ulcerative colitis and Crohn's disease) and haematologic diseases (leukaemia, preleukaemia and monoclonal gammopathy) have been reported in about 40–50% of PG patients in whom the treatment of the underlying disease is important for the improvement of the lesions. We herein report a colorectal adenocarcinoma patient with PG, who responded partially to topical treatments and systemic immunosuppressants and healed completely with the aid of surgical wound repair and hyperbaric oxygen therapy.     

Colon delivery of prednisolone based on chitosan coated polysaccharide tablets

Colon drug delivery is advantageous in the treatment of colonic disease and oral delivery of drugs unstable or suceptible to enzymatic degradation in upper GI tract. In this study, multilayer coated system that is resistant to gastric and small intestinal conditions but can be easily degraded by colonic bacterial enzymes was designed to achieve effective colon delivery of prednisolone. Variously coated tablets containing prednisolone were fabricated using chitosan and cellulose acetate phthalate (CAP) as coating materials. Release aspects of prednisolone in simulated gastrointestinal fluid and rat colonic extracts (CERM) were investigated. Also, colonic bacterial degradation study of chitosan was performed in CERM. From these results, a three layer (CAP/Chitosan/CAP) coated system exhibited gastric and small intestinal resistance to the release of prednisolone in vitro most effectively. The rapid increase of prednisolone in CERM was revealed as due to the degradation of the chitosan membrane by bacterial enzymes. The designed system could be used potentially used as a carrier for colon delivery of prednisolone by regulating drug release in stomach and the small intestine.     

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。