天麻钩藤饮联合甲泼尼龙治疗桥本脑病临床观察

目的:观察天麻钩藤饮联合甲泼尼龙治疗桥本脑病的临床效果。方法:26例随机分为治疗组和对照组各13例,两组均用甲泼尼龙治疗,治疗组加用天麻钩藤饮治疗。结果:WAIS-R评分操作量表分、WMS-R评分量表分治疗组均低于对照组(P<0.05),日常生活能力量表(ADL)评分治疗组高于对照组(P<0.05)。结论:天麻钩藤饮联合甲泼尼龙治疗桥本脑病可改善临床症状,减轻不良反应,优于单用西药治疗。     

Report of a combination of remdesivir,intravenous methylprednisolone pulse,and tocilizumab for severe coronavirus disease: 20-case series at a single institution

Many drugs have been marketed for treating coronavirus disease 2019 (COVID-19) infection, the disease that has caused a worldwide pandemic. However, in reported clinical trials, almost 30% of patients with COVID-19 did not show any health improvement. The 28-day survival rate was 69.5% when patients who required highflow oxygen therapy (HFNC), ventilation, and extracorporeal membrane oxygenation (ECMO) management were treated with remdesivir. The mortality rate of patients receiving 6 mg dexamethasone was 27%, and that of patients treated with tocilizumab and steroids was 31%. These results are unsatisfactory, and treatment for patients with severe respiratory failure has not yet been established. In our institution, we used remdesivir, methylprednisolone (mPSL) pulse therapy, and tocilizumab in 20 patients with COVID-19 whose PaO2/FIO2 (P/F) ratio was <200, and obtained good results for this combination therapy without any adverse events. In this study, we report the possible efficacy and safety of this treatment.     

Outcome of early-stage combination treatment with favipiravir and methylprednisolone for severe COVID-19 pneumonia: A report of 11 cases

Although the use of corticosteroids is not recommended in the World Health Organization statement for the treatment of coronavirus disease 2019 (COVID-19), steroid therapy may be indicated for critical cases in specific situations. Here, we report the successful treatment of 11 cases of severe COVID-19 pneumonia with favipiravir and methylprednisolone. All cases were severe and patients required oxygen administration or had a blood oxygen saturation ≤93% on room air. All were treated with favipiravir and methylprednisolone, and 10 of 11 patients responded well and required no further oxygen supplementation or ventilator management. This study shows the importance of the early-stage use of a combination of favipiravir and methylprednisolone in severe cases to achieve a favorable clinical outcome.     

甲泼尼龙琥珀酸钠对自身免疫性肺气肿模型大鼠氧化应激和抗内皮细胞抗体的影响

目的:研究甲泼尼龙琥珀酸钠对自身免疫性肺气肿模型大鼠氧化应激和抗内皮细胞抗体(AECA)的影响。方法:将雄性SD大鼠随机分为对照组、模型组和干预组,每组8只。除对照组大鼠腹腔注射等体积的完全弗氏佐剂外,模型组和干预组大鼠均腹腔注射体外培养的人脐静脉内皮细胞+完全弗氏佐剂混合物以复制自身免疫性肺气肿模型;造模给药后第2天,干预组大鼠腹腔注射甲泼尼龙琥珀酸钠10 mg/(kg·d),对照组和模型组大鼠均腹腔注射等体积的生理盐水,每日1次,连续21 d。末次给药后,取各组大鼠右肺组织制作石蜡切片并行苏木精-伊红染色,观察肺组织病理变化,测量单位面积内的肺泡数(MAN)和内衬间隔(MLI);检测左肺肺泡灌洗液(BALF)中丙二醛(MDA)、还原型谷胱甘肽(GSH)含量和超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)活性,以及BALF和血清中AECA含量。采用Pearson分析模型组大鼠BALF中AECA与MDA、GSH、SOD、GSH-Px的相关性。结果:与对照组比较,模型组大鼠肺组织可见明显的肺气肿病理变化,其MAN显著减少,MLI显著延长(P<0.01);BALF中GSH含量和SOD、GSH-Px活性均显著降低,BALF中MDA含量以及BALF、血清中AECA含量均显著升高(P<0.01)。与模型组比较,干预组大鼠肺组织的肺气肿病理变化明显改善,其MAN显著增加,MLI显著缩短(P<0.01);BALF中GSH含量和SOD、GSH-Px活性均显著升高;BALF中MDA含量以及BALF、血清中AECA含量均显著降低(P<0.01)。模型组大鼠BALF中的AECA与MDA呈正相关(r=0.710,P<0.05),与GSH、SOD、GSH-Px呈负相关(r=-0.754、-0.781、-0.736,P<0.05)。结论:甲泼尼龙琥珀酸钠可能通过减轻氧化应激反应、抑制AECA的表达,从而达到预防自身免疫性肺气肿的目的。     

甲基强的松龙与地塞米松治疗腹部术后早期炎性肠梗阻的疗效对比

【摘要】 目的 比较甲基强的松龙(甲强龙)与地塞米松治疗术后早期炎性肠梗阻的疗效。方法 回顾性分析2002年7月至2012年7月收治的66例炎性肠梗阻患者的临床资料,依据使用不同激素分为甲强龙组和地塞米松组,观察比较两组疗效及不良反应。结果 66例患者均采用保守方法治愈,无中转手术病例。甲强龙组腹胀、腹痛缓解时间,肛门排气时间和治愈时间均少于地塞米松组,具有统计学差异(P<0.05)。结论 甲强龙治疗术后早期炎性肠梗阻疗效优于地塞米松。     

甲基强的松龙联合盐酸溴己新治疗儿童毛细支气管炎的远期效果分析

目的 观察甲基强的松龙联合盐酸溴己新治疗儿童毛细支气管炎的远期效果.方法 85例毛细支气管炎患儿随机分为观察组(n=43)和对照组(n=42),对照组在常规治疗的基础上给予甲基强的松龙1~2 mg/kg,7 d,观察组在对照组的基础上给予盐酸溴己新4~8 mg/d,7 d.观察两组患儿的病情变化以及2年内喘息复发情况.结果 观察组患儿的症状、体征消失时间以及住院时间均明显低于对照组(P<0.05),喘息复发率也明显低于对照组(P<0.05).观察组总有效率为100.0%,明显高于对照组的88.0%,差异有统计学意义(P<0.05).观察组的不良反应发生率为9.3%,低于对照组的14.3%,但差异无统计学意义(P>0.05).结论 甲基强的松龙联合盐酸溴己新不仅能快速改善患儿的症状和体征,减少住院时间,还能减少喘憋发作,安全可靠,但仍需要进一步大样本多中心随机对照研究证实结论.     

短程甲基强的松冲击疗法加干扰素治疗小儿病毒性脑炎

目的：观察短程甲基强的松冲击疗法加干扰素治疗小儿病毒性脑炎的疗效。方法收集小儿病毒性脑炎患儿34例,随机分对照组15例和观察组19例。对照组采用干扰素治疗,观察组采用短程甲基强的松冲击疗法加干扰素治疗。比较2组患儿临床症状改善时间及疗效。结果观察组发热、抽搐、脑膜刺激征、病理征、意识障碍、颅内高压的恢复时间均显著短于对照组（P＜0.05）。观察组总有效率94.74％,显著高于对照组的60.00％（P＜0.05）。结论短程甲基强的松冲击疗法加干扰素治疗小儿病毒性脑炎能有效缩短临床症状改善时间并提高疗效。     

N-乙酰半胱氨酸联合甲基强的松龙治疗放射性肺损伤临床研究

目的探讨使用N-乙酰半胱氨酸(NAC)治疗放射性肺损伤的临床效果和应用价值。方法将100例放射性肺损伤患者随机平均分为甲基强的松龙治疗组(对照组)和甲强龙+N-乙酰半胱氨酸治疗组(治疗组),每组50例,疗程14天。4周后观察2组临床疗效。并分别于第1天和第14天观察血浆TNF-α、IL-6、TGF-β1和CRP水平变化。结果 4周后甲强龙治疗组总有效率为78%,甲强龙+N-乙酰半胱氨酸治疗组为88%,两组间临床疗效的差异有统计学意义(χ2=4.461,P<0.05)。2治疗组在第1天时血浆TNF-α、IL-6、TGF-β1和CRP水平无统计学差异(P均>0.05)。在第14天时,2治疗组血浆TNF-α、IL-6、TGF-β1和CRP水平较前明显下降,各指标差异均有统计学意义(P均<0.05)。同时,与甲强龙治疗组相比甲强龙+N-乙酰半胱氨酸组血浆TNF-α、IL-6、TGF-β1和CRP水平下降更明显,差异均有统计学意义(P均<0.05)。结论本研究发现在常规使用甲强龙治疗的基础上加用N-乙酰半胱氨酸进行辅助治疗,能有效减轻放射性肺损伤的临床症状,同时降低血浆TNF-α、IL-6、TGF-β1和CRP水平。N-乙酰半胱氨酸对于放射性肺损伤有保护作用,可常规应用于临床治疗。