托吡酯对戊四氮诱导癫疒间大鼠体重和血清胰岛素及海马胰岛素样生长因子 1水平的影响

目的观察托吡酯(TPM)对戊四氮(PTZ)致癫疒间大鼠血清胰岛素(INS)及海马胰岛素样生长因子 1(IGF 1)水平表达的影响及二者与体重变化的关系，探讨托吡酯引起体重下降的机制。 方法佳木斯大学附属第一医院儿科于2005 03—2005 09将114只大鼠随机分为4组:空白组,TPM对照组,PTZ组,TPM治疗组，每3d测1次体重,在2、4、6周末应用放射免疫法测血清INS水平,免疫组化法测海马IGF 1表达。 结果TPM对照组、TPM治疗组在第3周末较其它两组出现体重下降，4周末降至最低点(P<005)；在4周末TPM对照组、PTZ组、TPM治疗组与空白组相比，TPM治疗组与PTZ组相比，血清INS明显降低，海马IGF 1阳性神经元细胞数明显升高(P<005)。6周末TPM治疗组与空白组、TPM对照组相比血清INS水平均显著降低(P<005)；TPM治疗组与空白组、TPM对照组、PTZ组比较，海马IGF 1阳性神经元细胞数均明显升高(P<005)。 结论托吡酯能使大鼠体重减轻,但不是通过降低大鼠血清INS水平、升高脑海马IGF 1水平实现的。另外,癫疒间大鼠血清INS降低，海马IGF 1阳性神经元细胞数水平升高，二者是否参与了癫疒间的病理生理过程尚待进一步研究。     

丙戊酸对癫疒间患儿血浆胰岛素和瘦素水平的影响

目的探讨丙戊酸治疗对癫疒间患儿血浆胰岛素和瘦素水平的影响。 方法测定2003 04—2004 02在山东大学齐鲁医院儿科癫疒间治疗中心就诊且服用丙戊酸的32例癫疒间患儿和33例对照组(儿外患儿)血浆胰岛素、瘦素水平并计算胰岛素抵抗值、体重指数，并对服用丙戊酸的癫疒间患儿胰岛素抵抗值、瘦素与丙戊酸的剂量、疗程、体重指数进行相关分析。 结果丙戊酸治疗组体重指数、胰岛素、胰岛素抵抗值、瘦素水平高于对照组；胰岛素抵抗值、瘦素水平与体重指数、丙戊酸疗程显著正相关，与剂量无相关性；偏相关分析示对照组胰岛素、胰岛素抵抗值与瘦素显著负相关，而丙戊酸治疗组胰岛素、胰岛素抵抗值与瘦素显著正相关。 结论丙戊酸治疗可引起肥胖程度增加、胰岛素抵抗及瘦素抵抗；胰岛素抵抗、瘦素抵抗与肥胖程度增加有关，与丙戊酸疗程正相关；胰岛素抵抗与瘦素水平显著正相关。     

脑性瘫痪患儿合并癫疒间32例临床分析

目的探讨合并癫疒间的脑性瘫痪患儿的临床特点及癫疒间治疗效果。 方法总结1999年10月至2004年5月在西安交通大学第二医院住院的合并癫疒间的脑性瘫痪患儿的癫疒间发生率、临床类型、头颅计算机体层成像(CT)和(或)磁共振成像(MRI)、脑电图等方面的特点以及抗癫疒间治疗效果。 结果139例脑性瘫痪患儿中有32例合并癫疒间，占230%(32/139)；常见的癫疒间类型为强直 阵挛发作12例(375%)和部分性发作6例(188%)；25例(781%)癫疒间首发于1岁前；合并癫疒间脑性瘫痪儿童的头颅影像异常及脑电图异常分别占30例(938%)和27例(844%)；常见的头颅影像异常为脑发育不良11例(367%)、脑积水6例(200%)，余为脑萎缩、缺氧缺血性脑病样改变等13例(433%)；脑电图异常中局灶性和弥漫性所占比例分别为482%(13/27)和518%(14/27)；癫疒间多发生于痉挛性脑性瘫痪中(688%)；813%(26/32)的癫疒间需要2种及2种以上的抗癫疒间药物治疗。 结论脑性瘫痪患儿中癫疒间的发生率较高，其头颅影像学和脑电图分别以脑发育不良和弥漫性背景活动异常伴疒间样波发放为主；脑性瘫痪儿童的癫疒间大多为难治性，需要联合用药治疗。     

脑红蛋白在难治性癫疒间患儿脑组织中表达的初步研究

目的观察难治性癫疒间患儿脑内病灶中脑红蛋白(NGB)的表达。 方法选择2003年8~10月在北京天坛医院神经外科进行手术切除治疗的难治性癫 疒间患儿 7例，在对其临床资料分析的基础上，应用组织学染色观察手术切除标本(海马和颞叶)的病理改变；应用免疫组织化学方法，分别研究癫疒间患儿手术切除标本中海马和颞叶病灶NGB表达的变化情况，并进行半定量图像分析。 结果7例标本中，均出现反应性胶质细胞的显著增生，具有难治性癫疒间共同的病理学特征。海马中NGB免疫反应阳性细胞明显少于颞叶病灶；且随发作年限增加而减少。 结论难治性癫疒间患儿颞叶病灶NGB阳性细胞数多于海马，可能与发作时病灶处耗氧过度从而增加了对氧的需求有关。     

视频脑电图对婴幼儿非癫疒间性发作的诊断价值

目的评估视频脑电图对婴幼儿非癫疒间性发作的诊断价值。 方法无锡市儿童医院于2004年1月至2005年1月，对152例拟诊或需排除癫疒间的患儿进行视频脑电图检查。 结果非癫疒间性发作51例，其中非癫疒间性强直发作10例，良性夜间肌阵挛8例，屏气发作7例，婴幼儿擦腿综合征6例，脑瘫及运动发育迟缓肌张力增高导致异常动作强直、震颤、手足徐动5例，良性非癫疒间性婴儿痉挛5例，轻度胃肠炎伴发婴幼儿良性惊厥4例，其他疾病6例。 结论视频脑电图是鉴别发作性质及类型的最有效的检查方法,也是鉴别癫疒间与非癫疒间性发作的有效方法。     

不同子宫切除术式对胰岛素抵抗及血管紧张素转换酶的影响

目的:比较开腹全子宫切除术(AH)和腹腔镜辅助的阴式全子宫切除术(LAVH)对胰岛素抵抗及血管紧张素转换酶(ACE)的影响.方法:选择2009年10月至2011年3月择期行全子宫切除术患者80例,按患者意愿分成AH组和LVAH组,每组40例.监测两组患者麻醉前(T0时)、麻醉诱导插管后(T1时)、气腹建立或开腹30分钟(T2时)、气腹撤除或关腹10分钟(T3时)和术后1小时(T4时)、术后次日晨7时(T5时)、术后第3天晨7时(T6时)7个时点的血糖、胰岛素、C-肽、ACE水平,并计算两组患者在不同时点的胰岛素敏感指数(ISI).结果:①T0时两组患者的血糖、胰岛素、C-肽、ISI和ACE活性比较差异均无统计学意义(P＞0.05).②AH组血糖水平在T4～T6时均明显高于LAVH组(P ＜0.01,P＜0.05),AH组胰岛素及C-肽水平在T2时低于LAVH组(P＜0.01),但T5时和T6时均持续高于LAVH组(P ＜0.01,P＜0.05).③AH组T4～T6时ISI明显低于LAVH组(P＜0.01),两组T5时ISI水平与术中出血量呈负相关(rAH=-0.507,PAH=0.008；rLAVH=-0.424,PLAVH=0.017).④两组ACE水平在T2、T4时明显高于T0时(P＜0.01).LAVH组ACE水平至T2时点最高,并明显高于AH组(P＜0.01),术后下降迅速.结论:两种不同子宫切除术式均引起糖代谢和ACE的异常,LAVH对术后胰岛素抵抗的影响小于传统的AH,但CO2气腹对ACE活性的影响大于AH.     

视频脑电图诊断儿童发作性事件的临床意义

目的评价视频脑电图(Video EEG)对儿童发作性事件的临床应用价值。 方法对2005年5~12月在泉州儿童医院因发作性事件而经Video EEG监测的163例患儿的临床资料作回顾性分析。 结果163例患儿，40例(24.5%)监测到临床发作，其中23例(14.1%)判定为癫疒间性发作事件，17例(10.4%)判定为非癫疒间性发作事件；123例(75.4%)癫疒间患儿得到了证实，其中35例(35/123,28.4%)可进一步确定癫疒间综合征。 结论Video EEG对鉴别儿童发作性事件的性质、确定癫疒间发作类型及相关癫疒间综合征具有重要价值。     

偏侧惊厥 偏瘫和偏侧惊厥 偏瘫 癫疒间综合征11例临床分析

目的总结偏侧惊厥 偏瘫(HH)综合征和偏侧惊厥 偏瘫 癫疒间(HHE)综合征的临床特征。 方法对北京大学第一医院儿科1995~2003年收治的11例HH或HHE患儿的临床资料进行分析。11例均做了头颅MRI和(或)CT检查、脑电图(EEG)检查及血生化测定，6例做了尿代谢病筛查。 结果8例诊断为HHE，3例诊断为HH。发病年龄1个月至8岁5个月，平均为2岁9个月。4例首次惊厥前伴有发热。5例偏瘫前有惊厥持续状态。5例为右侧偏瘫，6例为左侧偏瘫。头颅影像学显示2例正常，7例大脑半球病变与临床症状相对应，1例为弥漫性病变，1例查出无关病变。11例EEG均为异常，其中8例EEG示双侧半球明显不对称，11例中4例有异常放电。6例代谢病筛查均为阴性，1例血乳酸、丙酮酸增高，1例血氨增高。7例采用了以卡马西平为主的抗癫疒间药治疗。 结论HHE为一种公认的惊厥持续状态导致的后遗症，临床上提高对该病的认识并积极进行治疗干预，有助于改善其预后。     

丙戊酸钠治疗儿童失神癫疒间的疗效

目的观察丙戊酸钠单剂治疗儿童失神癫疒间的疗效。 方法选择1990-04—2004-05在首都儿科研究所儿童医院诊断失神癫疒间并首选口服丙戊酸患儿123例，发作未能完全控制者加用氯硝西泮，观察其疗效并进行追踪。 结果123例患儿中，丙戊酸单药治疗后发作完全控制者105例，发作完全控制率844%，其余18例单用丙戊酸发作未能完全控制者，加用氯硝西泮后，发作均得到完全控制，全部患儿发作完全控制率为100%。追踪34例停药后的患儿9个月至10年，其中2例复发，占59%。 结论丙戊酸单药治疗失神癫疒间能使844%的患儿发作完全控制，发作不能完全控制者应加用氯硝西泮,二者联合用药可使患儿的临床发作得到完全控制,且起效快。     

内分泌疾病

生长激素促分泌素受体-1a基因在3T3-L1脂肪细胞诱导分化过程中的表达，特发性矮小患儿生长激素－胰岛素样生长因子轴变化的研究，儿童特发性矮小临床治疗新进展，矮小儿童309例的常见病因，生长激素缺乏和特发性矮小患儿血浆胃促生长素水平的变化     

Oral dehydroepiandrosterone supplementation modulates spontaneous and growth hormone-releasing hormone-induced growth hormone and insulin-like growth factor-1 secretion in early and late postmenopausal women

OBJECTIVE: To evaluate the effects of dehydroepiandrosterone (DHEA) supplementation on the growth hormone-releasing hormone-growth hormone (GHRH-GH) axis in lean and obese postmenopausal women. DESIGN: Prospective study. SETTING: Postmenopausal women in a clinical research environment. PATIENT(S): Thirty-one postmenopausal women were divided in two groups by age (50 to 55 and 60 to 65 years). Within each group, lean and obese patients were considered. INTERVENTION(S): All patients underwent hormonal evaluations before and at the third and sixth month of therapy (50 mg of DHEA orally each day) and a GHRH test (1 microg/kg) before and at the sixth month of treatment. Ultrasound and bone mass density (BMD) examinations were performed before and after the sixth month of therapy. MAIN OUTCOME MEASURE(S): Plasma dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), E1, E2, androstenedione (A), testosterone (T), osteocalcin, GH, insulin-like growth factor 1 (IGF-1) concentrations. RESULT(S): The levels of all of the steroids that derived from DHEA metabolism (E1, E2, A, T, DHEAS) and osteocalcin were increased in plasma under DHEA supplementation. The supplementation protocol also increased the levels of GH and IGF-1. However, GHRH-induced GH and IGF-1 responses were not modified by DHEA supplementation. CONCLUSION(S): Administration of DHEA significantly affects several endocrine parameters in early and late postmenopausal women independently from body mass index. Our data support the hypothesis that DHEA treatment acts similarly to estrogen-progestin replacement therapy on the GHRH-GH-IGF-1 axis. This suggests that DHEA is more than a more than a simple "diet supplement" or "antiaging product"; rather it should be considered an effective hormonal replacement treatment.     

抗幽门螺杆菌感染治疗后患儿肠道菌群的变化

【摘要】目的探讨儿童幽门螺杆菌(H·pylori)感染及抗H·pylori治疗对儿童肠道菌群状 态的影响。方法将浙江大学医学院附属儿童医院2004年4~10月门诊收治的68例慢性胃炎、十二指肠球炎患儿分为H·pylori阳性组36例、H· pylori阴性组32例二组。称取68例患儿新鲜粪便1.0g，分别进行需氧和厌氧培养，分离肠道菌群中最有代表性的三种需氧菌(肠杆菌、肠球菌、 酵母菌)和四种厌氧菌(双歧杆菌、乳杆菌、类杆菌、产气荚膜梭菌),菌落记数，同时计算B/E比值来代表定植抗力。对36例H·pylori阳性组中 的26例患儿进行“三联”抗H·pylori治疗1周后留取新鲜粪便进行肠道菌群分析，5例患儿在停药1个月后再次进行肠道菌群分析。结果H· pylori阳性组和H·pylori阴性组上述三种需氧菌和四种厌氧菌的菌落检出率比较，差异无统计学意义(P>0.05)。抗H·pylori治疗1周后双歧杆 菌、乳杆菌、类杆菌菌落数量较治疗前明显降低(P<0.05),B/E值明显下降(P<0.01)，酵母菌的检出率明显增加(P<0.05)，产气荚膜梭菌检出率 下降(P<0.05)。5例患儿在停药1个月后，乳酸杆菌数量仍继续下降，肠杆菌数量继续增加，双歧杆菌、类杆菌数量有所恢复，但仍低于治疗前 。结论儿童H·pylori感染后对肠道菌群影响不大；三联疗法抗H·pylori治疗对儿童肠道菌群产生明显的影响，因此在治疗H·pylori感染时须 考虑到大量抗生素治疗后可能对患儿的副作用及潜在的危险。     

Gonadotropin releasing hormone agonist therapy and its effect on bone mass

The effects on bone mass of a 6 month therapeutic cycle with a gonadotropin releasing hormone agonist (GnRHa) were studied in 22 patients, ten affected by pelvic endometriosis and 12 by uterine fibroids. All patients were subjected to preliminary full examinations to confirm their diagnosis (laparoscopy for the endometriosis group and precise ultrasound volume measurements for uterine fibroids group). Before the beginning of treatment, bone mineral density (BMD) was measured in each patient both on the distal third of the forearm, with single-photon absorptiometry, and on the lumbar spine (L1-L4), with dual photon absorptiometry. The gonadotropin releasing hormone agonist used was buserelin. In the first week of therapy 0.5 mg of the drug was administered subcutaneously thrice daily. In the following 25 weeks the same drug was given intranasally, at a dosage of 300 micrograms again three times a day. Bone mass measurements, both at the peripheral and at the axial site, were repeated at the end of the 26-week therapeutic cycle and then again 6 months later. At the 26th week, a significant decrease of BMD was observed at both sites. The loss was 1.5% (p less than 0.05) on the lumbar spine, and 2.1% (p less than 0.05) on the radius. No bone mass restoration took place in the following 6 months. On the contrary, a less significant but discernible trend towards a further bone loss was apparent in the BMD values measured 6 months after the end of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)     

The use of the preparation Anteovin in dysfunctional uterine hemorrhages and PCOS

The present prospective study is aimed at estimating the therapeutic effect of a biphasic oestrogen dominated contraceptive pill Anteovin in certain forms of dysfunctional uterine bleeding (DUB) and in polycystic ovary syndrome (PCOS) which is associated with dysfunctional bleeding. Two groups of women were studied--the first group (n = 34) consisted of women with DUB; the second group (n = 31) comprised PCOS. The nature and dynamics of uterine bleeding, contraceptive effectiveness and occurrence of side effects were followed up. In the second group the changes in the levels of testosterone (T), dehydroepiandrosterone sulfate (DHEA-S) and prolactin (Prl) were additionally investigated. RESULTS: A significant decrease in bleeding was observed in both groups. In the second group it is in parallel with a significant decrease of T even as early as on the third month and of DHEA-S on the sixth month of treatment. No significant changes in prolactin levels were found out during the treatment. CONCLUSION: The biphasic contraceptive pill Anteovin has a very good therapeutic effect in DUB and metrorrhagic forms of PCOS while at the same time the side effects are slightly expressed and transitory and an excellent contraception is achieved.     

Tamoxifen treatment of oligozoospermia: a re-evaluation of its effects including additional sperm function tests

Summary Because of previous contradictory results, we reevaluted the effects of tamoxifen on 29 men presenting with idiopathic oligozoospermia. To determine whether a possible increase in sperm concentration might be correlated with an improvement of sperm quality, the hamster ovum penetration (HOP) test and the hypo-osmotic swelling (HOS) test were included as additional tests of sperm function. Patients were treated with tamoxifen (20 mg/day) for 3 months. From 4 weeks until the end of the study, tamoxifen had a significant effect (P<0.001) on blood levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T), and estradiol (E₂). Prolactin (PRL) concentrations were not altered significantly (P>0.05). There was no significant improvement (P>0.05) of conventional semen parameters (volume, concentration, motility, morphology), and of HOP and HOS test results. The lack of correlation between a rise in hormone levels and improvement of sperm quality suggests that tamoxifen is of questionable value in men with idiopathic oligozoospermia.     

Sixth grade academic achievement among children conceived with IVF: a population-based study in Texas,USA

Purpose

To compare academic achievement in reading and mathematics at the end of sixth grade and progress from third to sixth grade by children conceived with in vitro fertilization (IVF) to those conceived naturally.

Methods

This was a retrospective population-based cohort study of IVF-conceived singleton and twin children who took the 3rd grade and 6th grade public school standardized reading and mathematics testing in Texas.

Results

There were 6623 children with reading scores in both the third and sixth grades and 6374 children with mathematics scores in both the third and sixth grades. Mean (± SE) scaled test scores for IVF and control singleton children for reading were 1544.6 ± 3.4 and 1527.7 ± 1.9, respectively, in third grade and 1701.2 ± 3.6 and 1681.0 ± 2.0, respectively, in sixth grade; for mathematics, the scores were 1564.4 ± 3.7 and 1548.9 ± 2.1, respectively, in third grade and 1774.0 ± 4.2 and 1752.0 ± 2.3, respectively, in sixth grade. In multivariate models, singleton IVF children scored significantly higher than control children in reading and mathematics, averaging 17.7 ± 4.0 points and 20.1 ± 4.1 points higher, respectively, in reading in third and sixth grades and 17.8 ± 4.4 points and 25.0 ± 4.8 points higher, respectively, in mathematics in third and sixth grades.

Conclusions

Children conceived with IVF and aged 8–9 years and aged 10–12 years performed as well on third and sixth grade reading and mathematics assessments as their counterparts conceived naturally.

     

The effects of add-back therapy with tibolone on myoma uteri

In this prospective, randomized, double-blind study, we evaluated the effects of tibolone therapy in association with preoperative gonadotropin releasing hormone agonist (GnRHa) therapy on the reduction of myoma volume. Twenty patients with myoma uteri were divided into two groups. Group I was given monthly triptoreline (3.75 mg every 28 days IM) treatment for six months. As for group II, tibolone was added on to this treatment. For all of the patients, physical examinations, pelvic ultrasonography, and hormone analyses were carried out and the myoma volume was measured by ultrasonography. The patients were called every month and physical examination, ultrasonography and hormone analyses were repeated. Side-effects were recorded. The SPSS/PC 6.0 program was used for statistical analysis. Statistical significance was defined as a p < 0.05. The results are expressed as means +/- SD. While the average volume of myoma was 72.97 +/- 68.5 cm3 in group I, 78.83 +/- 74.1 cm3 in group II before treatment; it was reduced to 29.91 +/- 27.8 cm3 in group I at the end of six months of treatment. Reductions of 59.6% in group I and 63.9% in group II were determined, however the difference was not statistically significant (p > 0.05). At the beginning the level of serum estradiol was 65.4 +/- 22.3 pg/ml in group I which decreased to 37.2 +/- 4.2 pg/ml by the end of the first month. Amenorrhea occurred in six patients after the second injection and four patients after the third injection in group I. Whereas the level of estradiol was 60.9 +/- 19.5 pg/ml in group II at the beginning, it was reduced to 40.5 +/- 6.2 pg/ml by the end of the first month. Amenorrhea occurred in four patients after the second injection and four patients after the third injection in group II. In group I the patients had the problem of flushing (80%), vaginal dryness (50%), and night sweats (30%). In group II these rates were 30%, 20%, and 20%, respectively. Triptoreline is a GnRHa which has been found to be effective in reducing myoma volume, but this effect could not be deactivated with tibolone. However, a decrease was observed in the side-effects resulting from hypoestrogenism.     

Does Parental Breastfeeding Knowledge Increase Breastfeeding Rates?

Objective: Although improving mothers' knowledge about breastfeeding can increase rates and duration of breastfeeding, little is known about the influence of fathers' knowledge. The purpose of this study was to assess the knowledge of mothers and fathers about breastfeeding before and after receiving postpartum advice and its relationship to the frequency of breastfeeding. Methods: A clinical trial was performed with mothers and fathers of normal children born at the Hospital de Clínicas de Porto Alegre, Brazil, between July 1994 and March 1995. The study intervention consisted of postpartum advice supplied by means of a video film discussing basic topics of breastfeeding, an explanatory leaflet, and open discussion after viewing the video. The first 208 couples comprised the control group, the next 197 comprised experimental group 1, and the remaining 196 comprised experimental group 2. Immediately after delivery, mothers and fathers in the three groups answered a test on breastfeeding knowledge; they completed the same test at the end of the first month. All families received home visits at the end of the first, second, fourth, and sixth months, or until breastfeeding ceased. Logistic regression was used to evaluate the association between the mothers' and fathers' knowledge and frequency of breastfeeding. Results: Postpartum advice increased the breastfeeding knowledge of mothers and fathers. The mothers with the highest level of knowledge had a 6.5 times higher chance of exclusively breastfeeding at the end of the third month, and 1.97 times higher chance of continuing breastfeeding to the end of the sixth month compared with other mothers. The fathers' knowledge also significantly influenced breastfeeding rates. The children whose fathers knew more had a 1.76 higher chance of being exclusively breastfed at the end of the first month, and 1.91 higher chance of receiving maternal milk at the end of the third month. Conclusion: A simple, inexpensive strategy can increase the level of breastfeeding knowledge of mothers and fathers and, consequently, have a positive impact on the frequency of breastfeeding.     

Tourette综合征患儿链球菌感染及其免疫功能检测

目的通过测定Tourette综合征(TS)患儿血清抗链球菌溶血素O(ASO)、T淋巴细胞亚群和自然杀伤细胞(NKC)，观察链球菌感染与TS的关系、TS细胞免疫功能状态及免疫调节剂的治疗作用。 方法2005 05—2005 10对首都儿研所神经科门诊就诊的58例TS患儿分别采用透射比浊法检测ASO，双色免疫荧光法检测T淋巴细胞亚群及NKC。以同期健康体检儿童为对照组。对细胞免疫异常者随机分为两组，分别予免疫调节剂或免疫调节剂+多巴胺受体阻滞剂治疗。 结果(1)TS患儿ASO阳性率较对照组显著增高(P<0.05)；(2)TS患儿中，ASO阳性组CD+4显著低于ASO阴性组(P<0.05)；TS患儿CD+3、CD+4、CD+4/CD+8显著低于对照组(P均<0.05)，NKC显著高于对照组(P<0.05)；(3)细胞免疫异常的TS患儿，单纯采用免疫调节剂治疗或免疫调节剂+多巴胺受体阻滞剂治疗，两组间疗效差异无显著性(P>0.05)。 结论部分TS患儿发病与链球菌感染有关；TS患儿存在细胞免疫功能改变，表现为T淋巴细胞亚群平衡失调和NKC升高,链球菌感染可能与之有关；单纯免疫调节剂治疗可能对链球菌感染触发的TS有效。     

Adrenal function under long-term raloxifene administration.

The aim of the present study was to evaluate the effect of long-term (12 months) administration of raloxifene hydrochloride (60 mg/day) on the steroid production of the adrenal cortex and on the hypothalamic-pituitary-adrenal axis in postmenopausal women. We performed a basal evaluation, a corticotropin releasing factor (CRF) (100 microg i.v. bolus) test and a dexamethasone (DXM) (0.25 mg) suppression-adrenocorticotropic hormone (ACTH) (10 microg i.v. bolus) stimulation test in 11 postmenopausal women, before and after 3, 6 and 12 months of raloxifene treatment. Raloxifene administration significantly modified circulating levels of adrenal steroids, decreasing cortisol (-24%), dehydroepiandrosterone (DHEA) (-36%), and its sulfate (DHEAS) (-41%), and androstenedione (-29%), and increasing circulating allopregnanolone (+39%) levels. Progesterone and 17OH-progesterone levels remained unmodified, while estradiol and estrone levels showed a significant decrease (-51% for estradiol and -61% for estrone). We also observed an increase in circulating ACTH (+58%) and beta-endorphin (+120%). No modifications in the hormonal responses to CRF were observed during the treatment. DXM significantly suppressed circulating steroids at any time with a lower suppression of cortisol from the third month and a higher suppression of DHEA at 12 months. ACTH administration was associated with a significantly blunted cortisol response from the sixth month and a significantly increased response of allopregnanolone from the third month. The present data exclude a raloxifene effect on pituitary sensitivity to CRF and demonstrate a reduced adrenal sensitivity to ACTH, sustained by the opposite changes in basal cortisol and Delta5 androgens, which were reduced, and in ACTH and beta-endorphin, which were increased, as well by the reduced response of cortisol to the direct ACTH stimulus. The reduction of circulating cortisol levels and cortisol response to the ACTH challenge suggests that raloxifene protects against the neurotoxic effects of endogenous glucocorticoids. Furthermore, the progressive increase in basal allopregnanolone and its increased response to ACTH indicate that chronic raloxifene administration exerts direct effects on the pattern of adrenal enzymes, leading to specific changes in the circulating levels of this anxiolytic progesterone metabolite. The important reduction in the circulating levels of estradiol and estrone under long-term raloxifene administration may represent a further mechanism by which this molecule may exert a protective effect against breast and endometrial malignancies.