复方甘草酸苷联合丹参酮治疗中度痤疮的疗效观察

目的 观察复方甘草酸苷联合丹参酮胶囊治疗中度寻常型痤疮的疗效与安全性。方法79例中度寻常型痤疮患者随机分为两组。治疗组40例,口服复方甘草酸苷片和丹参酮胶囊;对照组39例,口服丹参酮胶囊。两组患者在口服药物同时均外用护肤粉刺霜。疗程均为8周。于用药前、用药后2、4、8周末分别记录面部各种皮损的实际数目、全身以及局部不良反应。并分别在用药前、用药后8周检测血清肿瘤坏死因子α(TNF-α)、白介素8(IL-8)、白介素10(IL-10)水平。结果治疗8周后治疗组与对照组有效率分别为82.5％、60.52％(P=0.028),表明治疗组有效率明显高于对照组;复方甘草酸苷联合丹参酮治疗后痤疮复发率低、无明显不良反应。此外,治疗组患者血清IL-8水平由153.9±17.74pg/ml降为80.5±23.91pg/ml(P＜0.01);TNF-α水平由45.3±6.49pg/ml下降到19.5±4.87pg/ml(P＜0.01);IL-10水平由153.0±38.89pg/ml上升至261.3±15.60pg/ml(P＜0.01)。对照组患者血清IL-8水平由156.2±18.40pg/ml下降为129.7±6.24pg/ml(P＜0.01);TNF-α水平由46.5±7.46pg/ml下降为30.9±2.63pg/ml(P＜0.01)。对照组血清IL-10水平在治疗前后无明显改变(P＞0.05)。治疗后,治疗组血清IL-8、TNF-α的水平均较对照组显著降低(P＜0.01)而治疗组IL-10的水平较对照组显著升高(P＜0.01)。结论复方甘草酸苷联合丹参酮是治疗中度寻常型痤疮安全、有效的方法,且具有调节患者血清TNF-α、IL-8、IL-10水平的作用。     

原发性肾病综合征患者治疗前后血及尿IL-8、IL-13水平测定及其临床意义

目的探讨肾病综合征患者治疗前后血清及尿中IL-8、IL-13水平变化及其临床意义.方法采用ELISA法测定25例肾病综合征患者血清及尿中IL-8、IL-13水平并与正常对照进行比较.口服强地松(1mg/kg)8～12w后再次测定血清及尿中IL-8、IL-13水平并与治疗前相比较.结果治疗前血清、尿IL-8水平[(31.08±3.07)pg/ml、(46.22±1.83)pg/ml]较正常对照[(22.99±2.29)pg/ml、(24.61±1.04)pg/ml]显著升高(P＜0.05),血清、尿IL-13水平[(31.05±2.71)pg/ml、(65.80±12.50)pg/ml]较正常对照[(25.61=2.52)pg/ml、(53.5±6.41)pg/ml]显著升高(P＜0.05).治疗后血清、尿IL-8水平[(23.06±2.60)pg/ml、(25.85±4.01)pg/ml]较治疗前显著降低(P＜0.05),血清、尿IL-13水平[(27.40±7.09)pg/ml、(50.31±11.13)pg/ml]较治疗前显著降低(P＜0.05),与正常对照无显著差异.结论肾病综合征患者,血清及尿中IL-8、IL-13水平升高,两者均参与炎症过程,并在疾病的发展中起一定的作用,激素治疗在控制病情的同时,可降低IL-8、IL-13水平,故IL-8、IL-13水平变化一定程度上可提示病情变化,监测治疗效果.     

沙利度胺联合化疗治疗急性白血病临床疗效及对血管生成调控因子的影响

目的探讨沙利度胺联合化疗治疗急性白血病的临床疗效及对血浆血管内皮生长因子(VEGF)及碱性成纤维细胞生长因子(bFGF)水平的影响。方法将急性白血病患者38例随机分为观察组20例和对照组18例。2组均予以常规化疗方案标准剂量化疗,观察组同时口服沙利度胺100 mg/d,治疗前及治疗后8周分别采集外周血用双抗体夹心酶联免疫吸附法(ELISA)检测血浆VEGF及bFGF的水平变化及临床疗效。另设健康对照组16例。结果观察组与对照组有效率分别为85.0%(17/20)和44.4%(8/18),差异有统计学意义(P<0.05);治疗前血浆VEGF水平分别为(376.52±225.89)pg/ml、(312.49±121.62)pg/ml(P>0.05),高于健康对照组的(133.78±20.56)pg/ml(P均<0.05);治疗后分别为(206.71±33.67)pg/ml、(280.12±30.66)pg/ml(P<0.05),高于健康对照组(P均<0.05)。观察组与对照组治疗前血浆bFGF水平分别为(2.56±0.32)ng/ml、(2.43±0.30)ng/ml(P>0.05),均高于健康对照组的(1.78±0.41)ng/ml(P<0.05);治疗后分别为(2.10±0.15)ng/m1、(2.08±0.29)ng/ml(P>0.05),均高于健康对照组(P均<0.05);2组治疗后不良反应相比差异无统计学意义(P均>0.05)。结论沙利度胺联合化疗可提高急性白血病的临床缓解率,可能通过抑制血浆VEGF及其受体表达而发挥抗白血病作用。     

低剂量环磷酰胺联合泼尼松治疗多发性骨髓瘤的临床疗效及对血清VEGF、PDGF-BB水平的影响

目的 探讨低剂量环磷酰胺联合泼尼松治疗多发性骨髓瘤的临床疗效及其对血清血管内皮生长因子（VEGF）和血小板衍生生长因子BB（PDGF-BB）水平的影响。方法 54例难治或复发性多发性骨髓瘤患者给予低剂量环磷酰胺(CTX, 50mg／d) 联合泼尼松(Pred, 15mg／d) (CP方案) 持续口服,并于治疗前和治疗后2,4,6个月分别取患者的血清;应用ELISA法检测血清中VEGF和PDGF-BB的表达。结果 治疗总有效率达69%。其中有效并重复检测血清标本3次的患者30例（其中CR2例,VGPR4例,PR24例）,可评估无效患者7例。此30例有效组多发性骨髓瘤患者应用低剂量环磷酰胺联合泼尼松治疗前及治疗2,4,6个月后,血清VEGF(pg/ml)水平为516.68±59.6,394.48±56.71,267.58±32.1,216.66±19.9;PDGF-BB(pg/ml)水平为483.52±59.6,304.4±31.4,273.5±30.9,196.3±21.7;与治疗前相比均显著降低（P<0.01）。而7例无效组多发性骨髓瘤患者在治疗前及治疗后2个月血清VEGF(pg/ml)水平为498. 16±54.72,512.25±39.20,PDGF-BB(pg/ml)水平为488.23±44.21,452.33±39.13,与治疗前相比无明显差别（P>0.05）。结论 低剂量环磷酰胺联合泼尼松治疗多发性骨髓瘤患者有明显疗效,并明显降低血清VEGF及PDGF-BB水平。其在多发性骨髓瘤中的作用机制可能与抑制新生血管的生成有关。     

恩度联合TACE术治疗肝癌对患者血清VEGF、HIF-1A、OPN、MMP-9的影响及意义

目的 观察并探讨恩度联合肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)对肝癌(hepatocellular carcinoma,HCC)患者血清血管内皮生长因子(VEGF)、低氧诱导因子-1(HIF-1A)、骨桥蛋白(OPN)、基质金属蛋白酶(MMP-9)水平的影响。 方法 选择自2011年7月—2014年11月医院治疗的HCC患者80例,按照随机数字法分为2组,观察组和对照组各40例。对照组患者给予TACE治疗,观察组则在对照组基础上联合恩度治疗。治疗前及治疗后4周测定2组患者VEGF、HIF-1A、OPN和MMP-9水平变化,并在治疗结束后评价2组综合疗效及不良反应。 结果 术前2组VEGF、HIF-1A、OPN和MMP-9水平相比,差异不具有统计学意义(P＞0.05),治疗后,观察组VEGF、HIF-1A、OPN和MMP-9水平分别为(431.2±132.2)pg/ml、(58.4±0.7)ng/L、(76.4±18.2)μg/L和(194.3±82.2)ng/ml,对照组为(562.8±184.4)pg/ml、(62.4±1.1)ng/L、(88.3±19.2) μg/L和(238.4±94.4)ng/ml,观察组VEGF、HIF-1A、OPN和MMP-9水平均明显低于对照组(P＜0.05);观察组有效率为95.0%(38/40),对照组为77.5%(31/40),观察组有效率明显高于对照组(P＜0.05);2组不良反应发生率相比,差异不具有统计学意义(P＞0.05)。 结论 恩度联合TACE术治疗HCC能通过降低VEGF、HIF-1A、OPN和MMP-9水平来达到控制肿瘤进展的效果。      

非霍奇金淋巴瘤患者血清VEGF及Endostatin水平检测的临床相关研究

目的探讨非霍奇金淋巴瘤(non-Hodgkin's lymphoma,NHL)患者血清VEGF及Endostatin(ES)水平变化与其临床特征、治疗、预后因素的关系.方法采用ELISA法检测162例NHL患者和50例正常健康人血清VEGF及ES水平.结果①162例NHL患者血清中VEGF、ES水平(198.97±17.92)pg/ml和(34.82±7.91)pg/ml,均分别显著高于正常健康人(31.58±6.68)pg/ml和(16.80±3.87)pg/ml(P＜0.01),V/E比值也非常显著高于正常人.②NHL患者血清中VEGF、ES水平以及V/E比值与其恶性程度、临床分期和骨髓侵犯(VEGF除外)等显著相关(P＜0.05),而与其年龄、性别、细胞类型之间无明显关系.③50例NHL完全缓解(CR)患者血清中VEGF、ES水平及V/E比值均非常显著低于122例NHL初治患者(IP)(P＜0.01);但血清中VEGF、ES水平仍非常显著高于正常健康人(P＜0.01),而两者V/E比值差异并不明显(P＞0.05).39例复发/难治NHL患者(RRP)血清中VEGF水平显著高于IP组(P＜0.05),但其ES水平差异并不明显(P＞0.05),其V/E比值非常显著高于IP组(P＜0.01).④NHL患者血清VEGF、ES水平以及V/E比值与其预后指标LDH、CRP、β2-MG均呈显著正相关;血清VEGF、ES两者之间亦呈显著正相关.结论NHL患者血清中VEGF、ES水平升高,与淋巴瘤的恶性程度及肿瘤负荷大小密切相关,其两者的比值(V/E)对NHL患者的治疗、预后判断有重要意义.     

Formoterol对哮喘患者血清白细胞介素—8含量的影响

目的探讨长效β2-肾上腺素能受体激动剂formoterol(福莫特罗)在哮喘治疗中的抗炎途径.方法28例轻、中度发作期哮喘患者被随机分为两组formoterol治疗组14例,40μg每日2次,口服;procaterol(丙卡特罗)治疗组14例,50μg每日2次,口服,疗程4周.治疗前后ELISA法测定血清IL-8含量,同时测定肺通气功能.结果哮喘患者血清IL-8含量显著升高与同时测定的肺通气功能结果呈显著负相关(P＜0.02).formoterol治疗组血清IL-8含量由治疗前的(342.60±135.69)pg/ml降至治疗后的(170.93±82.83)pg/ml,差异有显著性(P＜0.005);procaterol治疗组血清IL-8含量由治疗前的(293.90±116.20)pg/ml降至治疗后的(232.00±112.72)pg/ml,差异无显著性(P＞0.05).两组IL-8治疗前后的差值比较差异有显著性(P＜0.01).结论formoterol治疗组IL-8下降更为明显,提示与formoterol抗炎作用有关.     

超声引导下射频消融治疗肝癌后VEGF和AFP的变化

目的:观察超声引导下射频消融治疗肝细胞性肝癌后患者血清VEGF、AFP的变化。方法:超声引导下经皮射频消融治疗46例肝细胞性肝癌,分别以ELISA法和免疫发光法测定患者术前、术后血清VEGF和AFP水平。结果:射频消融术前患者血清VEGF、AFP水平分别为263.69±95.71pg/ml、221.90±128.66ng/ml;术后即时稍有下降,分别为247.55±65.28pg/ml、210.65±95.48ng/ml;术后1周明显下降,分别为162.90±22.12pg/ml、125.17±79.97ng/ml;术后1月VEGF有所上升,为183.13±1.95pg/ml,而AFP继续下降,为41.57±39.07ng/ml。结论:超声引导下射频治疗肝细胞性肝癌可以有效消融肿瘤,消除了VEGF及AFP的来源,从而改善患者预后。     

卵巢上皮性肿瘤患者血清血管内皮生长因子的诊断及预后意义

目的探讨术前血清血管内皮生长因子(VEGF)检测在卵巢上皮性肿瘤诊断及预后判断方面的价值.方法利用酶联免疫吸附分析(ELISA)检测卵巢上皮性肿瘤患者(恶性47例,良性14例)术前血清VEGF浓度,11例正常妇女的血清作为对照.分析检测结果与临床资料的关系.结果血清VEGF检测结果,恶性组血清VEGF均值221.81 pg/ml(95%置信区间(CI)180.35～262.87 pg/ml),良性组均值158.21 pg/ml(95%CI 27.32～279.10 pg/ml),正常对照组均值121.48 pg/ml(95%CI 34.13～228.32 pg/ml).三组血清VEGF均数差异无显著性(P＞0.05).47例恶性上皮性卵巢肿瘤中,晚期患者(38例)的术前血清VEGF浓度比早期患者(9例)的高,差异有显著性(P＜0.05).肿瘤分化程度差(G3)的患者术前血清VEGF浓度高于肿瘤分化程度高(G1-2)的(P＜0.05).不同病理类型的患者术前血清VEGF水平无统计学差异(P＞0.05).对29例已经进行彻底的肿瘤细胞减灭术的患者随访,术前血清VEGF水平高的患者2年内肿瘤复发或远处转移的可能较大(P＜0.05).结论术前血清VEGF可能对反映患者的预后有一定价值.     

脑梗死患者血清TGF—β1、IL—8水平测定及意义

目的探讨血清转化生长因子β1(TGF-β1)、白介素8(IL-8)与脑梗死患者炎症损害之间关系.方法采取双抗体夹心ELISA法检测56例脑梗死患者、34例体检正常者血清TGF-β1、IL-8水平.结果脑梗死组TGF-β1、IL-8水平分别为(56.8±19.5)ng/ml、(98.8±62.7)pg/ml,对照组分别为(32.4±13.6)ng/ml和(29.5±13.8)pg/ml,两组TGF-β1、IL-8差异均有显著性意义(t=6.41,3.08,均P＜0.01).脑梗死组梗死体积≥6ml者(26例)TGF-β1、IL-8分别为(63.7±15.6)ng/ml、(94.3±61.3)pg/ml,梗死体积＜6ml者(30例)则分别为(50.7±20.8)ng/ml、(102.7±64.6)pg/ml,两者比较TGF-β1差异有显著性意义(t=2.61,P＜0.05),IL-8差异无显著性意义(t=0.09,P＞0.05).结论脑梗死患者血清TGF-β1、IL-8均升高,TGF-β1与脑梗死体积大小可能有关.     

反应停的抗肿瘤前景

反应停属镇静类药物,20世纪60年代因其致畸作用而被禁用。近年来由于发现其具有抗肿瘤的潜能,逐渐受到人们的重视,欧美各地的研究已将其应用于癌症治疗,反应停将有可能重新登上历史舞台,扮演一个重要角色。1反应停的发展史反应停(沙利度胺,酞咪哌啶酮,thalidomide)于1954年在前     

Canadian Thalidomide Experience

Data are presented on 115 children, including three sets of twins, born in Canada in 1961 and 1962 with congenital malformations associated with the use of thalidomide by their mothers in early pregnancy. The epidemiological method is described. Of the 115 children, 74 were alive at the time of reporting, 41 of these being severely handicapped; 8 had been stillborn; 33 had died. Limb involvement was usually bilateral, affecting the upper limbs alone in 42 cases, and the upper and lower limbs in 41. Of 112 mothers, only 60 had had the drug prescribed by the physician providing maternity care; 87 were estimated to have first taken the drug before their last menstrual period or within 56 days thereafter. A plea is made for the development of better methods of collecting information on the occurrence of congenital malformations, with the aid of practising physicians.     

Thalidomide, pregnancy and renal failure

A 26-year-old woman with upper limb phocomelia as a result of thalidemide embryopathy developed renal failure that required dialysis during pregnancy. The pregnancy was complicated by dialysis difficulties, uncontrollable hypertension and deteriorating renal function resulting in fetal loss at 26-weeks' gestation. The patient was left with end-stage renal failure and recently has undergone cadaveric renal transplantation. This case highlights the widespread effects, including urinary-tract abnormalities, that thalidomide may have and illustrates the peculiar difficulties in managing such a patient during and after pregnancy.     

Thalidomide: a re-look

Thalidomide was synthesized in 1954 in erstwhile West Germany and marketed as a sedative in over 46 countries until the early 1960s. Owing to serious teratogenic effects, the drug was withdrawn from the market in 1961. A chance observation suggested the utility of thalidomide in erythema nodosum leprosum (ENL). After many controlled and uncontrolled trials were published, the World Health Organization recommended its use in ENL. The Food and Drug Administration, USA approved it for use in ENL in July 1998. Only established and well-defined studies conducted to substantiate the efficacy of thalidomide have been included in this review. Thalidomide is considered the drug of choice for the treatment of ENL, but for other conditions, it is recommended only when resistance to the currently available form of therapy is encountered. Once the anti-inflammatory, immuno-modulatory, anti-TNF-alpha and anti-angiogenic properties of thalidomide were discovered, it was also tried in AIDS and related wasting, apthous ulcers, microsporidiosis and Kaposi's sarcoma. Thalidomide has no clinical place as an immunosuppressant in solid organ transplantation. However, it has a therapeutic role in graft-verus-host-disease. Among the dermatological conditions, thalidomide has been found to be effective in systemic lupus erythematosus, discoid lupus erythematosus, actinic prurigo and prurigo nodularis. Used correctly, it is a safe and effective medicine (except for its teratogenic potential and delayed neuropathy) in a variety of disease conditions.