六味地黄丸对糖皮质激素联合免疫抑制剂治疗系统性红斑狼疮减毒增效作用的Meta分析

目的:评价六味地黄丸对糖皮质激素联合免疫抑制剂治疗系统性红斑狼疮的减毒增效作用。方法:计算机检索中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普网(VIP)、万方数据库、Pub Med、Embase,检索时间为从数据库建库到2014年12月,搜集六味地黄丸联合糖皮质激素、免疫抑制剂与糖皮质激素、免疫抑制剂治疗系统性红斑狼疮的随机对照试验,采用Cochrance系统评价方法评价纳入文献的质量,使用Revman 5.2统计软件对纳入的文献进行Meta分析。结果:共纳入4个随机对照试验,涉及251例患者,Meta分析结果显示,六味地黄丸联合激素及免疫抑制剂治疗SLE的总有效率与糖皮质激素、免疫抑制剂组相当,合并的OR值为2.07,95%CI=[0.96,4.44];六味地黄丸联合激素及免疫抑制剂治疗系统性红斑狼疮总的不良反应发生率少于对照组,合并的OR值为0.13,95%CI=[0.07,0.24]。结论:六味地黄丸联合激素及免疫抑制剂治疗系统性红斑狼疮的疗效与激素及免疫抑制剂组相当,不良反应少于后者。     

滋肾解毒化瘀汤治疗系统性红斑狼疮效果观察

目的探讨滋肾解毒化瘀汤治疗系统性红斑狼疮(SLE)的临床疗效,评价中药替代或减少激素和免疫抑制剂I治疗SLE的可能性。方法将60例阴虚内热型SLE患者随机分为对照组和观察组各30例。对照组给予常规剂量激素及免疫抑制剂治疗;观察组不用免疫抑制剂,在激素减量的基础上给予滋肾解毒化瘀汤治疗。比较两组治疗3个月后的疗效、SLE疾病活动性指数(SLEDAI)评分、实验室检查结果及随访1年内复发率。结果两组总有效率及复发率比较,差异无显著性意义(均P>0.05);SLEDAI评分和各实验室检查结果比较,差异有显著性意义(P<0.05,P<0.01)。结论滋肾解毒化瘀汤在一定程度上可替代SLE患者激素和免疫抑制剂的应用或减少其用量,且治疗SLE效果显著。     

肝移植术后免疫抑制治疗方案中激素的撤离--匹兹堡中心长期随访经验

肾上腺糖皮质激素类药物是临床上最常用的免疫抑制剂。长期应用免疫抑制剂包括激素的毒副作用一直是进一步提高肝移植术后长期存活率不可忽视的障碍。因此有关肝移植术后激素撤离的研究已引起诸多移植中心的重视，但迄今尚无成熟统一的方案。激素撤离及激素未能撤离原因的长期随访报道也不多见。为此，总结匹兹堡中心1989年8月至1992年12月进行1000例肝移植中，     

吗替麦考酚酯联合他克莫司治疗难治性肾病患者疗效及对肾功能和外周血NF-κB、TLR-7mRNA水平的影响

正肾病综合征(NS)是临床常见的慢性肾病,以水肿、大量蛋白尿等为主要表现。RNS是指经糖皮质激素治疗后出现激素依赖、激素抵抗、反复发作的NS~([1])。对于RNS患者,反复应用激素治疗疗效差、可致使病程迁延,甚至可引起感染、股骨头坏死等并发症~([2])。近年来,各种新型免疫抑制剂在RNS治疗中取得应用,被发现能够提高临床疗效,但单一用药仍难以满足临床需求~([3])。研究报道~([4]),不同作用靶点的免疫抑制剂联合应     

乙型肝炎病毒相关性肾炎的治疗

乙型肝炎病毒相关性肾炎(hepatitis B virus - associated glomerulonephritis,HBV -GN)是免疫复合物介导的继发性肾小球疾病之一.乙型肝炎病毒(hepatitis B virus,HBV)感染与免疫介导的炎症并存,导致其治疗棘手,当前HBV - GN在国内外都缺乏确实有效的治疗方案,目前的治疗方案主要有抗病毒、激素及免疫抑制剂、中西医结合治疗等,其中抗病毒治疗是其他治疗方法的基础,而糖皮质激素及免疫抑制剂的应用与否及其应用的疗程和剂量尚存在争议.     

利妥昔单抗治疗儿童难治性肾病综合征进展

肾病综合征（nephrotie syndrome，NS）是儿童最常见的肾小球疾病，大多数对激素有效，但约有60％会频繁复发甚至发展为激素依赖，此时加用免疫抑制剂（immunosuppresive agents，ISA）如环磷酰胺、环孢霉素、他克莫司、霉酚酸酯等有较好效果，可以减少激素用量，达到撤减激素的目的，但是仍有一些严重病例治疗困难，对上述免疫抑制剂反应欠佳甚至成年期后仍持续复发。     

不同病因脾切除前后免疫功能变化的研究

作者通过观察正常对照、肝硬变,激素负荷加免疫抑制三组动物模型和临床上外伤性脾破裂、肝硬变脾亢、血液病三组病人脾切除前后免疫功能的变化,发现正常脾脏切除后可导致术后免疫功能下降,但多数可逐步代偿;而肝硬变脾亢和长期应用激素和(或)免疫抑制剂的血液病患者,脾切除前包括脾脏在内的免疫器官已受损害,免疫功能已明显低下,这可能是导致脾切除后感染率较高的主要原因,而切除有免疫障碍的脾脏只是一个次要的因素。     

肝移植术后免疫抑制剂的替换应用

目的 探讨和总结肝脏移植术后免疫抑制剂的替换应用情况和经验。方法 回顾性分析我院1993年4月－2001年7月施行的67例肝脏移植，对48例早期肝移植患者中发生的免疫抑制剂替换应用情况进行总结。结果 48例患者中，21例（43．8％）因术后出现排斥反应或严重毒副作用而替换为其它免疫抑制方案。环孢素A（CsA 硫唑嘌呤（Aza)＋激素方案组（31例）中，15例（48．4％）进行替换；CsA 霉酚酸酯（MMF）＋激素组（14例）中，6例（43％）进行替换。发生排斥反应者常规应用激素冲击治疗，同时替换免疫抑制剂，将CsA替换为他克莫司（FK506）或提高CsA剂量，可获得有效控制；出现药物性肝损害者应及时减少CsA用量或成FK506，其肝功能多能改善；出现肾功能损害者应减少CsA用量并改联用MMF，或替换成FK506后可有效挽救肾功能；白细胞减少或严重感染者，应停用Aza或MMF，或将CsA改为FK506后可有效挽救肾功能；白细胞减少或严重感染者，应停用Aza或MMF，或将CsA改为FK506；神经系统病变经更换免疫抑制剂可以好转。结论 合理应用免疫抑制剂是提高肝移植成功率的关键之一；治疗中应视具体情况及时、果断、合理地转换免疫抑制剂，可以有效控制排斥反应、毒副作用及相关并发症，提高移植肝的存活率。     

低剂量激素方案在肾移植中应用的疗效和安全性

皮质类固醇激素是肾移植术后常用的免疫抑制剂,但长期使用激素会带来许多不良反应,因此近年来国内外许多移植中心都尝试在肾移植术后早期降低激素剂量以减少激素的不良反应[1,2].     

肝癌肝移植免疫抑制治疗中激素的撤离

<正>肝移植开展初期,由于缺乏可供选择的免疫抑制剂,肾上腺皮质激素(激素)在肝移植术后免疫抑制治疗中占据主导地位,且对提高肝移植手术的成功率作出了重要的贡献。随着新型免疫抑制剂的不断研发,免疫反应作用机制认识的逐步深入,以及激素引发的多种不良反应,如代谢性疾病、感染,以及原发病[原发性肝癌(肝癌)、病毒性肝炎]复发等,国内外众多学者一直在研究相对理想的激素撤离方案。本文就目前肝癌肝移植免疫治疗中激素的撤离方案作一简述。     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.