球后视神经炎患者的情绪改变及心理护理

球后视神经炎发病急,视力下降显著,使患者的生活质量急剧下降[1],极易产生焦虑、恐惧、抑郁等心理状态,因此心理护理尤为重要.笔者对2005-01～2007-06在我科收治的52例球后视神经炎患者进行情绪及精神状态分析,有针对性的开展心理护理,现报告如下.……     

间歇性激素冲击疗法对急性球后视神经炎患者视功能恢复及自身免疫抗体的影响

目的探讨间歇性激素冲击疗法对急性球后视神经炎患者视功能恢复及自身免疫抗体的影响。方法抽取商丘市第三人民医院收治的64例急性球后视神经炎患者,通过随机数字表法分为研究组与对照组各32例。对照组采用地塞米松治疗,研究组采用甲泼尼龙进行间歇性激素冲击治疗,2组均持续治疗3个月,3个月后随访。疗程结束时统计2组临床疗效、不良反应发生率,对比治疗前后2组自身免疫抗体[水通道蛋白4抗体(AQP4-Ab)、抗核抗体(ANAs)]阳性率及视力水平变化情况。结果研究组总有效率(87.50%)高于对照组(65.63%),差异有统计学意义(P0.05);治疗前2组视力水平比较,差异无统计学意义(P0.05),治疗后2组视力水平均较治疗前增高,且研究组高于对照组,差异有统计学意义(P0.05);治疗前2组ANAs、AQP4-Ab阳性率比较,差异无统计学意义(P0.05),治疗后2组自身免疫抗体阳性率均较治疗前降低,且研究组ANAs、AQP4-Ab阳性率低于对照组,差异有统计学意义(P0.05);研究组不良反应发生率(31.25%)高于对照组(21.88%),但差异无统计学意义(P0.05)。结论间歇性激素冲击疗法治疗急性球后视神经炎效果显著,可降低自身免疫抗体阳性率,提高治疗效果及视力水平。     

甲基强的松龙冲击疗法治疗放射性脑水肿的疗效

目的 探讨甲基强的松龙（MP）冲击疗法治疗放射性脑水肿（RCE）的临床疗效。方法 回顾性分析2001~2012年收治46例的RCE的临床资料。26例给予MP冲击疗法（观察组）,20例给予地塞米松等传统治疗（对照组）。治疗30 d,评估临床疗效,分为显效、有效、无效、进展;总有效=显效+有效;根据中华医学会第二次全国脑血管病学术会议制定的评分标准评定神经功能缺损程度,分为基本治愈、显著进步、进步、无变化、恶化、死亡;采用修订的Barthel指数评定法评定日常生活活动能力。结果 观察组总有效率（90.91%）与对照组（72.22%）无统计学差异（P>0.05）,但是显效率（36.26%）明显高于对照组（5.56%;P<0.05）。治疗后30 d,观察组神经功能评分[（8.15±3.25）分]与对照组[（7.65±3.77）分]较治疗前均明显降低（P<0.05）,但两组之间无统计学差异（P>0.05）。治疗后30 d,观察组Barthel指数[（84.04±12.41）分]与对照组[（84.50±7.59）分]较治疗前均明显增高（P<0.05）,但是两组之间无统计学差异（P>0.05）。观察组不良反应发生率（42.31%）与对照组（45.00%）无统计学差异（P>0.05）。结论 MP冲击疗法和传统地塞米松疗法对RCE均具有治疗作用,但MP冲击疗法对颅内压增高症状的改善更快、更明显     

大剂量甲基强的松龙治疗视神经炎的疗效观察

<正>视神经炎(optic neuritis,ON)是指累及视神经急性或亚急性的炎性脱髓鞘眼底病变,是眼科常见疾病之一,早期即出现视力下降、视野缺损,常为多发性硬化的首发表现。该病主要表现为单眼或双眼视力下降,病势急剧,严重者可无光感,致盲率较高。ON多见于青壮年和儿童,40岁以下发病者占86%[1]。本文分析甲强龙和地塞米松治疗视神经炎的疗效,现报道如下。1资料与方法     

大剂量丙种球蛋白、甲基强的松龙治疗重症肌无力

目的探讨依次采用大剂量丙种球蛋白静滴、大剂量的甲基强的松龙治疗重症肌无力的临床疗效。方法时符合Osserman分型的61例患者,随机分为两组：治疗组（A组）31例,依次采用大剂量丙种球蛋白厦大剂量的甲基强的松龙治疗;对照组（B组）30例,采用传统大剂量地塞米松静滴治疗;观察两组的临床疗效。结果治疗组症状缓解快,激素治疗过程中发生呼吸肌瘫痪、使用呼吸机现象少,住院时间短,疗效好（均P〈0．05）。结论依次采用大剂量丙种球蛋白、大剂量的甲基强的松龙冲击治疗重症肌无力的临床疗效好,值得临床推广。     

甲基强的松龙和地塞米松治疗放射性脑水肿的差异

目的研究甲基强的松龙及地塞米松治疗放射性脑水肿的差异。方法建立大鼠脑胶质瘤模型。实验分组：A组（大剂量甲基强的松龙组）、B组（小剂量甲基强的松龙组）、C组（地塞米松组）、D组（对照组）、E组（空白组）。各组均颅内种植肿瘤，于种植15天后A、B、C、D各组给予C060照射，A、B、C组大鼠照射前后分别给予甲基强的松龙和地塞米松治疗。测量大鼠脑水肿情况。结果治疗后，与其他各组比较，D组大鼠脑组织含水率最高，E组最低（P〈0．05）；C组大鼠脑组织含水率明显高于A、B两组（P〈0．05）；但A、B两组间无显著性差异（P〉O．05）。结论甲基强的松龙和地塞米松都可以有效防治放射性脑水肿，且甲基强的松龙比地塞米松疗效更好。     

大剂量甲基强的松龙治疗急性脊髓炎的疗效观察

应用大剂量甲基强的松龙冲击疗法１２例病情较重的急性脊髓炎病人，并与１４例应用常规剂量激素治疗的病人进行比较。结果大剂量甲基强的松龙冲击疗法的病人在肌力改善时间、排尿恢复时间及下地行走时间等方面比对照组均有明显缩短。两组间比较有显著差异（Ｐ〈０．０５，Ｐ〈０．０１０，表明大剂量甲基强的松龙治疗急性脊髓炎效果较好。     

大剂量甲基强的松龙治疗急性脊髓炎疗效评价

我院2003年至今收治的重症急性脊髓炎病人部分采用大剂量甲基强的松龙治疗,取得理想效果,现将观察结果报告如下. 1 资料与方法     

甲基强的松龙与地塞米松在小儿急性播散性脑脊髓炎治疗中的临床疗效

目的探讨甲基强的松龙和地塞米松对小儿急性播散性脑脊髓炎患者的临床疗效。方法择取2013-01—2015-01平顶山三所收治的160例小儿急性播散性脑脊髓炎患者为研究对象,采用抛掷硬币方式将其分成2组,观察组80例,给予甲基强的松龙治疗,对照组80例,给予地塞米松治疗,比较2组疗效。结果经临床治疗和评估比较,观察组有效率为97.5%,对照组为85.0%,观察组明显高于对照组(P0.05);2组患儿治疗后的不良反应情况表现为肥胖、食欲增加等,观察组与对照组的发生率分别为27.%、25.0%,差异无统计学意义(P0.05)。结论对小儿急性播散性脑脊髓炎患者行甲基强的松龙治疗效果明显,可在各基层医院推广应用。     

Immunological effects of oral high-dose methylprednisolone in acute optic neuritis and multiple sclerosis.

The immunological effects of high-dose methylprednisolone in attacks of multiple sclerosis and acute optic neuritis have only been examined in a few randomized, controlled trials. We studied immunological changes in 50 patients with optic neuritis or multiple sclerosis who underwent lumbar puncture before and 1 week after completing a 15-day course of oral high-dose methylprednisolone treatment. Treatment resulted in a decrease in the concentration of myelin basic protein, a decrease in the serum concentration of immunoglobulin G (IgG) and intrathecal IgG synthesis, an increase in the cerebrospinal fluid concentration of transforming growth factor-beta1, and changes in the expression of CD25, CD26, and human leukocyte antigen-DR (HLA-DR) on CD4 T-cells. No effect was seen on the cerebrospinal fluid leucocyte count or the cerebrospinal fluid activity of matrix metalloproteinase-9 (MMP-9). The lack of a persistent effect on cerebrospinal fluid leucocyte recruitment and MMP-9 activity, despite changes in IgG synthesis, T-cell activation, and cytokine production, suggests that modulation of the function of inflammatory cells may contribute to the clinical efficacy of oral high-dose methylprednisolone treatment in optic neuritis and multiple sclerosis.     

薄芝糖肽注射液治疗儿童急性面神经炎疗效观察

目的：观察薄芝糖肽注射液治疗儿童急性面神经炎的疗效。方法将50例患儿随机分为对照组、实验组,对照组22例给予常规治疗,实验组26例在常规治疗基础上加用薄芝糖肽注射液治疗。2个疗程后观察2组临床疗效。结果对照组治愈7例（31.8％）,好转8例（36.4％）,无效7例（31.8％）;实验组治愈16例（61.5％）,好转9例（34.6％）,无效1例（3.8％）;实验组治愈率和总有效率均高于对照组,差异有统计学意义（ P＜0.05）。结论薄芝糖肽注射液能明显提高急性面神经炎患儿的治愈率和总有效率,值得临床应用。     

A possible harmful late effect of methylprednisolone therapy on a time cluster of optic neuritis

Clinical records of all patients (n = 26) suffering from optic neuritis during the last 16 years re-evaluated in relation to treatment. The patients were treated in 3 ways: with prednisone; with "pulse" megadoses of methylprednisolone; and untreated. A possibly frightening conversion to multiple sclerosis was seen in the group of patients with methylprednisolone, compared with the other 2 groups.     

The treatment of experimental allergic neuritis by plasma exchange

Experimental allergic neuritis (EAN) is a demyelinating disease of the peripheral nervous system that can be induced in laboratory animals. This disorder has been considered to show many similarities to acute inflammatory polyneuropathy (Guillain-Barré syndrome, GBS). Reports that plasma exchange may benefit patients with GBS prompted the investigation of the effect of plasma exchange in EAN. A controlled study was performed on New Zealand White rabbits. Sixteen animals were allocated to control or treatment groups at the onset of the disease. Clinical assessment on days 7 and 14 showed that treated animals were less severely affected neurologically (P = 0.05, day 7; P < 0.001 day 14), with a commensurate reduction in the severity of the histological lesions in peripheral nerves.     

Cerebrospinal fluid myelin basic protein-like material in acute monosymptomatic optic neuritis

Introduction
Cerebrospinal fluid (CSF) may provide markers of severity and outcome of optic neuritis.
Material and methods We examined the CSF from 29 patients with acute monosymptomatic optic neuritis (AMON) for content of myelin basic protein-like material (MBPLM) and correlated the levels with results of cranial magnetic resonance imaging. The length of the time from onset of AMON to the time of CSF collection did not exceed four weeks.
Results Only two patients (7%), one of whom developed an acute myelopathy one month after AMON, showed an elevated value of CSF MBPLM. No MBPLM was detected in 6 patients (21%), and other 21 (72%) had detectable levels of MBPLM but below the upper limit of normal of 0.1 ng/ml. The value of MBPLM was not significantly correlated with the interval to CSF sampling from onset of AMON or with severity of decreased visual acuity. The highest values of CSF MBPLM were observed among patients with severely decreased visual acuity and among patients with an abnormal MRI (13 of 27 i.e. 48%).
Conclusions CSF MBPLM was rarely abnormal in AMON. However, CSF MBPLM may have potential value in reflecting disease activity, as the highest values were obtained among patients with CSF sampled soon after the maximum visual dysfunction was reached, with severe visual impairment, and with an abnormal MRI.     

原位末端标记检测实验性变态反应性神经炎胸腺细胞的凋亡

目的为了探讨地塞米松对实验性变态反应性神经炎（ＥＡＮ）小鼠胸腺细胞的影响。方法应用原位末端标记法和电镜检测ＥＡＮ小鼠胸腺细胞的凋亡。结果以上两种方法均发现地塞米松处理组胸腺细胞凋亡率明显高于自然病程组和正常对照组。结论地塞米松可明显增强ＥＡＮ小鼠胸腺细胞凋亡。     

复方樟柳碱治疗青少年急性视神经炎临床疗效和安全性分析

目的 探讨复方樟柳碱治疗青少年急性视神经炎临床疗效和安全性.方法 选取我院眼科2010-12-2012-12收治的50例青少年急性视神经炎患者为研究对象,应用随机数字表法分为对照组和观察组,对照组给予血管扩张剂、营养视神经的药物以及激素等治疗,观察组则在上述治疗基础上加用复方樟柳碱治疗.观察2组患者治疗的有效性及安全性.结果 观察组治疗总有效率88.0%,显著高于对照的56.0%.2组相比差异有统计学意义（P＆lt;0.05）.视觉诱发电位检查,观察组仅2例表现P100波潜伏期延长,对照组分别存在波幅延长、振幅下降现象,2组相比差异具有统计学意义（P＆lt;0.05）.结论 复方樟柳碱治疗青少年急性视神经炎疗效显著,具有安全、高效和不良反应少等特点.     

Prophylactic treatment of episodic cluster headache with intravenous bolus of methylprednisolone

Abstract. We evaluated the efficacy of intravenous boluses of methylprednisolone followed by prednisone as a prophylactic treatment for episodic cluster headache. Fourteen male patients (mean age, 42.54 years) with episodic cluster headache were treated with 250-mg boluses of methylprednisolone on 3 consecutive days, followed by prednisone (90 mg/day orally) with gradual tapering in four weeks. Headache parameters of the active phases treated with methylprednisolone were compared with those of previous active phases in the same patients treated with other prophylactic medications. The primary efficacy criterion was decrease in the frequency of attacks during the first month of treatment. The statistical differences were calculated using Wilcoxons test. The attacks were significantly less frequent in the active phases treated with methylprednisolone boluses than those treated with other medications (p<0.05). This treatment seems to be more effective than the usual prophylactic treatments for episodic cluster headache.     

Magnetic resonance imaging of the brain in patients with acute monosymptomatic optic neuritis

Ophthalmologists and neurologists from a catchment area of 1.5 million people were asked to refer all patients with symptoms and signs of optic neuritis (ON) to our neurological department immediately. A total of 68 consecutive patients were extensively screened for known etiologies of ON. Eleven had definite multiple sclerosis (MS); 7 patients could not participate for various reasons. The cerebrum, cerebellum and brainstem of the remaining 50 untreated patients with monosymptomatic ON were MRI scanned at 1.5 T with 2 sequences (slice thickness 4 mm, voxel size 1.2 x 1.2 x 4 mm3): double spin-echo (TR = 1.8 s, TE = 30 and 90 ms, 12 slices axially) and inversion recovery (TR = 2.45 s, TI = 400 ms, TE = 30 ms, 5 slices sagittaly). Magnetic resonance imaging (MRI) was performed within 3-49 (median 16) days from onset of symptoms. MRI demonstrated multiple asymptomatic central nervous system (CNS) lesions in 62% of patients. The appearance, locations and extents of lesions were consistent with demyelination. A scoring system based on number and size of lesions is proposed. Seven of 50 patients developed definite MS during a median follow-up of 11 months; they all had CNS lesions on the first scan. MRI has thus improved the pathophysiological knowledge of idiopathic ON, which from the very onset is a manifestation of MS in at least two thirds of cases. Patients who have early CNS lesions run a much higher risk of later developing clinically definite MS.