雷公藤多甙和丙酸倍氯米松治疗激素依赖性哮喘的临床观察

３０例激光依赖軎才喘随机分为治疗组和对照组，治疗组口服雷公藤多甙和吸入丙酸倍氯米松，对照组吸入ＢＤＰ，结果表明，治疗组撤减口服激素成功率８６．６７％，对照组为４０．０％（Ｐ〈０．０５），两组病人治疗前后ＰＥＦＲ均有明显好转（Ｐ〈０．０１），血皮质醇浓度较治疗前提高（Ｐ〈０．０１），治疗组皮质醇升高较对照组尤为显著（Ｐ〈０．０５），提示雷公藤多甙与ＢＤＰ联合用药是治疗激素依赖型哮喘的较好方法。     

肾综合征出血热患者血,尿肽结合羟脯氨酸测定的临床意义

用紫外分光光度法测定了１５例正常人和３７例肾综合征出血热（ＨＦＲＳ）患者在不同病期血、尿肽结合羟脯氨酸（ＰＨＰ）的改变。３７例ＨＦＲＳ患者血ＰＨＰ均高于正常人（Ｐ〈０．００１）；尿ＰＨＰ排出量（μｍｏｌ／２４ｈ）在发热期、恢复期接近于正常人（Ｐ〉０．０５），在低血压休克期、少尿期均低于正常人（Ｐ〈０．００１），多尿期高于正常人（Ｐ〈０．０５）。低血压休克期和少尿期血ＰＨＰ与血尿素氮（ＢＵＮ）、肌酐     

不同剂量地塞米松治疗新生儿缺氧缺血脑病的临床研究

目的 探讨不同剂量地塞米松治疗新生儿缺氧缺血脑病（ＨＩＥ）的新疗及对肾上腺皮质功能的影响。方法 将ＨＩＥ新生儿分为地塞米松大剂量治疗组共２９例,小剂量治疗组３０例。两组生后于治疗前后测定血浆过氧化脂质（ＬＰＯ）、一氧化氮（ＮＯ）、血皮质醇（ＰＴＣ）和促肾上腺皮质激素（ＡＣＴＨ）水平,并进行治疗后新生儿行为神经（２０项ＮＢＮＡ评分）测定。结果 ＨＩＥ时,ＬＰＯ、ＮＯ均有明显升高（Ｐ〈０．０５或〈０．０１）,血ＰＴＣ升高,而ＡＣＴＨ基本正常。大剂量治疗后ＬＰＯ、ＮＯ、ＰＴＣ有明显下降而小剂量组则不明显。治疗后２０项ＮＢＮＡ评分在大剂量组明显高于小剂量组（Ｐ〈０．０５）。结论 短程大剂量地塞米松治疗ＨＩＥ确有一定疗效,且未发现血ＰＴＣ紊乱和肾小腺皮质功能受抑。     

结节病患者BALF—ACE的变化及其临床意义探讨

本文应用笠原法检测２０例结节病患者（０期１例，Ｉ期４例，Ⅱ期１５例）ＢＡＬＦ－ＡＣＥ和ＳＡＣＥ的水平，并以过敏性哮喘和正常人各５例为对照。结果发现结节病患者无论ＳＡＣＥ是否增高，ＢＡＬＦ－ＡＣＥ均可测得，对照组均为阴性，且ＢＡＬＦ－ＡＣＥ与ＳＡＣＥ之间存在显著相关（ｒ＝０．５０１，Ｐ〈０．０５）；经糖皮质激素治疗８例，用药前后ＢＡＬＦ－ＡＣＥ和ＳＡＣＥ均有明显降低（Ｐ〈０．０５）。提示：ＢＡＬＦ－     

API0134对血小板α颗粒膜蛋白和血小板聚集的影响

２０例急性心肌梗死患者在溶栓后随机分为穿心莲有效成分（ＡＰＩ０１３４,ＡＰＩ）组与对照组,治疗１５ｄ,均同时给予阿司匹林等药物。检测溶栓前后血浆α颗粒膜蛋白（ＧＭＰ－１４０）浓度和ＡＤＰ诱导的血小板聚集反应。结果表明,ＡＰＩ组溶栓后７２ｈ血ＧＭＰ－１４０浓度轻度增加,对照组显著性增加（Ｐ〈０．０１）,ＡＰＩ组ＧＭＰ－１４０在溶栓后７２ｈ和１５ｄ均义（７２ｈ,Ｐ〈０．０５;１５ｄ,Ｐ〈０．０１）。研     

用血液分析仪检测手指与耳垂血常规的对比观察

使用血液分析仪检测住院患者８１人、门诊体检者１９人，同时采耳血、手指血。体检者同时取手指血、静脉血作血液参数。结果血红蛋白（Ｈｂ）耳血与手指血差异有高度显著性，（Ｐ〈０．００１），而手指血与静脉血Ｈｂ则无差异（Ｐ〉０．０５）。白细胞（ＷＢＣ）耳血也略高于手指血（Ｐ〈０．０５），而正常人静脉血与手指血ＷＢＣ则无差异（Ｐ〉０．０５）。红细胞（ＲＢＣ）血小板ＰＬＴ耳血与手指血则无差异（Ｐ〉０．０５）。因     

长期吸入二丙酸氯地米松对哮喘患者肺功能及HPA轴的影响

观察３６例哮喘患者吸入类固醇激素（二丙酸氯地米松，ＢＤＰ）后对临床症状、肺通气功能、气道高反应性（ＡＨＲ）及下丘脑－垂体－肾上腺轴（ＨＰＡ）的影响。实验分三阶段进行：第一阶段ＢＤＰ剂量６００－９００μｇ／ｄ，第二阶段３００－４００μｇ／ｄ，第三阶段为停药观察病情转归。第一阶段临床有效率８７．５％，ＦＶＣ、ＦＥＶ１．０、ＰＥＦＲ、Ｖ５０及Ｒｒｓ．Ｃ、Ｄｍｉｎ均较治疗前显著改善，Ｓｄ无变化，血浆皮质醇     

剖腹手术及腹腔镜行胆囊切除术对肺功能影响的比较

目的：探讨腹腔镜及传统剖腹手术行腹腔胆囊切除术对术后肺功能的影响。方法：选择２０例腹腔镜组（Ａ组）、１６例剖腹手术组（Ｂ组）进行比较。结果：Ａ组仅在术后ｄ１和术前比较差异有显著性意义（Ｐ〈０．０５），Ｂ组在术后ｄ１￣ｄ７时肺功能指标较术前差异有显著意义（Ｐ〈０．０５），Ａ组与Ｂ组比较，术后至ｄ５或ｄ７时差异仍有显著意义（Ｐ〈０．０５），Ａ组术后肺功能明显优于Ｂ组。结论：使用腹腔镜行胆囊切除术对肺功     

鼻高反应性的检测及其临床意义

目的 探索常年性鼻炎特征：鼻高反应性和其在不同鼻病的表现及其临床意义。方法 将组胺配制成不同浓度,滴入滤纸片上,放在下鼻甲,检测５组患者及正常人鼻高反应性,（１）１６例常年性变应性鼻炎,（２）１５例常年性非变应性鼻炎,（３）１１例常年性鼻炎合并哮喘,（４）５例哮喘,（５）９例肥厚性鼻炎,（６）１６例正常人。结果 各组鼻高反应性强度依次为是（３）〉（１）,（２）（Ｐ〈０．０５）〉（４）（Ｐ〈０．０５     

高血压病并靶器官损害动态血压的变化

对１９９例高血压病患者（其中无靶器官损害者５１例，并靶器官损害者６８例）进行了２４小时动态血压监测（ＡＢＰＭ），结果显示，无靶器官损伤者血压流动曲线与正常人相似，基本呈“勺型者”（ｄｉｐｐｅｒ）心脑器官损害者的ｎＳＢＰ，ｎＤＢＰ及ｎＳＢＰ／ｎＳＢＰ，ｎＤＢＰ／ｄＤＢＰ较无靶器官损害者明显增高，有显著性或高度显著性差异（Ｐ〈０．０５，Ｐ〈０．０１）。肾脏损害者其２４ｈＳＢＰ，２４ｈＤＢＰ，ｄＳＢＰ，     

吸入糖皮质激素及联用长效β_2受体激动剂在儿童哮喘中的应用

目的:观察四种方法治疗儿童哮喘的疗效。方法:符合入选条件的哮喘患儿随机分为四组。A组42例:吸入沙美特罗替卡松干粉剂,每日早、晚各1吸;B组45例:吸入布地耐德干粉吸入剂,每日早、晚各2吸并联用福莫特罗干粉吸入剂,每日早、晚各1吸;C组48例:应用布地耐德干粉吸入剂,每日早、晚各1吸;D组43例:应用丙酸氟替卡松气雾剂,每日早、晚各1喷借助筒式吸舒吸入。吸入时间均为24周。观察晨间最大呼气峰流速占预计值的百分数为主要疗效指标。结果:治疗后第1周及第4周与治疗前相比,吸入治疗无论单用糖皮质激素或糖皮质激素联用长效β2受体激动剂均有差异性(P<0.05)。治疗后第8周、第12周及第24周与第4周相比差异无显著性。而4组间的比较差异无显著性。而使用短效β2受体激动剂方面4组患儿组间及用药前后均无差异。结论:大部分儿童哮喘患儿可以单用吸入糖皮质激素就能达到治疗效果。如果病情较重或病程较长者治疗初期可以先试用联合制剂,待病情稳定后改为吸入糖皮质激素。     

Adrenal crises in children treated with high-dose inhaled corticosteroids for asthma

Three children presented with adrenal crises, manifested by vomiting and hypoglycaemia, after protracted courses of high-dose inhaled corticosteroids for asthma. Significant dose reduction was possible in all three without loss of asthma control, emphasising the importance of back-titration to minimise dose. Parents of children taking high doses of inhaled corticosteroids should be alerted to the clinical features of adrenal insufficiency. If suspected, prompt medical assessment should be arranged, including serum glucose and cortisol measurement.     

Systemic activity of inhaled and swallowed beclomethasone dipropionate and the effect of different inhaler devices

Inhaled glucocorticoids such as beclomethasone dipropionate, which are used in the treatment of asthma, may be associated with systemic adverse effects. To determine whether any systemic absorption following the inhalation of beclomethasone was a result of drug being absorbed from the lung (inhaled fraction) or the gastrointestinal tract (swallowed fraction), we studied normal subjects after the inhalation or swallowing of 2 mg beclomethasone dipropionate. Systemic activity was assessed using early morning cortisol suppression. Both inhaled and swallowed fractions produced significant systemic activity, the degree of which depended on the inhaler device used. Systemic activity was greater using a dry powder inhaler (52%) than using a metered dose inhaler with a large volume spacer (28%). These findings suggest that to limit potential adverse effects from high-dose beclomethasone dipropionate it is better to use a metered dose aerosol with large volume spacer than a dry powder.     

毛细支气管炎患儿吸入激素治疗后血清皮质醇的变化

目的:探讨吸入布地奈德早期干预毛细支气管炎(毛支)对减少哮喘发病率的影响及血清皮质醇水平的动态变化。方法:将75例毛支患儿临床缓解后随机分为两组,干预组33例(失访3例)吸入布地奈德3个月,未干预组42例(失访13例)不再用药。两组病人干预前测定血清皮质醇基础值,12周后复查。以21例无喘息症状的同龄儿为正常对照组。结果:112周后干预组30例血清皮质醇虽有一定程度的下降,但与未干预组29例相比无显著性差异(P>0.05)。2随访至1年时干预组哮喘发病率(16.7%)低于未干预组(44.83%),两者相比有显著性差异(P<0.05)。干预组喘息复发率(30%)低于未干预组(58.62%),两组相比有显著性差异(P<0.05)。结论:毛支患儿早期吸入激素干预治疗可降低哮喘发病率,对肾上腺皮质功能无明显影响。     

小剂量吸入激素与β受体激动剂对哮喘的治疗作用

目的:研究β受体激动剂合并小剂量皮质类固醇对哮喘患者的疗效及对下丘脑-垂体-肾上腺轴的影响.方法:43例轻、中度的哮喘患者随机分成两组.β受体激动剂组(A组)21例,给予沙丁胺醇(1～2喷/次),加二丙酸倍氯米松(BDP)每天300 μg吸入;单纯激素组(B组)22例,仅给予BDP每天600 μg吸入及每晚吸入安慰剂,...     

Rapid assessment of corticotropin reserve after pituitary surgery

Corticotropin deficiency may occur after pituitary surgery, and, if unrecognized and untreated, it can be fatal. In this study the insulin tolerance test was used to assess hypothalamic-pituitary-adrenal reserve five to seven days after pituitary surgery, and postoperative morning serum cortisol concentration was compared with the insulin tolerance test for predicting corticotropin deficiency. In 35 patients with pituitary tumors studied prospectively, 27 had normal insulin tolerance test results five to seven days after pituitary surgery; in these patients, the morning serum cortisol concentration two to three days after surgery was 250 nmol/L (9 micrograms/dL) or greater. Eight patients had subnormal insulin tolerance test results or clinical evidence of adrenal insufficiency; the morning serum cortisol concentration in these patients was 80 nmol/L (3 micrograms/dL) or less. Postoperative adrenal insufficiency was transient (one to three months) in five of these eight patients. We retrospectively identified 45 patients whose postoperative morning serum cortisol values were 200 nmol/L (7 micrograms/dL) or greater; none of these patients had clinical evidence of adrenal insufficiency. We conclude that a morning serum cortisol level obtained two to three days after surgery and 24 hours after the discontinuation of hydrocortisone accurately predicts postoperative corticotropin reserve.     

Adrenal insufficiency after operative removal of apparently nonfunctioning adrenal adenomas

We describe a woman who developed adrenal insufficiency after removal of an apparently nonfunctional adrenal adenoma. She displayed no stigmata of Cushing's syndrome and had normal plasma and urinary cortisol levels. A second patient without clinical findings of Cushing's syndrome also had normal basal steroid levels. This patient displayed partial suppressibility with dexamethasone, had low-normal levels of serum corticotropin, and excreted a low concentration of urinary 17-ketosteroids. She also developed mild adrenal insufficiency after the operation. We believe the adrenal adenomas in these patients secreted enough cortisol to suppress the contralateral adrenal gland but not enough hormone to elevate basal steroid levels. Therefore, we suggest that all patients with adrenal masses be studied with the overnight dexamethasone suppression test rather than basal steroid hormone measurements to detect low levels of autonomous cortisol secretion. In addition, patients with adrenal masses that are not removed surgically should have serial adrenal function tests performed.     

Dopaminergic modulation of human bronchial tone

BACKGROUND: Dopamine exerts inhibitory and excitatory effects on different systems. Its effect on human bronchial tone is controversial. It has been reported that dopamine has no acute effect on human airways from normal subjects or those with asthma background. However, inhaled or infused dopamine decreased histamine-induced bronchoconstriction in both normal and asthmatic subjects. METHODS: We examined the possible modulating effect of dopamine on bronchial diameter by administering inhaled dopamine and the DA(2) dopaminergic blocker metoclopramide (MTC) to subjects with various degrees of bronchial tone.We examined 50 volunteers. Arterial blood pressure and heart rate were determined in each subject. By means of spirometry, we measured forced vital capacity (FVC), forced expiratory volume in the first second (FEV(1)), maximal forced expiratory flow (FEF(max)), and forced expiratory flow at 50% of vital capacity (FEF(50)), before and after each treatment. By inhalation with a nebulizer, we administered the following: a) dopamine (0.5 microg/kg/min) to 10 healthy subjects, 10 subjects with asthma without acute bronchospasm (AWAB), and nine subjects with acute asthma attack (AAA), and b) intravenous (i.v.) metoclopramide (7 microg/kg/min) was administered to 10 healthy subjects and 11 subjects with AWAB. For ethical reasons, MTC was not used in subjects with acute asthma attack. Non-parametric Wilcoxon test for paired samples, ANOVA test, and Bonferroni multiple comparison test were performed.Inhaled dopamine increased FEV(1) and FVC, FEF(max), and FEF(50) in the AAA group, but there were no modifications in the healthy group or in the AWAB group. Metoclopramide did not induce changes in respiratory parameters in healthy individuals or in those with AWAB. CONCLUSIONS: Inhaled dopamine is able to induce bronchodilatation when the bronchial tone is already increased by acute asthma attack but did not modify the resting bronchial tone in normal subjects or in asthmatics without acute bronchospasm. Additionally, DA(2) blockade with metoclopramide did not modify resting bronchial tone. Dopamine exerts a modulatory effect on the bronchial tone of human airways depending on the degree of preexisting tone.     

消化性溃疡的皮质醇分泌异常

采用放射免疫测定法研究了70例非应激性消化性溃疡患者的皮质醇分泌状态;并比较了患者与84例正常人的血清皮质醇浓度及其昼夜分泌节律。发现非应激性消化性溃疡血清皮质醇浓度明显高于健康对照组(P<0.01);然昼夜分泌节律相仿。结果提示,非应激性消化性溃疡有皮质醇分泌的明显异常。     

吸入性糖皮质激素对慢性阻塞性肺疾病患者糖代谢的影响

目的研究长时间使用吸入糖皮质激素对慢性阻塞性肺疾病（COPD）合并糖尿病患者糖代谢的影响。方法选择合并Ⅱ型糖尿病的肺功能Ⅲ～Ⅳ级COPD缓解期患者92例,长期吸入沙美特罗/氟替卡松干粉剂,观察治疗前及治疗3个月、半年后患者肺功能（FEV1、FEV1%）和空腹血糖、糖化血红蛋白、胰岛素、C-肽指标改变。结果使用吸入皮质激素3个月、半年后肺功能与治疗前比较有统计学意义（P〈0.05）,同时糖代谢指标与治疗前差异无统计学意义（P〉0.05）。结论长期吸入糖皮质激素对合并糖尿病的COPD患者糖代谢无明显影响。