甲泼尼松龙治疗系统性红斑狼疮血液系统损害的临床观察

目的探讨甲泼尼松龙冲击和常规剂量强的松治疗系统性红斑狼疮(SLE)血液系统损害的近期疗效。方法147例伴有血细胞减少的SLE患者,分别采用甲泼尼松龙冲击(试验组)和常规剂量强的松(对照组)治疗,治疗后第10天根据血常规结果判断疗效,并进行对比分析。结果与治疗前相比,试验组和对照组有效率分别为血红蛋白34.8%和14.0%,白细胞76.7%和63.0%,血小板66.7%和27.3%,两组治疗前后比较血红蛋白、白细胞、血小板差异均有统计学意义,P<0.01;两组间比较差异亦有统计学意义,P<0.05。结论从近期疗效看,甲泼尼松龙冲击治疗起效快,有效率高。     

人血免疫球蛋白治疗特发性血小板减少性紫癜

[目的]观察人血免疫球蛋白治疗特发性血小板减少性紫癜(ITP)的临床疗效。[方法]将符合诊断标准的58例ITP患者随机分为观察组和对照组,每组29例。2组均给予全反式维甲酸、泼尼松片治疗:全反式维甲酸,10mg/次,3次/d,口服;泼尼松片,1mg/(d.kg体质量),3次/d,口服。观察组同时给予人血免疫球蛋白静脉滴注,400mg/(kg.d),连用5d。2组均以治疗1个月为1个疗程,治疗1个疗程后评价疗效。[结果]观察组痊愈率51.72%,总有效率96.55%;对照组痊愈率34.48%,总有效率79.31%。2组痊愈率、总有效率比较差异有统计学意义(P﹤0.05)。PAIgG、PAIgM、PAIgA等观察指标治疗后2组组间相比差异有统计学意义(P﹤0.05),2组治疗前后组内相比差异有统计学意义(P﹤0.05)。外周血CD4+CD25+T及CD4+CD25highT阳性率、血小板计数2组治疗后组间相比差异有统计学意义(P﹤0.05)。2组有效止血时间、血小板上升时间、血小板恢复正常时间相比差异有统计学意义(P﹤0.05)。[结论]人血免疫球蛋白治疗ITP疗效显著,可缩短止血时间、血小板上升时间及血小板恢复正常的时间。     

Clinico-laboratory study of methylprednisolone and cyclophosphamide treatment in patients with multiple sclerosis relapse

INTRODUCTION: The effect of combined treatment (methylprednisolone and cyclophosphamide) of multiple sclerosis relapse within one year was investigated in an open clinical trial study of 70 patients. The sample comprised subjects shown to have clinically proven multiple sclerosis according to the criteria of C Poser and degree of neurological deficit according to EDSS rating from 2.5 to 6.0 points. MATERIAL AND METHODS: Methylprednisolone (200 mg, i.v., every other day, 10 doses, total course dose 2 g) was administered to 35 patients (mean age 31.34 +/- 1.53 years). Methylprednisolone using the same schedule and cyclophosphamide (200 mg, i.v.) given in the methylprednisolone-free day, 10 doses plus 200 mg i.v. once a month in the first three consecutive months (total course dose 2.6 g) were applied in another 35 patients (mean age 33.22 +/- 1.32 years). RESULTS AND DISCUSSION: The changes of EDSS ratings at the end of months 1 and 12, of the CD+ T-lymphocytes subpopulations and B-lymphocytes from peripheral blood--prior to treatment and between the 5th and 9th week of treatment were compared. The neurological deficit degree according to EDSS dropped significantly (P < 0.01; P < 0.001) after one month of treatment in both groups. At the end of month 12 this indicator reached its baseline value in the group treated only with methylprednisolone while remaining significantly lower in the combined therapy group (P < 0.01). After methylprednisolone and cyclophosphamide application the suppressor/inducer CD8+ T-cells increased significantly in percentage (P < 0.05), while the values of B-lymphocytes decrease significantly (P < 0.05), in contrast to the results from the methylprednisolone-only treatment. CONCLUSIONS: The results clearly indicate the greater efficaciousness of treatment by combining two immunosuppressive drugs.     

阿莫西林、咖啡酸联合强的松治疗ITP的临床研究

目的研究阿莫西林、咖啡酸及强的松联合治疗特发性血小板减少性紫癜的疗效。方法将98例初治特发性血小板减少性紫癜患者随机分为两组,治疗组和对照组各48例,对照组给予强的松1ms／（d·kg）,连用8周,治疗组除强的松外口服阿莫西林1000mg,连用7d,咖啡酸片0．3g口服,3次／d,连用8周,同时观察不良反应及ltlt]J,板变化。结果治疗组与对照组均未见明显不良反应发生。治疗组在第2周及第5周血小板提升作用强于对照组,差异有统计学意义（P〈0．05）。结论阿莫西林、咖啡酸及强的松三联治疗初治特发性血小板减少性紫癜经济、安全、有效,尤其适合于基层医院推广。     

甲强龙联合复方樟柳碱治疗ON的观察及护理

目的：观察糖皮质激素甲基强的松龙联合复方樟柳碱治疗视神经炎的疗效,并评估甲基强的松龙联合复方樟柳碱治疗的有效性和优越性。方法：视神经炎患者共51例（69只眼）随机分为治疗组和对照组,治疗组在常规治疗基础上联合应用复方樟柳碱,常规治疗为对照组。结果：两组疗效比较显示,治疗组总有效率（88.4%）明显优于对照组（56%）,差异具有统计学意义（P<0.05）。结论：甲基强的松龙联合复方樟柳碱治疗视神经炎有显著疗效。     

大剂量地塞米松对ITP患者调节性T细胞及叉头状转录因子FoxP3表达的影响

目的:观察特发性血小板减少性紫癜(ITP)患者调节性T细胞(Treg)和叉头状转录因子FoxP3的表达情况及地塞米松治疗前后的变化。方法:用流式细胞术检测ITP患者外周血Treg、FoxP3的表达情况并与正常人群进行比较、并同时记录大剂量地塞米松治疗前后ITP患者Treg、FoxP3的表达情况,比较激素治疗对机体免疫的影响。结果:ITP患者外周血中CD4+T细胞的比例显著低于正常组(P<0.05),CD4+CD25+Treg及CD4+CD25+T在总CD4+T细胞中所占比例也低于正常对照组(P<0.05)。ITP患者未经激素治疗前外周血中FoxP3表达比例明显低于正常对照组(P<0.05),经大剂量地塞米松治疗后Foxp3表达比例升高(P<0.05),与正常人群比较差别仍有统计学意义(P<0.05)。结论:ITP患者的Foxp3表达下降,CD4+CD25+Treg细胞患者数量减少,Treg及Foxp3在ITP的发生发展中起到重要作用,大剂量地塞米松可显著提高CD4+CD25+Treg及FoxP3的表达。     

大剂量甲基强的松龙冲击治疗Graves眼病的近期疗效及护理体会

目的阐述大剂量甲基强的松龙(MPSS)冲击治疗Graves眼病(Graves ophthalmopathy,GO)患者的临床疗效及护理体会。方法回顾我院39例应用大剂量MPSS冲击治疗的GO患者,观察患者在使用MPSS前后的全身情况及护理的重要作用。结果结果发现,患者经MPSS冲击治疗后,总有效率达92.3%;有15.4%的GO患者出现了轻度失眠、胃部不适、血压增高、头痛、转氨酶(ALT)增高等副作用,通过严密护理和及时治疗后均好转,显著提高了大剂量MPSS冲击治疗GO患者的疗效及治疗安全性。结论精心的护理在确保MPSS冲击治疗GO取得良好临床疗效、避免出现严重并发症中具有重要作用。     

糖皮质激素在川崎病治疗中作用的循证医学研究

目的 通过循证医学方法研究肾上腺皮质激素在川崎病治疗中的作用.方法 采用循证医学方法,检索国内外5种大型专业数据库,筛选出随机或半随机对照研究的文献,再人工筛查确定适宜文献.通过Meta分析,比较激素与丙种球蛋白治疗川崎病在退热时间和冠状动脉病变发生率方面的差异.结果 初筛得到443篇文献.经过人工检索,8篇文献符合要求而被纳入标准.其中,3篇文献共有49例川崎病患儿接受甲基强的松龙治疗,5篇文献共有406例患儿接受强的松治疗.对照组共有33例接受静脉丙种球蛋白治疗,435例接受阿司匹林治疗.各组间患儿性别、年龄、病程差异无显著意义.①甲基强的松龙组(3篇文献):24例发生冠状动脉病变,对照组18例发生,两组病变发生率差异无显著意义.在退热方面,1篇文献显示甲基强的松龙组发热时间明显较丙种球蛋白组缩短,差异有显著意义;2篇文献显示差异无显著意义.②强的松组(8篇文献):28例发生冠状动脉瘤,阿司匹林对照组11例发生,3篇文献提示强的松组冠状动脉瘤发生率明显高于对照组.强的松组76例发生冠状动脉扩张,对照组75例发生,3篇文献提示强的松组冠状动脉扩张发生率明显高于对照组,2篇文献提示强的松组冠状动脉扩张发生率略低于对照组,但差异无显著意义.结论 目前的研究资料显示,激素治疗与丙种球蛋白治疗川崎病在冠状动脉病变发生率方面尚无差异或增高.在缩短热程上两者差异也不显著.尚可进一步通过更大数量病例的随机对照研究来证实本结果.目前治疗川崎病不主张单独应用激素.     

强的松辅助治疗顽固性肺结核小咯血临床观察

目的:观察强的松辅助治疗顽固性肺结核小咯血的临床疗效及不良反应.方法:采用开放随机方法对强的松与其他止血药治疗肺结核小咯血48例进行对比观察.结果:加用强的松组治疗3天有效率(83.3%)明显高于对照组(29.2%),两组差异有显著性(P<0.01).结论:短期合理使用强的松辅助治疗顽固性肺结核小咯血疗效确切,无明显不良反应.     

大剂量甲基强的松龙冲击治疗Graves眼病的近期疗效及护理体会

目的 阐述大剂量甲基强的松龙（MPSS）冲击治疗Graves眼病（Graves ophthalmopathy,GO）患者的临床疗效及护理体会。方法回顾我院39例应用大剂量MPSS冲击治疗的GO患者,观察患者在使用MPSS前后的全身情况及护理的重要作用。结果结果发现,患者经MPSS冲击治疗后,总有效率达92．3％;有15．4％的GO患者出现了轻度失眠、胃部不适、血压增高、头痛、转氨酶（ALT）增高等副作用,通过严密护理和及时治疗后均好转,显著提高了大剂量MPSS冲击治疗GO患者的疗效及治疗安全性。结论精心的护理在确保MPSS冲击治疗GO取得良好临床疗效、避免出现严重并发症中具有重要作用。     

泼尼松和米诺地尔联合治疗雄激素性秃发临床研究

目的 观察近生理剂量泼尼松、锌制剂联合2%米诺地尔治疗雄激素性秃发的临床疗效.方法 将98例雄激素性秃发患者按就诊先后1∶1比例,分为治疗组和对照组,治疗组口服近生理剂量泼尼松和自制锌制剂口服液联合2%米诺地尔酊外用,对照组仅口服近生理剂量泼尼松和自制锌制剂口服液.3个月为1个疗程,用药1～4个疗程分别观察疗效.结果 治疗后3、6个月治疗组有效率分别为10.2%(5/49)、36.7%(18/49),对照组分别为6.1%(3/49)、22.4%(11/49),两组比较差异无统计学意义(P＞0.05).治疗后9、12个月治疗组有效率分别为77.6%(38/49)、91.8%(45/49),对照组分别为42.9%(21/49)、59.2%(29/49),两组比较差异有统计学意义(P＜0.05).结论 近生理剂量泼尼松、锌制剂联合2%米诺地尔治疗雄激素性秃发的临床疗效满意,长期用药效果理想,安全性和耐受性良好.     

地塞米松冲击疗法治疗成人原发免疫性血小板减少症的疗效观察

目的：观察地塞米松冲击疗法治疗成人原发免疫性血小板减少症（ITP）的临床疗效。方法：自2006年7月-2013年9月间笔者所在医院收治成人ITP患者38例,患者均给予胸腺肽α1联合大剂量维生素C治疗,其中19例同时应用4 d地塞米松冲击治疗,观察临床症状、血小板计数和不良反应。结果：胸腺肽α1＋大剂量维生素C治疗组总有效率78.9%,平均起效时间（16.8±3.2）d;胸腺肽α1＋大剂量维生素C联合地塞米松冲击治疗组总有效率84.2%,平均起效时间（6.7±2.7）d。两种治疗方案的不良反应均较轻微。结论：胸腺肽α1联合大剂量维生素C与冲击量地塞米松联合应用治疗成人ITP疗效较好,副作用少,可缩短起效时间。     

New treatment methods for autoimmune thrombocytopenia

--For many years, splenectomy has been considered the only therapy with proven efficacy in patients with relapsed/refractory idiopathic thrombocytopenic purpura (ITP) following corticosteroid therapy. --A broad spectrum of (mostly immunosuppressive) agents are available for patients who fail to respond to splenectomy. However, the risks associated with these agents sometimes outweigh their benefits. --Recently, several new or renewed strategies have been evaluated for chronic refractory ITP. --Short-term therapy with high-dose dexamethasone is an effective alternative to long-term treatment with corticosteroids. --Depletion of B lymphocytes with rituximab, an agent that has an established role in the treatment of non-Hodgkin's lymphoma, also appears to be effective in autoimmune disorders, particularly in ITP. --Although the main problem in ITP is the increased destruction of thrombocytes, stimulation of thrombocyte production with thrombopoietin(TPO)-receptor agonists can increase thrombocyte counts. --Two TPO-receptor agonists, AMG531 and eltrombopag, induce responses in 70-80% of ITP patients and are expected to gain approval for use in ITP soon.     

Consensus for infliximab treatment of patients with Crohn's disease

Very recently infliximab--a tumour necrosis factor blocking antibody--was registered as an important novel immunomodulating therapy for active Crohn's disease in the Netherlands. Although this treatment can have a very significant and sometimes dramatic effect (on remission induction), its longterm effects are still uncertain and the high cost is a major drawback. An expert committee of specialists in inflammatory bowel disease (IBD) in the Netherlands therefore produced a consensus report on specific treatment indications for its use. It is stated that only immunosuppressive-resistant patients or patients with incompatibilities and allergies to prednisone, azathioprine and methotrexate should be candidates, a second indication being patients with serious enterocutaneous fistulae not reacting to a full course of conventional therapy. Its use is not indicated in patients with stenosing disease. It is also stated that the effect of longterm repeated therapy in active Crohn's disease still has to be established. Since budget limitations for medications are a major disadvantage, the formation of expert committees (with an expert in the treatment of complicated inflammatory bowel disease) in each hospital should be stimulated to limit the treatment to only cases with real immunosuppressive-resistant disease.     

感染对儿童特发性血小板减少性紫癜的丙种球蛋白与激素治疗疗效的影响

目的 探讨儿童特发性血小板减少性紫癜(ITP)合并感染的情况及感染对不同治疗方法疗效的影响.方法 检测初治急性ITP患儿是否伴有特殊病原体感染,根据感染种类,分为特殊感染组、普通感染组及无感染组,依治疗方法的不同分为丙种球蛋白(IVIG)治疗组和IVIG联合激素治疗组;分析感染对儿童急性ITP两种治疗疗效的影响.结果 特殊感染组、普通感染组及无感染组有效率分别为40.6%、78.4%、78.0%;普通感染组和无感染组的治疗有效率显著高于特殊感染组,均P<0.05;而普通感染组与无感染组之间有效率差异无统计学意义(P>0.05);对伴有特殊感染的病例,单用IVIG的治疗有效率优于IVIG联合激素治疗,有效率分别为81.8%及19.5%,P<0.05;而对普通感染组及无感染组病例,上述两种治疗有效率差异无统计学意义,普通感染患者两组有效率分别为85.7%及73.3%,无感染患者两组有效率分别为80.0%及76.9%,均P>0.05,对治疗有效的患者,约87.0%的病例在前3 d显效.结论 初治时伴特殊感染的儿童ITP疗效欠佳;对有特殊感染患者,单用IVIG治疗反而较IVIG联合激素疗效好,可能与激素早期应用不利于感染清除有关.     

POEMS综合征9例临床分析

目的探讨POEMS综合征的临床特征和诊断治疗。方法对9例POEMS综合征患者临床资料、相关检查及治疗方法进行回顾性研究。结果主要临床特征:多发性周围神经病、脏器肿大,内分泌改变,单克隆浆细胞异常,皮肤改变,骨破坏,水肿是POEMS的主要表现。予强的松联合环磷酰胺治疗,有效率50%。结论POEMS综合征是一种少见的多脏器损害疾病,诊断较难。临床上需对可疑病例需进行密切观察及必要的检查,以免误诊。POEMS综合征患者主要治疗包括放疗、皮质激素、烷化物治疗,还包括大剂量化疗、外周血液干细胞移植。     

Synergistic immunosuppressive effect of anti-TNF combined with methotrexate on antibody responses to the 23 valent pneumococcal polysaccharide vaccine

INTRODUCTION: The efficacy of the immune response upon vaccination in patients treated with anti-tumor necrosis factor-alpha (anti-TNF) with or without methotrexate is the subject of debate. We studied the effect of immunosuppressive treatment, including anti-TNF and methotrexate, on the response to pneumococcal polysaccharide (PPS) vaccine. METHODS: Fifty-two patients treated with immunosuppressives including anti-TNF (anti-TNF group), 41 patients given a similar immunosuppressive regimen without anti-TNF (no anti-TNF group), and 18 healthy controls were vaccinated with a 23 valent PPS vaccine. The percentage of patients treated with methotrexate in the anti-TNF and no anti-TNF group was 65% and 76%, respectively. Antibodies against four of the vaccine antigens (PPS 6B, 9V, 19F and 23F) were measured before and 4 weeks after vaccination. The primary outcome was the response rate, defined as the percentage with a postvaccination titer 0.35 microg/ml in combination with at least a twofold increase in antibody titer. The protection rate was defined as a postvaccination titer > or = 0.35 microg/ml. RESULTS: The use of methotrexate was the strongest predictor of impaired vaccination outcome. Anti-TNF caused an additional immunosuppressive effect in the presence of methotrexate, leading to the lowest response percentages in patients using the combination of these two drugs. The underlying disease, other immunosuppressives such as prednisone or type of anti-TNF agent used did not influence vaccination outcome. CONCLUSIONS: Patients who were treated with the combination of methotrexate and anti-TNF demonstrated a significantly impaired immune response following pneumococcal polysaccharide vaccination as compared to patients treated with either methotrexate or anti-TNF only or immunosuppressives excluding these two compounds.     

儿童慢性特发性血小板减少性紫癜与幽门螺杆菌感染的临床研究

[目的]探讨儿童慢性特发性血小板减少性紫癜(cITP)与幽门螺杆菌(HP)的关系,观察根除HP对儿童cITP的疗效。[方法]对cITP患儿进行13C尿素呼吸试验检测,将确诊HP感染的14例患儿随机分成研究组(9例)和对照组(5例)。研究组采用免疫治疗加根除HP治疗,而对照组只采用免疫治疗,比较两组治疗前以及治疗后d7、第1,2,3月血小板的数目和临床效果。[结果]66例cITP患儿中有HP感染14例(21.2%),研究组的9例中,其中7例成功根除HP(77.8%)。治疗后d7、第1,2,3月血小板的数目比较显示,研究组明显高于对照组(P﹤0.01)。临床效果比较显示研究组的疗效显著高于对照组(P﹤0.05)。[结论]本临床研究中,HP的感染率为21.2%,采用HP根除治疗的根除率为77.8%,根除HP治疗有助于HP感染的cITP患儿的血小板恢复,取得明显的临床效果。     

117例输卵管间质部妊娠诊治分析

目的探讨输卵管间质部妊娠(interstitial tubal pregnancy,ITP)的诊治方法。方法对川北医学院附属医院2006年7月至2016年6月收治的117例ITP病例的临床资料进行回顾性分析。结果 (1)诊断:保守治疗组13例全部经阴道三维B超诊断。手术治疗组104例,术前B超拟诊异位妊娠83例,其中确诊ITP61例,准确率73.5%(61/83);21例因腹腔内出血急诊术中探查确诊,占20.2%(21/104)。(2)治疗:腹腔镜手术较开腹手术时间短、出血少、术后活动时间早,差异有统计学意义(P0.05);保守治疗组选用氟尿嘧啶(fluorouracil,5-FU)与甲氨蝶呤(Methotrexate,MTX)化疗,血清β-人绒毛膜促性腺激素(β-human choionic gonadotophin,β-hCG)降至正常时间较手术组长,差异有统计学意义(P0.05)。结论 (1)对ITP需做到"三早",即早就诊、早诊断、早治疗。为明确妊娠部位,阴道三维B超可作为首选检查方法;(2)手术仍是ITP的主要治疗方法,腹腔镜较开腹手术具有时间短、出血少、术后恢复快等优势;(3)对于血β-hCG浓度低、无内出血、病灶小的早期间质部妊娠或稽留流产型患者选用5-Fu与MTX保守治疗可取得满意疗效。     

全程无缝隙护理对激素治疗特发性血小板减少性紫癜患者的影响观察

目的 探讨全程无缝隙护理模式对激素治疗特发性血小板减少性紫癜患者的效果和依从性的影响.方法 根据入院顺位将52例接受激素治疗的特发性血小板减少性紫癜（ITP）患者分为两组,单数26例患者（对照组）沿用常规护理,双数26例患者（观察组）从入院起采用全程无缝隙护理模式,对患者依从性进行评价.所有患者均随访3～6个月,复查血小板计数,并记录出血发生率.结果 观察组依从性好的患者占88.46％,显著高于对照组的61.54％ （P ＜0.05）.观察组患者入院时和出院时血小板计数与对照组相比均无显著差异（P＞0.05）;观察组随访3个月、6个月平均血小板计数均显著高于对照组（P＜0.05）.观察组出血发生率为11.53％,明显低于对照组的38.46％ （P ＜0.05）.结论 全程无缝隙护理覆盖全疗程,对提高ITP患者激素治疗依从性,降低再出血发生率具有积极的意义.