Steroid pulse therapy for severe fever with thrombocytopenia syndrome patients may not improve prognosis: Retrospective analysis with overlap weighting using a national inpatient database

BackgroundSevere fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease caused by the SFTS virus. Effective treatment for SFTS has not been established, but steroid pulse therapy is often used. This study aimed to verify whether steroid pulse therapy for SFTS improves prognosis or not.MethodsData of SFTS patients were obtained from the Japanese Diagnosis Procedure Combination Database from April 2013 to March 2021. Patients treated with steroid pulse therapy were compared with untreated patients, using overlap weighting and traditional multivariable regression analysis to evaluate the impact of steroid pulse therapy on prognosis.Results412 SFTS patients were included in this study, and 66 (16%) underwent steroid pulse therapy within 3 days of admission and were allocated to the steroid pulse therapy group. After overlap weighting, patients in the steroid pulse therapy group had a significantly higher in-hospital mortality rate than patients in the control group (31.1% vs. 20.5%; difference: +10.6%; 95% confidence interval: +2.2% to +19.0%). There were no statistically significant differences in hospitalization cost and length of hospital stay between the two groups. The results of the sensitivity analysis using traditional multivariable regression were similar to those of the main analysis.ConclusionIn the analysis of SFTS patients using the Japanese Diagnosis Procedure Combination inpatient data, steroid pulse therapy did not improve patient prognosis. The evidence does not support the universal use of steroid pulse therapy in patients with severe SFTS.     

A retrospective study of pulse steroid therapy for acute respiratory failure associated with tuberculosis

BackgroundTuberculosis can cause acute respiratory failure, which is associated with a high mortality rate, even in patients receiving effective anti-tuberculosis therapy. We retrospectively analyzed patients with acute respiratory failure associated with tuberculosis who underwent pulse steroid therapy to describe the clinical characteristics and effectiveness of pulse steroid therapy in this condition.MethodsThe medical records of patients admitted to our hospital for culture-proven tuberculosis treatment from April 1, 2017, to March 31, 2022, who received pulse steroid therapy for acute respiratory failure associated with tuberculosis were reviewed.ResultsIn total, 10 patients were included in this study. Chest computed tomography (CT) revealed diffuse ground-glass opacities and consolidation in these patients. Overall, 70% of the patients (7/10) showed an adjudicated response to pulse steroid therapy, with improved respiratory condition and radiological findings. Three patients died without response to pulse steroid therapy. One patient died of pancreatic cancer after recovering from respiratory failure. The remaining six patients were discharged without supplemental oxygen and completed anti-tuberculosis therapy.ConclusionsPulse steroid therapy can lead to dramatic improvements in some patients with acute respiratory failure associated with tuberculosis.     

环磷酰胺冲击治疗难治性肾病综合征34例护理体会

目的:探讨环磷酰胺(CTX)冲击治疗难治性肾病综合征(RNS)的疗效及护理方法.方法:将68例RNS患者随机分为治疗组与对照组各34例,对照组采用强的松、洛汀新、潘生丁等治疗,治疗组在以上治疗的基础上加用CTX冲击治疗,并在治疗的前、中、后期实施不同的护理干预.结果:治疗组总有效率为85.29%,对照组为58.82%;治疗组1年内复发率为24.14%,时照组为65.00%.两组比较均有极显著性差异(P＜0.01).结论:CTX冲击治疗RNS效果满意,在冲击治疗的各个时期分别实施不同的护理干预,有助于减轻CTX冲击治疗的副作用,提高疗效,降低RNS复发率.     

油漆相关有机溶剂综合征的白质脑病临床及影像学特征分析

目的探讨油漆相关有机溶剂综合征的白质脑病临床和影像学特征，为该类疾病的早期诊断和治疗提供依据。方法对8例在河南省人民医院神经内科住院的以白质脑病为临床表现的油漆工人的一般资料、临床特征、入院处理、磁共振检查特征、精神心理与智能相关量表评分、激素冲击治疗后反应等资料进行总结分析。结果8例患者均有不同程度的精神、心理、神经功能方面的损害，磁共振检查均有弥漫性白质损害；经激素冲击治疗后，油漆工作经历〈5a者3例，治疗效果良好，其中1例磁共振表现为DWI上高信号和Flair上低信号，治疗效果更显著；5a～10a者4例，临床症状有改善，而影像学检查无明显变化；〉10a者1例，治疗后临床症状无明显改善。结论油漆接触史人群应高度警惕有机溶剂造成的白质脑病；职业暴露史、磁共振检查呈弥漫性白质损害是诊断的重要依据；激素冲击治疗是主要治疗方法，其中细胞内水肿征象的患者激素冲击预后最佳；职业暴露时间、年龄、饮酒史可能是决定预后的关键因素。     

血液灌流联合血液透析对行骨化醇冲击治疗的继发性甲状旁腺功能亢进症患者的干预效果

目的分析血液灌流联合血液透析对行骨化醇冲击治疗的继发性甲状旁腺功能亢进症患者的干预效果。方法将80例继发性甲状旁腺功能亢进症患者按照入院治疗时间分为对照组(38例,在骨化醇冲击治疗基础上采用血液透析治疗)和试验组(42例,在骨化醇冲击治疗基础上采用血液灌流联合血液透析治疗)。比较两组治疗前、后的肾功能指标、血钙、血磷、甲状旁腺功能、Klotho水平以及不良反应发生情况。结果治疗后,两组的尿素氮、血清肌酐水平比较,差异无统计学意义(P>0.05)。治疗后,试验组的血钙、Klotho水平明显高于对照组,血磷、甲状旁腺激素、碱性磷酸酶水平明显低于对照组(P<0.05)。试验组的不良反应总发生率明显低于对照组(P<0.05)。结论血液灌流联合血液透析在行骨化醇冲击治疗的继发性甲状旁腺功能亢进症患者中的应用效果显著,能有效改善患者肾功能,且治疗安全性高。     

The indication of steroid pulse therapy and apheresis therapy for multiple sclerosis

We discuss steroid pulse therapy and apheresis therapy indicated for the treatment of multiple sclerosis (MS). In the basic treatment course for MS, steroid pulse therapy is a first-line treatment for relapsing-remitting multiple sclerosis (RR-MS) in the course of the exacerbation, and apheresis therapy is performed in refractory cases. Treatment strategies for chronic progressive MS are not to be established. Steroid pulse therapy has been established as a treatment for MS in the active phase through randomized controlled trials (RCT). Apheresis therapy includes plasmapheresis and cytapheresis, and plasmapheresis includes plasma exchange (PE) and immunoadsorption plasmapheresis (IAPP). PE and IAPP are performed for MS treatment. PE has been established as a useful treatment for active phase MS. The efficacy of IAPP has been frequently reported, but no reports have been based on RCT. We also summarize the indications, methods, and adverse reactions of steroid pulse therapy and apheresis therapy.     

Methylprednisolone pulse therapy rescued life-threatening pulmonary hemorrhage due to idiopathic pulmonary hemosiderosis

Idiopathic pulmonary hemosiderosis (IPH) is an extremely rare cause of massive pulmonary hemorrhage in children. During the acute phase, death due to massive alveolar hemorrhage and subsequent severe respiratory failure. We report two cases of IPH children who developed hypoxemic respiratory failure and massive pulmonary hemorrhage. One case of a 10-year-old boy was treated with methylprednisolone pulse therapy (10 mg/kg/d) for the first three days and followed by systemic steroid therapy, he successfully decannulated 10 days later and discharged with a favorable quality of life. Another case of a 4 year-old female child with Down's syndrome diagnosed as IPH for over one year and treated with oral corticosteroids for maintenance therapy. She sudden suffered severe hypoxemia with rapid falls in the hemoglobin level. We applied methylprednisolone pulse therapy (10 mg/kg/d) for three days and other supportive therapies, the girl survived through complicated with oxygen dependence. We suggest that methylprednisolone pulse therapy provides a chance of recovery and survival for patients with IPH at the acute phase, even if accompanied by severe pulmonary hemorrhage.     

Crossroads of the effects of cyclophosphamide pulse therapy for lupus nephritis--experience of 11 cases.

In this study time for initial assessment of monthly intravenous cyclophosphamide (CP) pulse therapy is discussed for a better outcome with less complications. Eleven patients with lupus nephritis (LN) resistant to conventional therapy (serum creatinine level < or = 2.7 mg/dl) were given 500 mg/m2 of CP 7-9 times with an interval of one month. Urinary protein (Up) decreased in all patients after 3 courses of CP pulse therapy and kept similar levels thereafter. In one group of patients (n = 7), Up decreased to < 2 g/day after 3 courses, while in the other group (n = 4), it did not decrease to < 4 g/day. Creatinine clearance increased by 0-100% in the former group, while it decreased by 5-20% in the latter group after 6-9 courses. Renal function of the patients with insufficient response after 3 courses tended to show no further improvement or worsened thereafter, although Up decreased during CP pulse therapy. A relatively small dose of CP (500 mg/m2) pulse therapy was useful in most LN patients regardless of the renal histology and it was thought important to assess its effects after 3 courses for a prediction of the clinical course. Modification of the protocol at that time might be necessary in regard to dose or interval of CP administration especially for patients with insufficient outcome.     

脉冲调整技术和关节松动术治疗肩峰下撞击综合征的临床疗效对比

目的:比较脉冲调整技术和关节松动术对肩峰下撞击综合征患者的临床疗效。方法:将38例肩峰下撞击综合征患者随机分为脉冲组(脉冲调整技术)和松动组(关节松动术)各19例。脉冲组进行脉冲调整技术治疗、常规理疗和运动训练,松动组进行关节松动术、常规理疗和运动训练。两组患者均进行12周治疗,并于治疗前和治疗第1周、第4周、第12周随访时采用VAS评分和CMS量表进行评估。结果:治疗后第1周、第4周、第12周脉冲组VAS分数分别为2.4±1.3、1.2±1.0、0.9±0.9,CMS总分分别为76.5±11.0、84.3±8.8、89.0±7.1;松动组VAS分数分别为3.5±1.3、2.1±1.3、1.4±1.2,CMS总分分别为69.4±13.1、82.9±6.7、88.5±6.8。两组VAS分数和CMS总分组内对比差异均有显著性意义(P0.01);治疗1周后,脉冲组VAS分数低于松动组,差异有显著性意义(P=0.008),脉冲组CMS评分中的疼痛得分、ADL得分均高于松动组,差异均有显著性意义(P=0.008,P=0.009);治疗4周后,脉冲组VAS分数低于松动组,差异有显著性意义(P=0.034),CMS评分中的疼痛得分高于松动组,差异有显著性意义(P=0.048)。结论:在常规理疗和运动训练基础上无论联合应用脉冲调整技术还是关节松动术,均能有效改善肩峰下撞击综合征患者肩部的疼痛和功能障碍。而脉冲调整技术与关节松动术相比,能在治疗早期更快地减轻疼痛并改善患者日常生活活动能力。     

Improved survival in severe paraquat poisoning with repeated pulse therapy of cyclophosphamide and steroids

Purpose  

To clarify the efficacy of repeated methylprednisolone (MP) and cyclophosphamide (CP) pulse therapy and daily dexamethasone (DEX) therapy in patients with severe paraquat (PQ) poisoning.     

Efficacy of tonsillectomy plus methylprednisolone pulse therapy for a child with Henoch-Schoenlein purpura nephritis

Henoch-Schoenlein purpura (HSP) is a systemic disorder characterized by a leukocytoplastic vasculitis involving small vessels with the deposition of immunoglobulin A (IgA) immune complexes. Renal involvement is the principal cause of morbidity and mortality in children with HSP. We report here an 11-year-old boy with Henoch-Schoenlein purpura nephritis (HSPN) accompanied by recurrent purpura and persistent nephropathy despite conventional therapy such as prednisolone, methylprednisolone pulse therapy and immunosuppressive agent (Mizoribine). The patient was treated with tonsillectomy plus methylprednisolone pulse therapy. This treatment decreased proteinuria, induced disappearance of microscopic hematuria, and improved renal pathological findings. Tonsillectomy plus methylprednisolone pulse is effective and useful therapy for some children with recurrent purpura and persistent nephropathy.     

Repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe paraquat poisoning

OBJECTIVE: Paraquat is widely used in the world, and all treatments for paraquat poisoning have been unsuccessful. Many patients have died of paraquat poisoning in developing countries. A novel anti-inflammation method was developed to treat severe paraquat-poisoned patients with >50% to <90% predictive mortality: initial pulse therapy with methylprednisolone (1 g/day for 3 days) and cyclophosphamide (15 mg/kg/day for 2 days), followed by dexamethasone 20 mg/day until Pao2 was >11.5 kPa (80 mm Hg) and repeated pulse therapy with methylprednisolone (1 g/day for 3 days) and cyclophosphamide (15 mg/kg/day for 1 day), which was repeated if Pao2 was <8.64 kPa (60 mm Hg). DESIGN: Randomized controlled trial. SETTING: Academic medical center in Taiwan. PATIENTS: Twenty-three paraquat-poisoned patients with >50% and <90% predictive mortality assessed by plasma paraquat levels were prospectively and randomly assigned to the control and study groups at a proportion of 1:2. INTERVENTIONS: The control group received conventional therapy and the study group received the novel repeated pulse treatment with long-term steroid therapy. MEASUREMENTS AND MAIN RESULTS: We measured patient mortality during the study period. There was not a different distribution of basal variables between the two study groups. The mortality rate (85.7%, six of seven) of the control group was higher than that of the study group (31.3%, five of 16; p = .0272). CONCLUSIONS: The novel anti-inflammatory therapy reduces the mortality rate for patients with severe paraquat poisoning.     

Lupus nephritis: efficacy of monthly pulse therapy with intravenous methylprednisolone

Fourteen patients with severe systemic lupus erythematosus and nephritis were treated with high-dose intravenous methylprednisolone (IVMP) pulse therapy. Six patients (group 1) received one or two courses of 1 gm of IVMP when they were acutely ill with rapidly progressive renal failure or with multisystemic disease. All patients had a poor outcome; three died and three had end-stage renal disease. Eight patients (group 2) were treated with repeated pulses of 1 gm of IVMP for four to 21 months. Six of the eight patients had a favorable outcome, with four in complete remission and two in partial remission. One of the eight patients had partial response with stable renal disease at 16 months after pulse therapy. Only one patient had no response, with gradual worsening of renal function. All patients in both groups had rapid improvement of levels of anti-DNA and CH50 after pulse therapy was started. Patients in group 2 were compared to 21 randomized patients (group 3) with comparable severity of disease. Renal function deteriorated in group 3, with a mean duration of disease of 82.5 +/- 56.4 months. Renal function improved in group 2, with a mean duration of disease of 87.8 +/- 46.8 months. We conclude that repeated monthly pulse therapy with IVMP in severe SLE was effective and that major side effects can be avoided with proper timing of pulsing.     

心肌肌钙蛋白Ⅰ对环磷酰胺冲击治疗狼疮肾炎心脏毒性评估的临床意义

目的探讨心肌肌钙蛋白I（cTnI）对环磷酰胺冲击治疗狼疮肾炎的心脏毒性评估的临床意义。方法应用美国贝克曼库特公司生产的进入2免疫分析系统（Access Immunoassay System2,AIS2）对环磷酰胺冲击治疗狼疮肾炎前后cTnI水平进行测定,比较治疗前后cTnI的变化,对环磷酰胺的心脏毒性进行评估。结果环磷酰胺冲击治疗前患者血清cTnI为（0.034±0.013）ng/L,冲击治疗后次日患者血清cTnI为（0.038±0.012）ng/L,冲击治疗后1周患者血清cTnI为（0.037±0.011）ng/L,冲击治疗后2周患者血清cTnI为（0.036±0.012）ng/L,以上3组结果两两比较,差别无统计学意义。结论环磷酰胺以20mg/kg剂量冲击治疗狼疮肾炎未发现有cTnI明显升高,说明该剂量冲击治疗狼疮肾炎未引起心脏毒性的发生。     

Changes in brachial-ankle pulse wave velocity in subclinical hypothyroidism during normalization of thyroid function.

OBJECTIVE: Subclinical hypothyroidism affects 5-15% of the population and is associated with increased cardiovascular morbidity, although this is controversial. We recently reported a significant increase in brachial-ankle pulse wave velocity (baPWV), a parameter of arterial stiffening and an independent predictor for cardiovascular events, in subclinical hypothyroidism. The current study was performed to assess changes in enhanced baPWV in subclinical hypothyroidism during normalization of thyroid function. METHODS: Forty-two subclinical hypothyroid patients (male/female ratio 8/34) were monitored for changes in baPWV before and after levothyroxine (L-T(4)) replacement therapy. RESULTS: After attaining euthyroidism, 59.5% and 40.5% of the patients showed reduction and increase of baPWV, respectively. Baseline baPWV and pulse pressure were significantly higher in patients with reduced baPWV (1940.3+/-126.4 vs. 1726.4+/-110.4 cm/s, P=0.046; 62.1+/-3.1 vs. 50.7+/-3.7 mmHg, P=0.026, respectively). Baseline baPWV was significantly correlated with baseline pulse pressure in both groups, but the change in baPWV was significantly correlated with baseline pulse pressure only in patients with reduced baPWV (rho=-0.522, P=0.046). The male/female ratio was significantly lower in patients with reduced baPWV (4/21 vs. 7/10), and systolic, diastolic and pulse pressures and pulse rate decreased significantly only in patients with reduced baPWV. CONCLUSIONS: Our results suggest that L-T(4) replacement therapy may be especially beneficial in female subclinical hypothyroid patients with high baseline baPWV and pulse pressure. The beneficial effects of L-T(4) replacement therapy in decreasing arterial stiffening and thus preventing cardiovascular disease might be limited to this sub-population.     

缬沙坦对原发性高血压患者血管内皮功能及臂踝脉搏波传导速度的影响

目的 探讨缬沙坦对原发性高血压患者血管内皮功能及臂踝脉搏波传导速度(baPWV)的影响.方法 检测30例原发性高血压患者应用缬沙坦治疗前后血压、血一氧化氮(NO)及臂踝脉搏波传导速度的变化.结果 应用缬沙坦后,原发性高血压患者血压及臂踝脉搏波传导速度显著下降(P<0.05及P<0.01)、N0明显提高(P<0.01),且臂踝脉搏波传导速度下降与NO升高之间具有相关性(r=-0.71,P<0.01).结论 缬沙坦除可有效降压外,还有逆转原发性高血压患者血管内皮功能、改善大动脉弹性的作用,同时臂踝脉搏波传导速度可用于评估缬沙坦时血管内皮功能的改善程度.     

Tonsillectomy and steroid pulse therapy for IgA nephropathy

IgA nephropathy (IgAN) is the common cause of primary glomerulonephritis worldwide. The clinical course of IgAN is extremely variable and ranges from asymptomatic microscopic hematuria to rapidly progressive renal failure. The pathogenetic mechanisms of IgAN are still unclear, but a hypothesis consisting of two pathways has been proposed. The first pathway is continuous antigenic stimulation of the innate immune system by the tonsillar mucosa via the mucosa-bone marrow axis. In the second pathway, the anomalous stimulated immune response in the bone marrow results in the production of aberrantly glycosylated IgA1 and its subsequent deposition within the mesangial area. Based on the hypothesis, tonsillectomy plus steroid pulse therapy were introduced. A recent meta-analysis showed that tonsillectomy with or without steroid pulse therapy resulted in clinical remission with favorable long-term efficacy in IgAN patients. Tonsillectomy plus steroid pulse therapy now seems to be an effective treatment for IgAN patients with hematuria and minimal proteinuria, and it is more effective in patients with less severe histological findings. The efficacy of the combination therapy depends on the duration of the IgAN. Randomized, controlled trials are needed to examine the efficacy of tonsillectomy plus steroid pulse therapy in different clinical stages of IgAN.     

甲基强的松龙冲击治疗颅内幕上肿瘤脑水肿疗效观察

目的观察大剂量甲基强的松龙冲击治疗对幕上脑肿瘤瘤周水肿的临床疗效和不良反应。方法选择35例幕上脑肿瘤伴瘤周水肿患者术前应用甲基强的松龙冲击治疗,采用MRI测算每个患者冲击治疗前后的水肿指数。结果甲基强的松龙冲击治疗后,轻度、中度、重度瘤周水肿患者的平均水肿指数分别减少1.79%、8.81%和12.02%,中度和重度患者的水肿指数明显低于治疗前(P<0.01),轻度患者的水肿指数与治疗前的差异无显著性意义(P>0.05)。结论大剂量甲基强的松龙冲击治疗对中度及重度幕上脑肿瘤瘤周水肿有明显的治疗作用,无严重不良反应。     

阿法骨化醇胶囊冲击联合血液灌流治疗 CAPD患者重度继发性甲状旁腺功能亢进症

【目的】评价持续性非卧床腹膜透析（CAPD）合并重度继发性甲状旁腺功能亢进症（SHPT）患者行阿法骨化醇胶囊（阿法迪三）冲击联合血液灌流（HP）治疗的疗效与安全性。【方法】收集本院 CAPD合并重度 SHPT患者37例。随机分为阿法迪三冲击联合 HP治疗组（A组,19例）和阿法迪三冲击治疗组（B组,18例）。两组药物起始剂量均为每次2～4μg,2次/周。A组同时血灌治疗,1次/周,共治疗3周。随访6月。比较两组治疗前后甲状旁腺激素（iPTH）值,临床症状及心脏瓣膜钙化情况。【结果】①治疗后,联合治疗组iPTH达标率、症状缓解率明显高于单独冲击组,且两组相比较差异有显著性（P＜0．05）。②随访6个月, A组患者心脏瓣膜钙化率低于B组（73．6％ vs 83．3％,P＜0．05）。iPTH 达标率 A组高于 B组（94．7％ vs 77．8％,P＜0．05）。③A组治疗耐受性良好,无一例严重不良反应。B组中3例因高钙高磷血症中断阿法迪三治疗。【结论】合并重度 SHPT的CAPD患者,阿法迪三冲击联合 HP治疗较之单纯阿法迪三冲击具有更好的疗效及耐受性。     

甲泼尼龙冲击治疗小儿肾病综合征型过敏性紫癜肾炎疗效观察——附13例分析

目的：探讨甲泼尼龙冲击治疗肾病综合征型过敏性紫癜肾炎患儿的疗效。方法：肾病综合征型过敏性紫癜肾炎患儿24例,分为甲泼尼龙冲击治疗组（激素冲击组,13例）和泼尼松口服治疗组（激素口服组,11例）。2组患儿均同时使用环磷酰胺冲击治疗及常规应用双嘧达莫,在此基础上,激素冲击组予甲泼尼龙冲击治疗（甲泼尼龙剂量每次15～30mg／kg,隔日1次,共6次）,之后予口服泼尼松1．5～2．0mg／（kg·d）,4周后减量。如患儿治疗3个月、5个月时蛋白尿仍未缓解,则再次予甲泼尼龙冲击治疗。激素口服组则无应用甲泼尼龙冲击治疗。观察患儿治疗1个月、2个月、3个月、4个月、5个月的尿常规结果,以尿蛋白和尿红细胞定性作为衡量蛋白尿和血尿的指标。结果：激素冲击组治疗1个月的尿蛋白减少总有效率为92％,明显高于激素口服组的总有效率45％（P〈0．05）,且该组治疗2个月、治疗3个月的尿蛋白减少的显效率分别为67％和91％,均明显高于激素口服组的18％和3／9（均为P〈0．05）。对血尿疗效方面,激素冲击组在治疗1个月、2个月显效分别为1例、2例,总有效率分别为31％、75％,而口服激素组在治疗1个月、2个月无显效病例,总有效率分别为36％、36％。结论：对于肾病综合征型过敏性紫癜肾炎患儿,甲泼尼龙冲击治疗与口服泼尼松治疗比较,前者可以更快缓解蛋白尿和血尿。