张北地震后应激障碍患者神经内分泌和细胞因子的研究

目的研究应激障碍患者血浆皮质醇、生长激素、泌乳素和白细胞介素(IL)2,6,8与正常个体的差异.方法于河北省张北尚义发生里氏6.2级地震后3个月,在当地选取因地震导致的创伤后应激障碍(PTSD)患者34例(PTSD组),未达到PTSD诊断标准且不符合其他精神障碍的受应激个体30例(非PTSD受应激组),未受应激者34名(对照组),进行血浆皮质醇、生长激素、泌乳素和白细胞介素(IL)2,6,8的检测.血浆皮质醇、生长激素、泌乳素、IL-2检测采用放射免疫法; IL-6和IL-8检测采用酶联免疫法.结果 PTSD组患者和非PTSD受应激组的血浆皮质醇浓度均明显高于对照组,差异有统计学意义(P=0.013,P=0.006);血浆IL-2浓度均明显低于对照组,差异均有统计学意义(P=0.000,P=0.000).三组间泌乳素及IL-6的差异无统计学意义(P=0.389,P=0.363).PTSD组的生长激素浓度与非PTSD受应激组(P=0.099)及对照组(P=0.511)的差异无统计学意义.非PTSD受应激组的生长激素浓度明显高于对照组(P=0.014).PTSD组患者IL-8浓度明显高于非PTSD受应激组 (P=0.021), 而与对照组的差异无统计学意义 (P=0.078).非PTSD受应激组IL-8浓度明显低于对照组(P=0.000).结论 PTSD患者的神经内分泌和免疫系统有异常改变.     

Hydrocortisone delivery to healthy and inflamed eyes using a micellar polysorbate 80 solution or albumin nanoparticles

Hydrocortisone was loaded onto albumin nanoparticles by sorption. Two systems were tested, one comprised of a 0.03% saturated drug solution, the other of a 0.2% micellised drug solution. In both cases 45–70% of the originally available drug was bound to the carrier surface. The systems were further tested by measuring the in vitro transport of radiolabelled hydrocortisone through porcine cornea. Nanoparticles led to sustained drug transport through the cornea. The distribution of both 0.2% hydrocortisone preparations (nanoparticles and solution) was then evaluated under in vivo conditions in healthy and inflamed eyes of rabbits. In all tissues the level of drug was higher in the inflamed than in the healthy eye due to increased cell permeability as a result of inflammatory processes. The application of nanoparticles led to lower hydrocortisone tissue concentrations than the reference solution due to the strong binding of hydrocortisone onto the particle system and the resulting slow release. An exception occurred with the reference solution in the conjunctiva, as less drug was found in the inflamed than in the normal tissue, since enhanced lacrimation led to increased drug drainage. In contrast, the corresponding nanoparticle preparation was more efficiently retained at the inflamed than at the normal conjunctiva. Consequently, in the inflamed eye, hydrocortisone-loaded nanoparticles enabled targeting to the precorneal area away from the inner segments of the eye.     

The neuroendocrine challenge paradigm in headache research

The neuroendocrine challenge paradigm provides a "window" on central neurotransmitter function in vivo. This strategy is based on the premise that the sensitivity of certain central receptors can be inferred from the magnitude of the hormonal response to specific pharmacologic probes. For example, the serotonin (5HT) receptor agonist m-chlorophenylpiperazine (m-CPP) stimulates the release of cortisol and prolactin and induces migraine-like headaches. We have previously reported that the headache and cortisol responses to m-CPP are highly correlated, which may implicate a disturbance in central serotonergic neurotransmission in the pathogenesis of migraine. As pharmacologic probes with greater specificity for 5HT receptor subtypes become available, we may be able to elucidate these mechanisms with greater precision. The neuroendocrine challenge methodology is also applicable to the study of other neurotransmitter systems and other headache disorders.     

Phenylethanolamine-N-methyltransferase-immunoreactive cells in developing rat superior cervical ganglion and the effect of hydrocortisone on their number

Rats were subcutaneously injected with hydrocortisone acetate. Control rats were similarly injected with saline. PNMT-immunoreactive cells in the superior cervical ganglia were immunohistochemically demonstrated, and the cell densities (number/mm³) of the PNMT-immunoreactive cells were counted.PNMT-immunoreactive cells were detected in ganglia of all age groups of the saline-treated control rats. With increasing age, there was a tendency to cluster formation. The number of the PNMT immunoreactive cells dramatically increased if hydrocortisone administration was initiated during the first two postnatal weeks. Hydrocortisone also caused appearance of numerous PNMT-immunoreactive fibres, which were not seen in controls. The cell density of the PNMT-immunoreactive cells in the hydrocortisone-treated rats was still increased, although less, if the hydrocortisone injections were started during the third postnatal week, as compared with the saline-injected control rats of the same age.After discontinuation of the first, early postnatal hydrocortisone treatment on days 2–6, the number of the PNMT-immunoreactive cells decreased during the following 2 weeks, but a second treatment with hydrocortisone daily for 7 days initiated as late as on postnatal day 63 caused a new significant increase in cell density and the appearance of immunoreactive fibres from them.It is concluded that PNMT-immunoreactive cells are present in the normal rat superior cervical ganglion during the whole postnatal developmental period. Their number can be increased with hydro-cortisone, as assessed on the basis of counted cell densities, during the first three postnatal weeks. Early postnatal hydrocortisone treatment preserves some cells in a stage in which they, on second exposure to glucocorticoids, can express PNMT immunoreactivity and increase in cell density.     

维生素A拮抗氢化可的松延迟大鼠结肠吻合口愈合的作用

结肠吻合口而是结肠手术后重要的并发症和死亡原因。本研究通过动物实验观察到氢化可的松延迟结肠吻合口愈合，而维生素Ａ能促进结肠吻合口愈合，并拮抗氢化可的松的抑制作用。同时探讨了其作用机理。为临床长期应用类固醇制剂而需行结脉手术者，使用维生素Ａ以期降低吻合口漏发生率，提供了初步的实验依据。     

氢化可的松琥珀酸钠联合雾化布地奈德治疗Ⅲ度喉梗阻

目的:观察氢化可的松琥珀酸钠联合雾化布地奈德治疗Ⅲ度喉梗阻的疗效。方法:观察组26例急性感染性喉炎合并Ⅲ度喉梗阻患儿,应用氢化可的松琥珀酸钠静脉注射联合氧气驱动雾化吸入布地奈德治疗。对照组25例给予静脉注射地塞米松,同时雾化吸入地塞米松治疗。两组均铺以抗生素等对症治疗。结果:入院治疗2h后,两组疗效比较差异有统计学意义(P<0.05)。结论:氢化可的松琥珀酸钠联合雾化布地奈德治疗III度喉梗阻起效极快,疗效明显优于用地塞米松静脉注射并同时吸入地塞米松,可避免行气管切手术。     

新氢化可的松凝胶的制备及质量控制

目的研制新氢化可的松凝胶。方法以硫酸新霉素、氢化可的松为主药制备凝胶,采用抗生素微生物检定法和紫外分光光度法测定凝胶中硫酸新霉素、氢化可的松的含量。结果硫酸新霉素效价为标示量的90%～110%,氢化可的松的平均回收率为100.16%,RSD为0.18%,临床有效率为86.45%。结论该凝胶制备工艺简单,成本低廉,性质稳定,质量可控,疗效确切。     

RP—HPLC法测定醋酸氢化可的松乳膏中醋酸氢化可的松的含量

目的：建立了RP—HPLC法测定醋酸氢化可的松乳膏中醋酸氢化可的松的含量。方法：采用AgilentHC C18（4．6IDATI×250mm,5μm）色谱柱,乙腈-水（36：64）为流动相,检测波长254nm,流速1．0ml／min,柱温40℃。结果：醋酸氢化可的松在0．506～202．4μg／ml浓度范围内呈良好线性关系（r=0．99999）;醋酸氢化可的松乳膏的平均回收率为99．28％,RSD为0．42％（n=9）。结论：该方法快速、简便、准确、灵敏、重现性好,并能有效控制药品质量。     

Cortisol levels in patients with severe community-acquired pneumonia

Objectives To evaluate cortisol levels and prevalence of adrenal insufficiency in patients with severe community-acquired pneumonia (CAP). Design and setting Retrospective cohort study in a 24-bed medical-surgical intensive care unit (ICU). Patients Forty patients with severe CAP admitted to the ICU from March 2003 and May 2005. Measurements and results Random cortisol levels were measured up to 72 h after ICU admission. A threshold of 20 μg/dl was considered for the diagnosis of adrenal insufficiency. Median cortisol levels were 15.5 μg/dl (IQR 10.8–25.1), and 26 patients (65%) met the criteria for adrenal insufficiency. Other cutoff levels of cortisol were evaluated, and 30 patients (75%) had cortisol levels below 25 μg/dl and 19 (47.5%) had cortisol levels below 15 μg/dl. When only patients with septic shock (n = 19) were evaluated, 12 (63%) had adrenal insufficiency. Conclusions Relative adrenal insufficiency occurs in a high proportion of patients with severe CAP. This finding highlights the importance of measuring cortisol levels and may help explain the potential benefits of hydrocortisone infusion in these patients.     

5-氨基水杨酸保留灌肠治疗慢性溃疡性结肠炎280例观察

目的探讨5-氨基水杨酸保留灌肠治疗慢性溃疡性结肠炎的临床效果。方法分别采用5-氨基水杨酸保留灌肠（0.9%NaCl-60ml＋5-氨基水杨酸制剂4 g,保留灌肠,Qd）和常规治疗法（0.9%NaCl-60ml＋氢化可的松100mg,保留灌肠,Qd）对慢性溃疡性结肠炎患者进行治疗,比较其治疗效果。结果 5-氨基水杨酸保留灌肠治疗可加快慢性溃疡性结肠炎患者粘液脓血便及腹泻症状的缓解。但对患者的腹疼症及里急后重症状的治疗,两组方法无明显差异。5-氨基水杨酸保留灌肠治疗法能够有效提高慢性溃疡性结肠炎患者的治疗有效率（其有效率为98.58%）。结论针对慢性溃疡性结肠炎患者采用5-氨基水杨酸保留灌肠治疗,可明显提高患者的治疗有效率,加快部分临床症状的缓解。