糖皮质激素对慢性免疫性血小板减少症患儿树突状细胞的影响

目的：探讨树突状细胞（DCs）在儿童慢性免疫性血小板减少症（cITP）中的变化以及糖皮质激素对cITP患儿DCs的作用。方法：流式细胞术分别检测15例cITP患儿应用糖皮质激素治疗前后和20例对照者外周血DCs亚群的变化;体外培养并收集cITP患儿外周血单核细胞来源的DCs,采用流式细胞术检测其免疫表型。结果：与对照组比较,cITP患儿治疗前髓样DC（mDC）绝对数无明显改变,浆细胞样DC（pDC）绝对数降低,mDC/pDC比值增高（P<0.05）;cITP治疗后,pDC绝对数较治疗前增高,而mDC绝对数及mDC/pDC比值较治疗前降低（P<0.05）;cITP 患儿治疗前外周血DCs的HLA-DR、CD80、CD83和CD86 阳性表达率均明显高于对照组（均P<0.01）;治疗后cITP患儿DCs的HLA-DR、CD80、CD83和CD86表达率较治疗前均明显下降（P<0.01）,与对照组比较差异无统计学意义（P>0.05）。结论：DCs亚群比例失衡及功能失调与儿童cITP的发病有关;糖皮质激素能增强cITP患儿 DCs的免疫抑制效应,可能是糖皮质激素有效治疗儿童cITP的机制。     

糖皮质激素受体与儿童激素耐药型肾病综合征研究进展

原发性肾病综合征是儿科常见的泌尿系统疾病,糖皮质激素是其首选和基础用药,然而临床中约有10％ ～ 20％的患者对激素耐药,耐药机制复杂.研究显示糖皮质激素受体参与了耐药的发生.本文就肾病综合征患儿糖皮质激素受体表达及其基因多态性做一综述.     

儿童分泌性中耳炎治疗中应用糖皮质激素疗效分析

目的研究腺样体切除及鼓膜置管术后鼻腔局部应用糖皮质激素治疗儿童分泌性中耳炎的疗效。方法将57例分泌性中耳炎患儿随机分为实验组和对照组,实验组术后给予糠酸莫米松鼻喷雾剂喷鼻4周,对照组给予呋麻滴鼻液滴鼻1周,比较两组的有效率、复发率及中耳感染率。结果术后两组患儿有效率差异无统计学意义(p>0.05),复发率、感染率两组间差异有统计学意义(p<0.05)。结论对于儿童分泌性中耳炎在腺样体切除及鼓膜置管术后鼻腔局部应用糖皮质激素可减少复发及感染率。     

术后早期炎性肠梗阻治疗中糖皮质激素的应用

目的：探讨糖皮质激素治疗术后早期炎性肠梗阻（early postoperative inflammatory smallbowel obstruction,EPISBO）的可行性及其临床疗效。方法：回顾性分析江宁医院普外科2006年5月至2008年5月收治的39例EPISBO患者的临床资料,其中糖皮质激素治疗组20例,非糖皮质激素治疗组19例,分析比较两组病例并发症发生情况及各临床疗效指标。结果：糖皮质激素治疗组同非糖皮质激素治疗组相比,在出现应激性溃疡、切口感染或不愈、肠坏死、急性腹膜炎等并发症两者差别不显著（P〉0.05）;而糖皮质激素治疗组在腹胀、腹痛、便秘、呕吐等临床症状缓解上明显比非糖皮质激素治疗组迅速。结论：糖皮质激素治疗EPISBO安全可靠,其临床疗效优于非糖皮质激素治疗。     

诱导11β-HSD1表达对GC保护血管内皮炎性损伤作用的影响

目的探讨诱导11β-HSD1的表达在GC保护血管内皮炎性损伤中的影响。方法用甘草次酸(GA)诱导人脐静脉内皮细胞11β-HSD1的表达,观察GA作用后体外培养的人脐静脉内皮细胞在LPS和(或)Dex刺激下IL-6等炎性细胞因子的分泌及发生凋亡的变化,同时观察不同浓度的GA对人脐静脉内皮细胞11β-HSD1的表达的诱导情况。结果 GA单独作用于人脐静脉内皮细胞时,能够上调11β-HSD1mRNA的表达。GA与GC(Dex)合用也可促进11β-HSD1mRNA的表达。GA能显著抑制LPS诱导的HUVEC分泌IL-6和sICAM-1,同时显著降低LPS诱导的HUVEC的细胞凋亡率。结论 GA通过诱导11β-HSD1表达,可增强GC抑制IL-6等前炎症细胞因子的产生,加强对血管内皮细胞炎性损伤的保护。     

关注非甾体类抗炎药在眼表炎症中的正确应用

炎症是眼表的常见疾病。糖皮质激素类药物治疗眼表炎症的疗效确切,但局部长期及大量应用此类药物易发生严重的不良反应。非甾体类抗炎药（NSAIDs）具有抗炎、抗过敏、止痛等作用,局部应用可预防和治疗眼部多种原因导致的炎症性疾病,不良反应较少,临床应用比糖皮质激素更安全,因此近年来在眼表炎症的治疗中日益受到重视。虽然NSAIDs抗炎作用强,不良反应少,但在临床应用过程中也需根据病情正确选择使用,在一些炎症性眼表疾病治疗过程中需与糖皮质激素药物联合应用,以加强疗效并减少药物不良反应的发生。     

泼尼松联合阿法骨化醇治疗原发性肾病综合征的临床观察

目的观察泼尼松联合阿法骨化醇治疗原发性肾病综合征的临床疗效。方法选择2008年1月—2009年10月住院及门诊治疗的原发性肾病综合征患者56例,随机分为2组:C组28例常规泼尼松治疗,T组28例常规泼尼松联合阿法骨化醇(0.5μg/d)治疗,比较2组治疗前后临床症状的改善,血清钙、磷、甲状旁腺激素(PTH)、25-(OH)_2D_3以及1,25-(OH)_2D_3水平以及尿蛋白定量变化。结果治疗3、6及12个月后,T组缓解率均明显高于C组(P<0.05)。治疗6个月,C组患者24 h尿蛋白下降(P<0.05),血钙、血磷、血25-(OH)_2D_3及1,25-(OH)_2D_3、PTH水平稍有改善,但差异无统计学意义(P>0.05);T组血钙、25-(OH)_2D_3及1,25-(OH)_2D_3水平上升(P<0.05),24 h尿蛋白、PTH水平下降(P<0.05),且与C组治疗后相比,差异具有统计学意义(P<0.05),而血磷水平无明显变化(P>0.05)。结论泼尼松联合阿法骨化醇治疗原发性肾病综合征疗效明显。     

雄激素对糖皮质激素致大鼠不同类型骨骼肌萎缩的拮抗作用研究

目的:探讨地塞米松对不同类型骨骼肌的致萎缩作用以及睾酮的拮抗效果.方法:雌性SD大鼠160只,随机分为4组(n=40):①对照组:前肢皮下注射芝麻油1 ml·kg-1·d-1,连续3 d后同时腹腔注射生理盐水1 ml·kg-1·d-1,每日1次;②地塞米松组:注射地塞米松1 mg·kg-1·d-1(代替生理盐水)和芝麻...     

Nervous temperament in infant monkeys is associated with reduced sensitivity of leukocytes to cortisol’s influence on trafficking

There is growing evidence that temperament/personality factors are associated with immune function and health-related outcomes. Neuroticism, in particular, is a risk-factor for several diseases, many with a strong inflammatory component. We propose that neuroticism (or nervous temperament in monkeys) is related to dysregulation of immune function by glucocorticoids. The present study tested the hypothesis that animals with a nervous temperament would show no relationship between cortisol concentrations and leukocyte numbers in peripheral blood (an easily obtainable measure of glucocorticoid-mediated immune function), while animals low on this factor would show expected relationships. Infant rhesus monkeys (n = 1507) experienced a standardized testing procedure involving blood sampling, behavioral tests, and temperament ratings. Results confirmed the hypothesis: low-nervous animals showed the expected positive relationship between cortisol levels and neutrophil numbers, while high-nervous animals showed no relationship. High-nervous animals also showed elevated cortisol concentrations at most sample points, and responded to a human challenge with more negative emotional behavior. These data suggest that individuals with a nervous temperament show evidence of glucocorticoid desensitization of immune cells. Differences with other studies, including the specific types of leukocytes that are affected, are discussed, and implications for disease processes are suggested.     

Glucocorticoid receptor gene haplotype predicts increased risk of hospital admission for depressive disorders in the Helsinki birth cohort study

Background

Although glucocorticoid receptors (GR) are involved in mediating hypothalamic-pituitary-adrenal-axis functioning, which is altered in acute depression, data on associations between GR gene (NR3C1) polymorphisms and depression are scarce. We examined if single nucleotide polymorphisms (SNPs) and their haplotypes spanning the entire NR3C1 are associated with depressive disorders and with self-reported depressive symptoms in adulthood.

Methods

We successfully genotyped 10 SNPs spanning the NR3C1, and performed SNP and haplotype analyses in 1075 women and 928 men participating in the Helsinki birth cohort study. Diagnoses of depressive disorders were extracted from the Finnish Hospital Discharge Register covering a 35-year period from early to late adulthood. In addition, depressive symptoms were self-reported with standardized questionnaire in late adulthood.

Results

In comparison to the most common haplotype, one haplotype in the regulatory region of the NR3C1 was associated with increased risk of hospital admission (OR: 3.35; 95% confidence interval 1.5 to 7.3) for depressive disorders after adjusting for sex, birth year, and education. The association was statistically significant after Bonferroni correction for multiple testing. There were no other significant associations.

Conclusions

Haplotypic variation in the regulatory region of the NR3C1 may increase vulnerability to depressive disorders requiring hospital admission, but is not associated with self-reported symptoms.