Clinical analysis of osteonecrosis of the femoral head induced by steroids

Objective: To explore the clinical characteristics of osteonecrosis of the femoral head (ONFH) induced by steroids. Methods: From January 2000 to October 2009, 497 hips in 270 cases of ONFH induced by steroids were studied. A questionnaire was administered when the patients were admitted; the questions concerned the underlying disease, duration of steroid usage, total dosage of steroid, incubation period (time interval between commencement of steroid therapy and onset of pain), severity of pain, location of initial complaint, primary diagnosis, time lag from onset of pain to final diagnosis and physical signs when admitted. The correlations between pain and Association Research Circulation Osseous (ARCO) stage, bone marrow edema (BME) and lesion size were analyzed. Results: The median of time between commencing steroid medication and developing ONFH for the 269 cases was 18 months (range, 2–384 months). 78.82% cases presented with pain within three years of steroid initiation, only 10.41% patients first complained of pain six or more years after commencing steroid therapy. Fifty‐six cases (20.82%) were misdiagnosed, lumbar disorders being the most frequent misdiagnoses. 79.29% of symptomatic hips presented with abnormal physical tests. Of 420 symptomatic hips, 166 hips were type C1, 223 hips type C2; 299 hips had collapsed; and there was BME in 209 hips. Conclusion: Most patients with ONFH induced by steroids complained of pain within 3 years of commencing steroid therapy. Pain was associated with lesion size, collapse and BME. Atypical location of pain, failure to perform a physical examination and MRI findings were the main causes of misdiagnoses.     

联用吸入型糖皮质激素和长效β2-受体激动剂在COPD缓解期治疗中的疗效观察

目的 观察缓解期慢性阻塞性肺疾病（COPD）患者吸入糖皮质激素和长效β2-受体激动剂（ICS／LABA）后对临床症状和肺功能的影响程度。方法 按照随机、对照、单盲的设计，将120例稳定期COPD患者分为两组，观察组给予舒利迭^TM（SAL／FP，50μg，2次／d）与对照组给予施立稳^TM（FP，50μg，2次/d）吸入治疗3个月，观察治疗前后测定肺功能第1秒用力呼吸气量占预计值的百分比、用力肺活量，并记录临床症状评分。结果 观察组COPD患者吸入SAL／FP治疗后，临床症状积分和肺功能指标差异有统计学意义（P〈0．01），与对照组比较差异有统计学意义（P〈0．05）。结论 联合应用吸入型糖皮质激素和长效β2-受体激动剂用于缓解期COPD患者的治疗及预防，对缓解症状和改善肺功能均能收到良好效果，且较单用长效β2-受体激动剂疗效好（P〈0．05）。     

A multivariate analysis of risk factors for anterior atlantoaxial subluxation and an evaluation of the effect of glucocorticoid treatment on the upper rheumatoid cervical spine

Summary A cross-sectional, retrospective computerized analysis of risk factors for anterior atlantoaxial subluxation (AAS) was performed. Logistic regression performed on the clinical variables involved in 145 cases of rheumatoid arthritis (RA) disclosed a high joint score index and a low blood haemoglobin level as significant independent risk factors. This means that the development of anterior AAS is connected with widespread RA. Linear multiple regression analysis showed an association between the extent of anterior AAS in millimetres and the spread of erosions of the dens of axis and negative correlation with the severity of vertical atlantoaxial dislocation (VD). This suggests that whereas the presence of anterior AAS is connected with the severity of the systemic disease, its actual extent is associated with signs of local involvement, other than severe VD. The duration or cumulative dosage of glucocorticoids were not associated with the development or extent of anterior AAS, nor with the severity of vertical dislocation. This suggests that low dose glucocorticoid treatment is not involved with the development of rheumatoid changes in the upper cervical spine. It should be borne in mind, of course, that although no correlation was found, a causal relation cannot be excluded.     

糖皮质激素在慢性疼痛神经阻滞疗法中的应用

糖皮质激素在慢性疼痛的神经阻滞疗法中发挥着重要作用。局部小剂量注射糖皮质激素有强大的抗炎镇痛作用，效果持久，副作用小等优点。但是由于其潜在的毒、副作用，临床上应严格掌握适应证和禁忌证。由于临床上对糖皮质激素的使用有些混乱，引起了人们对其安全性的质疑，故选择正确的剂型和剂量，选择正确的注射部位，掌握好注射技术尤为重要。本文综述近几年来糖皮质激素在神经阻滞中的应用，并归纳了几种常用糖皮质激素的作用特点。     

儿童C1q肾病临床病理研究

目的 :探讨儿童C1q肾病临床病理特征及诊断与治疗。方法 :分析 8例C1q肾病患儿临床病理特点及激素或免疫抑制剂治疗效应 ,并与同期 77例原发性NS患儿作比较。结果 :8例C1q肾病患儿临床上大多表现为原发性NS(6例 ) ,仅 2例表现为肾炎综合征和单纯性血尿。LM主要包括MC(3例 )、MsPGN(2例 )、FSGS(2例 )和ECPGN(1例 )。IF显示明显的系膜区C1q沉积 ,伴或不伴有Ig和补体沉积。EM检查仅 1例有系膜区和内皮下电子致密物沉积。与原发性NS相比 ,6例表现为NS的C1q肾病患儿对泼尼松初次治疗产生耐药的相对危险度为 2 1(P <0 .0 0 1) ,但对免疫抑制剂治疗均敏感。结论 :儿童C1q肾病临床上以对激素耐药的NS为常见表现 ,IF是其主要诊断依据 ,使用免疫抑制剂治疗有效     

Glucocorticoid receptors in idiopathic nephrotic syndrome

The variable response of patients with idiopathic nephrotic syndrome (NS) to glucocorticoid (GC) treatment has not been explained. Earlier studies indicated that the response is limited by cellular GC receptors. We investigated these receptors in mononuclear leukocytes of 28 pediatric patients with NS divided into three groups: steroid-sensitive in relapse, steroid-sensitive in remission, and steroid-resistant. Density and binding affinity of GC receptors were determined by a dexamethasone binding assay; no significant differences were found between the three patient groups and between these and healthy controls, although a few patient values fell outside the range of controls. Total and free plasma concentrations of cortisol were low in all three patient groups. A weak positive correlation was found between the number of GC receptors and total plasma cortisol (r=0.36, P=0.03). The results suggest that factors other than GC receptors that mediate the cellular effects of GC are involved in the variable response of NS patients to GC. Received: 29 December 1998 / Revised: 12 April 1999 / Accepted: 19 April 1999     

Effects of elevated circulating cortisol concentrations on maternal behavior in common marmoset monkeys (Callithrix jacchus)

Both acute and chronic stress can impair maternal behavior and increase rates of infant abuse in several species. The mechanisms inducing these effects are unknown, but experimental manipulation of circulating corticosterone levels alters maternal behavior in rats, and circulating or excreted cortisol concentrations have been found to correlate either positively or negatively with maternal behavior in humans and nonhuman primates. In this study, therefore, we experimentally tested the hypothesis that both acute and chronic treatment with exogenous glucocorticoids would alter maternal behavior in a primate, the common marmoset (Callithrix jacchus). Multiparous females, approximately 3–5 weeks postpartum, received daily injections of either cortisol (hydrocortisone sodium succinate and hydrocortisone acetate; N = 7) or vehicle (N = 7) for 8 days, and maternal behavior was characterized under baseline conditions as well as during exposure to a noise stressor. Cortisol treatment successfully elevated both morning and afternoon plasma cortisol concentrations and suppressed circulating levels of adrenocorticotropic hormone. In home-cage observations, cortisol-treated females carried their infants significantly less than control mothers, and in noise-stressor tests, several hours after the first cortisol or vehicle treatment, cortisol-treated mothers inspected their infants significantly more often than controls. Aggression towards infants was infrequent and mild, and did not differ between treatment groups. These findings provide the first experimental evidence that cortisol elevations can alter maternal behavior in primates. As these effects were limited in scope, however, they suggest that other stress-responsive hormones or neuropeptides may additionally play a role in mediating the effects of stress on maternal behavior.     

重组人白细胞介素-11联合糖皮质激素治疗免疫性血小板减少症的疗效分析

目的 探讨采用重组人白细胞介素(rhIL)-11联合糖皮质激素治疗初治免疫性血小板减少症(ITP)患者的疗效及安全性.方法 选取2011年12月至2014年12月于江苏省张家港市第一人民医院血液科接受住院治疗的60例初治ITP患者为研究对象.按照简单随机抽样法将60例初治ITP患者分为研究组(n=30)与对照组(n=30).研究组患者采用rhIL-11联合糖皮质激素方案进行治疗;对照组患者单用糖皮质激素进行治疗.本研究纳入标准:符合ITP诊断标准的初治患者,年龄大于18岁.排除标准:继发性血小板减少症患者,以及伴有基础疾病,如糖尿病、心功能不全或心律失常的ITP患者.检测并记录两组患者治疗前、治疗第4、7天血小板计数的变化情况及其血小板计数≥100×109/L的平均时间,根据ITP出血评分表(BAT)统计出血评分,以及治疗第7天患者的疗效评价、不良反应,并进行统计学分析.本研究遵循的程序符合江苏省张家港市第一人民医院人体试验委员会所制定的伦理学标准,得到该委员会批准.两组患者年龄与性别构成比等一般临床资料,以及治疗前血小板计数、出血评分比较,差异均无统计学意义(P＞0.05).结果 ①两组初治ITP患者治疗后血小板计数均逐步增高.研究组患者治疗第4天血小板计数[(37.9±30.4)×109/L]显著高于对照组[(22.5±16.0)×109/L],且差异有统计学意义(t=2.308,P=0.028);研究组患者治疗第7天血小板计数[(121.8±29.2)×109/L]亦显著高于对照组[(91.2±28.7)×109/L],且差异亦有统计学意义(t=5.444,P=0.000).但研究组血小板计数≥100×109/L的时间[(7.0±1.4)d]较对照组[(9.3±3.5)d]缩短,且差异有统计学意义(t=-3.820,P=0.001).②两组初治ITP患者治疗后出血评分均逐步减低.研究组患者治疗第4天出血评分[(2.0±1.1)分]显著低于对照组[(2.7±1.0)分],且差异有统计学意义(t=-2.588,P=0.015);研究组患者治疗第7天出血评分[(0.1±0.4)分]亦显著低于对照组[(0.5±1.2)分],且差异亦有统计学意义(t=-2.249,P=0.032).③研究组治疗第7天完全有效率达90.0％显著高于对照组(60.0％),且差异亦有统计学意义(x2=5.69,P＜0.05).④研究组初治ITP患者中有6例(20.0％,6/30)出现水、钠潴留,采用利尿剂治疗后好转;3例(10.0％,3/30)自感心悸,2例(6.7％,2/30)心电图结果示频发心房早搏,停药后均好转;1例(3.3％,1/30)快速房颤,停用rhIL-11,予毛花苷丙(西地兰)静脉注射后好转;20例(66.7％,20/30)发生结膜充血,未行特殊处理;其中有2例患者合并2种不良反应.对照组初治ITP患者中有5例(16.7％,5/30)患者出现体重轻度增加,无下肢浮肿,未行特殊处理;2例(6.7％,2/30)出现窦性心动过速,停药后好转;其余患者均无不良反应.结论 rhIL-11联合糖皮质激素治疗初治ITP患者起效快、疗效好、安全性高,且患者可耐受.     

糖皮质激素的临床应用

糖皮质激素（Glucocorticoids,GC）是肾上腺皮质分泌的一种甾体激素,具有调节机体的物质代谢和应激反应等功能,是临床用药甾体激素药物中十分重要的一种。本文在全面地阐述了糖皮质激素的生理作用和药理作用的基础上,通过对本院临床用药的分析并结合国内其他学者的用药经验,较为深入地分析了糖皮质激素的临床应用和不良反应以及相应的并发症,总结了糖皮质激素临床应用中的相关注意事项。     

抗结核药联合大剂量糖皮质激素冲击治疗晚期结核性脑膜炎临床观察

目的 观察抗结核药联合大剂量糖皮质激素冲击疗法治疗晚期结核性脑膜炎的临床疗效和安全性.方法 77例晚期结核性脑膜炎患者在知情同意下随机分为观察组39例和对照组38例,两组均给予规范的抗结核治疗,对照组加用地塞米松20 mg/d,静脉滴注,至患者症状明显改善后减量;观察组给予甲泼尼龙500 mg/d,静脉滴注,冲击治疗5 d后,改为80 mg/d,并逐渐减量至维持剂量.两组疗程均为3个月,观察比较两组临床疗效及不良反应发生情况.结果 治疗3个月后,观察组治愈32例、有效6例、无效1例、总有效率97.4%,对照组分别为22例、8例、8例、78.9%,两组总有效率差异有统计学意义（x2=7.57,P＜0.05）.观察组意识恢复时间（2.7±1.3）d、发热时间（13±5）d、脑脊液白细胞计数（112.37±27.57）× 106/L、脑脊液蛋白含量（3.04±0.82）g/L、脑脊液氯化物（32.7 ±6.4）mmol/L、脑脊液葡萄糖（1.67±0.65）mmol/L,对照组分另为（5,2±2.4）d、（19±6）d、（93.74±20.18）×106/L、（1.92±0.64）g/L、（25.4±5.2）mmol/L、（1.04±0.34）mmol/L,两组差异均有统计学意义（t=5.70、4.77、3.88、6.67、5.48、5.31,均P＜0.01）.两组不良反应发生率差异无统计学意义（P＞0.05）.结论 抗结核药联合大剂量糖皮质激素冲击疗法治疗晚期结核性脑膜炎具有显著临床疗效,能迅速改善患者症状和体征,且不良反应无明显增加,值得临床推广.