外周T细胞淋巴瘤合并自身免疫性溶血性贫血的临床特点分析

背景与目的:与自身免疫性溶血性贫血(autoimmune hemolytic anemia,AIHA)相关的淋巴瘤病理学类型多见于惰性B细胞淋巴瘤,而很少见于弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)及外周T细胞淋巴瘤(peripheral T-cell lympho...     

糖皮质激素治疗重症药物性肝损伤的临床研究

目的探索糖皮质激素治疗重症药物性肝损伤的疗效和安全性。方法 37例重症药物性肝损伤患者分为激素治疗组16例和对照组21例。对照组采用常规保肝、退黄药物方案;激素组在对照组治疗基础上,加用小剂量、短疗程糖皮质激素治疗,观察生化学应答情况、有效率和安全性。结果激素治疗组生化学应答较早,ALT、AST、TBil、DBil、ALP水平在治疗2周时分别为(93.2±65.6)U/L;(61.7±30.7)U/L;(168.3±98.9)μmol/L;(124.7±81.4)μmol/L;(117.2±40.1)U/L、4周时分别为(52.6±32.0)U/L;(77.4±144.1)U/L;(88.9±59.7)μmol/L;(64.7±48.4)μmol/L;(116.6±63.1)U/L均较治疗前(172.9±104.8)U/L;(264.7±169.7)U/L;(259.1±108.8)μmol/L;(182.2±82.4)μmol/L;(153.8±69.9)U/L显著降低(P均0.05);对照组治疗2周仅ALT、AST降低明显(P0.05),而TBil、DBil于治疗4周后方明显降低(P均0.05);两组GGT治疗前后均无显著改善(P0.05)。治疗4周时激素组治疗有效率、显效率均显著高于对照组(93.8%比66.7%,χ~2=11.919,P=0.001;87.5%比57.1%,χ~2=6.081,P=0.014)。两组总体不良反应发生率差异无统计学意义(P0.05)。结论早期应用小剂量、短疗程糖皮质激素,可有效地治疗重症药物性肝损伤,且安全性较好。     

吸入性变应原和口服糖皮质激素对过敏性哮喘患者血清可溶性CTLA-4的影响

目的 探讨吸入变应原与口服糖皮质激素对过敏性哮喘患者血清可溶性细胞毒T淋巴细胞相关抗原-4（sCTJA-4）浓度的影响。方法 采用随机、双盲、安慰剂对照,平行分组,第一组为单相哮喘反应和双相哮喘反应组给予患者吸入变应原,第二组为口服强的松或安慰剂组．1次／d,共2周。吸入性变应原或强的松前后抽静脉血检验血清,用酶链免疫吸附分析法测定血清中sCTLA-4浓度。结果 在吸入变应原后24h,双相哮喘反应组血清sCTLA-4浓度（中位数）从29．0μg／L上升到44．0μg／L,而单相哮喘反应组sCTLA-4浓度与基础值相比无显著提高。强的松治疗2周后血清sCTAL-4与基础值相比显著下降,从37．0μg／L下降至22．0μg／L。而安慰剂组则没有显著下降。结论 过敏性哮喘患者血清sCTLA-4浓度在吸入变应原后升高,而用强的松治疗后其浓度则下降。     

Differential induction of helper and killer T cells from isolated CD4+CD8+ thymocytes in suspension culture

Thymocytes of T cell receptor transgenic mice with nonselecting and RAG-2^−/− backgrounds were developmentally arrested at the CD4⁺CD8⁺ stage before positive selection. These thymocytes underwent lineage commitment upon transient stimulation with a combination of ionomycin, a calcium ionophore, and phorbol 12-myristate 13-acetate (PMA), a protein kinase C activator, in suspension culture. The effective drug doses were limited within narrow ranges and much lower than those which induce proliferation of mature T cells. The doses corresponded to those which inhibit glucocorticoid-induced apoptosis in these thymocytes. CD4 lineage commitment required longer duration, higher intensity of the stimulation, or both, than CD8 lineage commitment. Functional helper T cells (Th1 and Th2) were induced from the CD4 lineage-committed cells upon secondary stimulation with a combination of ionomycin and PMA followed by lymphokine treatment. Cytotoxic T cells were induced from the CD8 lineage-committed cells upon incubation with concanavalin A and irradiated splenic dendritic cells, but not with the combination of ionomycin and PMA. These results indicate that positive selection is mimicked by the pharmacological stimulation in the absence of other cell types, but that final maturation of CD8 T cells may require a different signal.     

糖皮质激素受体-α mRNA在鼻息肉组织中的定量表达

目的通过检测糖皮质激素受体-α(GR-α)mRNA在鼻息肉和鼻腔正常黏膜中的定量表达,探讨糖皮质激素在鼻腔局部用药的吸收途径.方法采用荧光定量逆转录PCR(FQ-RT-PCR)方法检测1 01例鼻息肉和31例鼻腔正常黏膜中GR-α mRNA的定量表达.结果GR-α在鼻腔正常黏膜(135.4±5.25)×104拷贝/μg中比鼻息肉(23.5±12.1)×104拷贝/μg中表达高,两组之间有显著性差异.结论鼻息肉组织中GR-α mRNA低表达提示糖皮质激素不经鼻息肉黏膜吸收,而是经过鼻腔的正常黏膜吸收.     

肺力咳合剂联合糖皮质激素治疗小儿肺炎疗效观察

目的:观察肺力咳合剂联合糖皮质激素治疗小儿肺炎的疗效。方法:选取我院儿科2016年12月~2018年7月接收的肺炎患儿120例,按随机数表法分为观察组和对照组,每组60例。对照组确诊后用糖皮质激素进行治疗;观察组确诊后用糖皮质激素联合肺力咳合剂进行治疗。治疗结束后评估两组临床效果,详细记录治疗前、治疗3 d后与治疗7 d后肺部炎症的积分情况以及咳嗽消失时间、发热消失时间、胃肠道反应时间、肺啰音消失时间与X线肺部炎症吸收时间。结果:肺力咳合剂联合糖皮质激素治疗的观察组临床治疗效果明显优于仅用糖皮质激素治疗的对照组(P<0.05);观察组治疗3 d、1周后,肺部炎症积分比对照组明显降低,咳嗽消失时间、发热消失时间、胃肠道反应时间、肺啰音消失时间与X线肺部炎症吸收时间得到有效的改善(P<0.05)。结论:对小儿肺炎以肺力咳合剂联合糖皮质激素辅助治疗效果显著,利于缓解症状及体征,减少住院治疗时间,值得临床推广。     

穴位埋线治疗进行性肌营养不良的疗效观察

目的观察穴位埋线联合糖皮质激素及神经营养药物治疗进行性肌营养不良的临床疗效。方法 50例进行性假肥大性肌营养不良患者,随机分为治疗组和对照组,每组25例。对照组采用糖皮质激素及神经营养药物治疗,治疗组在对照组基础上采用穴位埋线治疗。观察两组治疗前后10米步行时间和登梯时间及血清肌酸磷酸激酶(CPK)、乳酸脱氢酶(LDH)水平的变化,并比较两组临床疗效。结果两组治疗后及随访10米步行时间和登梯时间与同组治疗前比较,差异有统计学意义(P<0.05);两组治疗后及随访10米步行时间和登梯时间比较,差异有统计学意义(P<0.05)。两组治疗后及随访血清CPK、LDH水平较同组治疗前明显下降,差异有统计学意义(P<0.01);治疗组治疗后及随访血清CPK和LDH水平低于对照组(P<0.01)。治疗组总有效率为96.0%,对照组总有效率为72.0%,治疗组总有效率高于对照组(P<0.05)。结论穴位埋线联合糖皮质激素治疗进行性肌营养不良的临床疗效显著,可作为临床治疗进行性肌营养不良方案的优选方法。     

Outcomes of Glucocorticoid Treatment in HBV-Associated Acute-on-Chronic Liver Failure Patients: A Retrospective Observational Study

BackgroundOur study aimed to investigate the effects of glucocorticoid (GC) treatment on liver function, hospitalization length, and expenses, as well as 28-day mortality in patients suffered from hepatitis B virus (HBV)-associated acute-on-chronic liver failure (ACLF).MethodsThis is a retrospective study of 349 patients who were hospitalized with HBV-associated ACLF. Biochemical assay results of alanine aminotransferase (ALT) level, aspartate aminotransferase (AST) level, total bilirubin (TBil) level, and creatinine (Cr) level both at admission and before discharge were recorded. GC and antivirus treatment condition, hospitalization length and expenses, as well as 28-day status were also recorded.Results Among 349 patients with HBV-associated ACLF, GC treatment did not benefit in liver function outcomes, and even ended in higher ALT and TBil levels comparing to patients treated without GC. However, patients treated with GC might have lower 28-day mortality. Similar results were shown in patients with or without antivirus treatment. In addition, GC treatment could not shorten hospitalization length and could increase the expenses.Conclusion Using GC in HBV-associated ACLF patients could not improve their liver function, but might reduce the risk of death, no matter the patient had had antivirus treatment or not. In addition, GC treatment could not shorten hospitalization length and could increase the expenses in HBV-associated ACLF patients.     

全氟辛酸暴露对哮喘小鼠炎症介质IL-4和IFN-γ及糖皮质激素受体的影响

目的:研究全氟辛酸(PFOA)对哮喘小鼠气道炎症、外周血炎症介质白细胞介素4(IL-4)和干扰素γ(IFN-γ)以及肺组织糖皮质激素受体(GR)表达的影响及其可能机制。方法:30只BALB/c小鼠随机分为正常对照(C)组、哮喘模型(A)组、哮喘+PFOA低剂量(AP10)组、哮喘+PFOA中剂量(AP50)组和哮喘+PFOA高剂量(AP100)组,根据不同分组分别制作哮喘模型及PFOA暴露模型。留取肺组织标本后进行HE染色,透射电镜标本制作,ELISA法检测外周血IL-4及IFN-γ水平,并以Western blot及免疫组织化学染色法检测肺组织GR的蛋白表达。结果:肺组织病理切片HE染色结果显示,与正常小鼠相比,哮喘小鼠气道及血管周围可见明显的炎症细胞浸润及黏液分泌,AP各组表现更为明显。透射电镜结果显示,哮喘小鼠肺组织超微结构破坏明显。ELISA检测血清炎症因子结果表明,与C组相比,A组及AP各组外周血炎症因子IL-4升高,IFN-γ明显降低(P0.05);与A组相比,AP10组及AP50组无明显差异,而AP100组外周血炎症因子IL-4升高,IFN-γ明显降低(P0.05)。Western blot结果显示哮喘小鼠肺组织GR表达较正常小鼠降低(P0.05),而A组与AP各组之间无显著差异。免疫组化结果提示GR蛋白主要表达于小鼠肺组织支气管柱状上皮细胞、气道平滑肌细胞及血管平滑肌细胞胞浆。结论:哮喘小鼠气道PFOA急性暴露可通过诱导Th2型免疫反应加剧肺部炎症,促进气道及血管周围的炎症细胞浸润并破坏肺组织超微结构,且与剂量相关。     

糖皮质激素治疗SLE对骨代谢标志物的影响分析

目的 研究骨代谢标志物在糖皮质激素治疗系统性红斑狼疮(SLE)前后的变化,及其与治疗疗程进展的关系,探讨激素治疗后育龄期、围绝经期、绝经后女性患者骨代谢水平的特征;分析骨代谢标志物与骨密度在糖皮质激素治疗SLE中诊断骨质疏松的价值.方法 检测40例SLE患者经糖皮质激素治疗前及治疗后3、6、12个月的骨代谢标志物(BGP、β-CTX、PICP),测定不同部位的骨密度,并运用统计学方法进行处理.结果 ①糖皮质激素治疗前骨形成标志物和骨吸收标志物均较正常对照组明显降低(P＜0.05),差异有统计学意义;②激素治疗早期,骨形成标志物BGP、PICP明显下降,骨吸收标志物β-CTX明显上升,治疗3、6、12个月后的骨代谢标志物水平与治疗前比较差异有统计学意义(P＜0.05);③激素治疗后,围绝经期组较育龄期组β-cTx、PTH、FSH水平明显升高(P＜0.05),绝经后组与围绝经期组比较,β-CTX、BGP、PICP、FSH均显著升高(P＜0.05),差异有统计学意义.④糖皮质激素治疗3、6、12个月后测股骨近端、腰椎、Ward三角的骨密度,其不同部位骨密度的变化差异缺乏一致性.结论 糖皮质激素治疗SLE患者,骨代谢标志物在治疗早期有明显变化;而同阶段不同部位骨密度变化存在差异,骨代谢标志物对早期诊断骨质疏松有重要意义,骨代谢标志物联合雌二醇(E2)可为围绝经女性骨质流失的评估提供参考.