三黄烧伤灵对烧烫伤休克期大鼠肾功能保护作用的实验研究

目的探索外用中药制剂对严重烧烫伤休克期大鼠肾脏的保护作用及机制。方法通过血液检测、ELISA等方法在休克期的8h、24h、48h测定肾功能(Bun、Cr)、肾组织髓过氧化物酶(MPO)。结果三黄烧伤灵治疗组血清BUN和Cr与碘伏治疗组比较有明显下降,肾脏髓过氧化物酶活性降低。结论三黄烧伤灵直接外敷于患处,以油膏为基质,其内含有清热解毒、活血化瘀类中药,贴敷在创面能有效地避免空气对末梢神经刺激,阻止外界细菌侵入,抑制细菌寄生、生长、繁殖,改善创面的血液循环,促进组织生长,通过组织吸收后改变内毒素的结构,以灭活解毒或降低其毒素。通过减少内毒素的释放,促进内毒素的排泄,减弱或消除肿瘤坏死因子(TNF-α)、白介素(IL-6)的作用,以达到保护内脏的目的。     

Pharmacotherapy of vasculitis

The systemic vasculitides are characterized by inflammatory lesions in blood vessels. Therapeutic approaches should be based on the aetiology or pathophysiology of disease. Unfortunately, for many of these disorders neither is fully understood and empirical treatment based on clinical presentation and the pattern of organ involvement is used. This approach is effective in improving survival in the most serious forms. We undertook a systematic literature review to assess the evidence for using drug therapies in vasculitis. Glucocorticoids remain essential for many forms of vasculitis; indeed, in giant-cell arteritis, they may be the only therapy necessary. However, additional immunosuppressive agents are required for other forms of vasculitis: methotrexate in Takayasu's arteritis and non-renal small-vessel vasculitis and cyclophosphamide for classic Wegener's granulomatosis, microscopic polyangiitis, polyarteritis nodosa and Churg–Strauss syndrome with poor prognostic features. Subsequent disease control is with low-dose glucocorticoid and azathioprine or methotrexate. Biologic therapy is being used in resistant cases. Patients experience significant short- to medium-term toxicity, especially infection and steroid side effects. Late sequelae due to high cumulative doses of cyclophosphamide include infertility and malignancy. Such risks are being reduced due to more judicious use of short courses of cyclophosphamide followed by substitution by safer agents.     

Rituximab for refractory Wegener’s granulomatosis

Wegener’s granulomatosis is a rapidly progressing small vessel vasculitis involving mainly the lungs and kidneys and has antineutrophil cytoplasm antibodies against protease 3 as a common immunological marker. Therapy is aimed at prolonging survival, inducing remission of the active disease and preventiong its relapse. Several immunosuppressive agents are currently used in conventional regimen, and cyclophosphamide is the most commonly used. In patients refractory to such therapies, other drugs have to be used and rituximab (an antibody against CD20⁺ cells) could be a potentially effective treatment for this subset. The data on its clinical efficacy are only preliminary and further studies are needed.     

Foreword

The mortality experience of 594 individuals occupationally exposed to benzene was investigated using a retrospective cohort design. Three hundred thirty-five of the employees began working in benzene areas prior to 1950, which provided a sound data base from which to examine latency. Data derived from work histories and industrial hygiene records permitted estimation of exposure intensities and cumulative dosages for each employee. No mortalities directly attributable to benzene exposure were observed. Several cases of leukemia and other blood disorders were noted and discussed.     

Clinical and pathophysiological significance of anti-neutrophil cytoplasmic autoantibodies in vasculitis syndromes

Abstract

Necrotizing vasculitis of small blood vessels is a rare condition, but when it affects important organs it can lead to life-threatening organ damage and death. Thus, recognizing these conditions at an early stage before they spread to become systemic is a constant challenge to clinical medicine. The objectives of this review are: to give advice on clinical indications for ANCA diagnostics and laboratory procedures for highly specifically detecting the most important ANCA; to provide some data on the autoantigens involved in ANCA reactivity in small vessel vasculitides; and to discuss at the occurrence of ANCA in different vasculitic populations and at different stages of disease. One important task for the near future will be to standardize the assays used for ANCA detection/quantification and to harmonize the results given to clinicians by ensuring that international reference reagents are used by laboratories and the diagnostic industry. Finally, the author has attempted to summarize the role that ANCA are currently believed to play in the immuno-inflammatory events that take place in tissues and that affect small vessels in idiopathic vasculitis. The review concludes that the presence of ANCA is likely to become an important criterion for diagnosing idiopathic small vessel vasculitis.     

Proteinase 3-ANCA Vasculitis versus Myeloperoxidase-ANCA Vasculitis

In patients with GN or vasculitis, ANCAs are directed against proteinase 3 (PR3) or myeloperoxidase (MPO). The differences between PR3-ANCA-associated vasculitis (AAV) and MPO-AAV described in the past have been supplemented during the last decade. In this review, we discuss the differences between these two small-vessel vasculitides, focusing especially on possible etiologic and pathophysiologic differences. PR3-AAV is more common in northern parts of the world, whereas MPO-AAV is more common in southern regions of Europe, Asia, and the Pacific, with the exception of New Zealand and Australia. A genetic contribution has been extensively studied, and there is a high prevalence of the HLA-DPB1*04:01 allele in patients with PR3-AAV as opposed to patients with MPO-AAV and/or healthy controls. Histologically, MPO-AAV and PR3-AAV are similar but show qualitative differences when analyzed carefully. Clinically, both serotypes are difficult to distinguish, but quantitative differences are present. More organs are affected in PR3-AAV, whereas renal limited vasculitis occurs more often in patients with MPO-AAV. For future clinical trials, we advocate classifying patients by ANCA serotype as opposed to the traditional disease type classification.     

Drug-Induced Glomerular Disease: Immune-Mediated Injury

Drug-induced autoimmune disease was initially described decades ago, with reports of vasculitis and a lupus-like syndrome in patients taking hydralazine, procainamide, and sulfadiazine. Over the years, multiple other agents have been linked to immune-mediated glomerular disease, often with associated autoantibody formation. Certain clinical and laboratory features may distinguish these entities from their idiopathic counterparts, and making this distinction is important in the diagnosis and management of these patients. Here, drug-induced, ANCA-associated vasculitis, drug-induced lupus, and drug-associated membranous nephropathy are reviewed.