Mucosal Biopsy After Bone Marrow Transplantation

Gastrointestinal mucosal biopsies in the hematopoietic stem cell transplantation setting are challenging because histologic features of graft-versus-host disease (GVHD), which is treated by increasing immunosuppression, overlap with those of other conditions, such as infection, which can get worse with GVHD treatment. More than one condition can occur at the same time. It is important to understand the histologic features of GVHD, drug toxicity, infection, and clinical factors surrounding patients, including timing of biopsy in relation to transplantation, medication history, and laboratory data. Rendering a correct diagnosis and generating a pathology report with standard language that can direct clinical management ensure proper management.     

霉酚酸酯与环磷酰胺治疗Ⅱ、Ⅲ级紫癜性肾炎的疗效比较

目的比较分析激素联合霉酚酸酯（MMF）与环磷酰胺（CTX）治疗Ⅱ、Ⅲ级紫癜性肾炎（HSPN）患儿的临床疗效。方法选取经肾穿刺肾脏病理活检确诊为Ⅱ或Ⅲ级的接受激素联合免疫抑制剂治疗的HSPN患儿45例,按照治疗措施分为MMF组15例和CTX组30例。记录治疗前及治疗后1、3、6、9、12个月尿常规、24h尿蛋白定量、血清白蛋白、血清肌酐、血尿素氮等指标,观察临床表现变化,记录两组治疗期间出现的药物不良反应。结果治疗3、6、9个月时MMF组24h尿蛋白定量均明显低于CTX组,差异均有统计学意义（均P＜0.05）。MMF组治疗1、3个月尿蛋白转阴比例分别为46.7%（7/15）和86.7%（13/15）,高于CTX组的16.7%（5/30）和56.7%（17/30）,差异均有统计学意义（均P＜0.05）。治疗3、6个月时MMF组血尿缓解率分别为60.0％（9/15）和73.3％（11/15）,明显高于CTX组的23.3％（7/30）和40.0％（12/30）,差异均有统计学意义（均P＜0.05）。治疗3个月时MMF组血清白蛋白明显高于CTX组,差异有统计学意义（P＜0.05）。两组患儿治疗1、3、6、9、12个月时总缓解率比较差异均无统计学意义（均P＞0.05）;但治疗6、9个月时MMF组完全缓解率均明显高于CTX组,差异均有统计学意义（均P＜0.05）。MMF组出现胃肠道反应及上呼吸道感染各1例;CTX组出现胃肠道反应4例,上呼吸道感染1例,白细胞下降、肝损害、脱发各3例。结论激素联合MMF治疗Ⅱ、Ⅲ级HSPN患儿的近期疗效优于CTX,能更快速地缓解血尿、降低蛋白尿、升高血清白蛋白,达到临床完全缓解,且胃肠道反应、骨髓抑制及肝损害等常见不良反应发生率低,安全性较高。     

国产、进口及国外三种吗替麦考酚酯胶囊的体外溶出曲线对比研究

目的通过建立有区分力的溶出曲线测定方法,对国产、进口原研及美国橙皮书收载的参比制剂三种吗替麦考酚酯胶囊进行体外溶出曲线的对比研究,以评价国产制剂、进口及国外原研参比制剂溶出行为的一致性。方法参考美国FDA溶出曲线数据库、日本IF文件及中国药典公布的吗替麦考酚酯胶囊溶出检测条件,选择0.1 N HCl、水、pH6.8磷酸盐缓冲液和pH5.0柠檬酸缓冲液4种不同pH值的溶出介质,对国内外上市的三种吗替麦考酚酯胶囊溶出曲线进行对比研究,通过相似因子(f2)法对溶出曲线进行评价。结果三种制剂在0.1 N HCl介质中15 min累计溶出量均大于85%;国产制剂与国内外参比制剂在水、pH6.8磷酸盐缓冲液和pH5.0柠檬酸缓冲液三种溶出介质中的溶出曲线相似因子f2均大于50。结论国产制剂、进口及国外三种制剂在4种不同溶出介质中的溶出曲线均一致。     

吗替麦考酚酯联合激素治疗血管炎性IgA肾病患者的临床效果分析

目的分析吗替麦考酚酯联合激素治疗血管炎性IgA肾病患者的临床效果。方法选取2016年3月～2018年6月期间我院收治的血管炎性IgA肾病患者40例为研究对象,随机分为研究组和对照组,每组20例。对照组在常规治疗基础上加用环磷酰胺、泼尼松,研究组在常规治疗基础上加用吗替麦考酚酯、泼尼松。观察两组临床治疗效果、治疗前后相关生化指标及尿量变化情况、药物所致不良反应发生情况。结果对照组治疗总有效率为70.0%,低于研究组的95.0%,差异有统计学意义(P0.05);治疗前两组血肌酐、白蛋白、总蛋白、24 h尿蛋白检测值及尿量比较,差异无统计学意义(P0.05),治疗后研究组血肌酐、24 h尿蛋白检测值较之前下降幅度以及白蛋白、总蛋白检测值及尿量较治疗前提高幅度均优于对照组,组间、组内数据比较,差异有统计学意义(P0.05);两组治疗期间药物相关不良反应发生情况比较,差异无统计学意义(P0.05)。结论吗替麦考酚酯、激素联合治疗血管炎性IgA肾病有效性、安全性均较优,值得临床应用以及推广。     

Epstein-Barr virus-associated primary central nervous system lymphoma in a patient with diffuse cutaneous systemic sclerosis on long-term mycophenolate mofetil

BackgroundEpstein Barr virus (EBV)-associated primary central nervous system lymphoma (ePCNSL) is increasingly recognized in immunocompromised subjects, including patients receiving systemic immunosuppressive therapy. Here, we report the first case of primary CNS lymphoma associated with EBV in a patient with diffuse cutaneous systemic sclerosis (dcSSc) receiving long-term mycophenolate mofetil (MMF).Case reportA 51-year-old female with dcSSc had been on MMF 2 grams daily, which was initiated for a rapidly rising modified Rodnan skin score (mRSS), severe pruritus, and progressive joint contractures. She had an impressive response to this therapy with a significant decrease in her mRSS. Her condition remained stable for the next five years, after which she developed worsening headaches for 2–3 weeks, associated with dizziness, gait instability, and left homonymous hemianopia. MRI scan of the brain revealed a solitary 2.4 cm peripherally enhancing right parietal lobe mass. Excised tissue from the right parietal lobe mass showed EBV-associated diffuse large B cell lymphoma. She received four cycles of chemotherapy (high dose methotrexate and rituximab). Currently, her condition is being monitored. Her left homonymous hemianopia persists.ConclusionBecause of a favorable toxicity profile, MMF is increasingly being used as long-term immunomodulatory therapy for a wide variety of autoimmune disorders. Nevertheless, patients on long-term MMF should still undergo regular CNS surveillance, not only for opportunistic infections but also for opportunistic malignancies such as PCNSL. Progressive focal or non-focal neurological deficits should always raise the alarm. Prompt evaluation and management can prevent irreversible neurological sequelae.     

霉酚酸酯用于狼疮肾炎的循证治疗

目的探讨霉酚酸酯治疗增生性狼疮肾炎的最佳方案。方法计算机检索Cochrane图书馆(2005年第4期)、MEDLINE(1990~2006.12)、CMB(1980~2006.12)、CNKI(1979~2007.10)和中国循证医学/Cochrane中心数据库(2006年第2期),收集霉酚酸酯治疗增生性狼疮肾炎的系统评价、临床随机对照试验等,并对所获证据的质量进行评价。并将证据应用于临床实践。结果共纳入4篇系统评价和6篇高质量随机对照研究(A级证据)。高质量的临床证据表明霉酚酸酯联合激素用于诱导期及缓解期能有效治疗弥漫增殖型狼疮肾炎,与环磷酰胺相比毒副作用较少。结论据患者意愿,结合我们的经验与当前最佳临床证据,制定出霉酚酸酯起始用量为1000mg/d的治疗方案。对患者进行3个月的随访,未发现明显副作用。     

霉酚酸酯对不同病理类型原发性肾小球疾病的疗效分析

目的　分析霉酚酸酯 (MMF)治疗原发性肾小球疾病不同病理类型与临床疗效的关系 ,探讨MMF治疗原发性肾小球疾病的作用机制。方法　观察 2 0 0 0 - 0 2 2 0 0 3- 0 1中国医科大学附属第二医院住院或门诊的 4 8例原发性肾小球疾病患者应用MMF治疗的临床效果。结果　膜增殖性肾小球肾炎 (MsPGN)的显效率及有效率明显高于其他类型 ;MMF的治疗效果与原发性肾小球疾病的病程有关 ,病程在 1 5年以内应用MMF治疗者效果明显好于病程在 1 5年以上的应用者。结论　MMF对原发性肾小球疾病的疗效与病理类型及用药时机有关     

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目的探讨霉酚酸酯(MMF)治疗难治性特发性血小板减少性紫癜(ITP)的疗效。方法选择2001-01～2004-01汕头市中心医院门诊及住院难治性ITP患者16例,使用MMF进行治疗。MMF剂量为每日1.0～1.5g,分早晚2次口服,疗程3个月,有效者原剂量继续服用3个月后逐渐减量维持。结果显效4例,良效7例,进步1例,无效4例。总有效率68.75%。副反应主要为轻度消化道症状。结论MMF对难治性ITP有较好的疗效,副反应小,可作为难治性ITP治疗的有效手段之一。     

Relevance of immunomodulatory therapy for interstitial lung disease in systemic sclerosis

Systemic sclerosis is an autoimmune disease that prominently leads to skin and tissue fibrosis. The efficacy of autologous stem cell transplantation not only attests to the autoimmune pathophysiology for systemic sclerosis, but also for interstitial lung disease as its most frequent manifestation of fatal organ involvement. Accordingly, a variety of immunomodulatory therapies were tried on patients with systemic sclerosis-interstitial lung disease. Until very recently, all of these therapeutic approaches constituted off-label treatment for systemic sclerosis, given that neither of these therapies was approved by the United States Food and Drug Administration (FDA) or the European Medicines Agency. For tocilizumab, this has now changed with FDA approval in March 2021. Already 2020, nintedanib, which is an antifibrotic drug that does not target autoimmunity, became the first approved drug for interstitial lung disease in systemic sclerosis. The present review analyzes the evidence for immunomodulatory treatment of systemic sclerosis-associated interstitial lung disease. The review focuses on randomized controlled trials, which provides evidence for the effects of drugs such as cyclophosphamide, mycophenolate, rituximab and tocilizumab.