糖皮质激素预防过敏性紫癜患儿肾损害随机对照试验的Meta分析

目的 评价糖皮质激素对过敏性紫癜（HSP）患儿肾损害的预防作用。方法 检索Cochrane图书馆、Medline、EMBASE、中国期刊全文数据库、万方数据库、中文科技期刊全文数据库等,收集有关糖皮质激素预防HSP患儿肾损害的RCT或类随机对照试验（quasi-RCT）文献,检索文献起止时间均为1990年1月至2012年6月。由2名作者进行资料提取和文献质量评价。应用RevMan 4.3软件进行Meta分析,根据异质性结果选择相应的效应模型分析;无法进行Meta分析时采用描述性分析。结果 5篇RCT和1篇quasi-RCT进入Meta分析。4篇文献描述了具体随机化方法,采用了充分的分配隐藏和盲法,纳入6篇文献均报道了失访和退出情况;4篇为低度偏倚风险,2篇为高度偏倚风险。Meta分析结果显示,诊断HSP后6个月以内肾损害的发生率,糖皮质激素预防组为22.2%(42/189),对照组为26.3%(50/190),合并RR=0.67（95%CI: 0.17～2.62）,差异无统计学意义,P=0.57;诊断HSP后6个月以上肾损害发生率,糖皮质激素预防组为109%(41/373),对照组为12.6%(46/364),合并RR=0.85（95%CI: 0.44～1.64）,差异无统计学意义,P=0.65。剔除2篇高度偏倚风险文献行敏感性分析,结果无改变。结论 本Meta分析结果尚不支持早期糖皮质激素治疗能预防HSP患儿肾脏损害。建议临床医生根据患儿具体临床表现和实验室检查,慎重应用糖皮质激素或辅以抗凝、抗过敏等对症治疗。     

The effect of joint aspiration and corticosteroid injections in osteoarthritis of the knee

Aim: To evaluate the benefits of knee joint aspiration and injection in knee osteoarthritis (OA). Methods: A retrospective, pilot study involved 110 patients with knee OA from a dedicated OA clinic in a Melbourne tertiary hospital from 2007 to 2009. Only those who had completed two Multiple Attribute Prioritization Tool (MAPT) questionnaires within 6 months of the initial review were included. The MAPT was designed to help prioritise patients on orthopedic waiting lists. Three groups were analyzed: patients who had no corticosteroid injection or aspiration, patients who received corticosteroid injections, and patients who received both joint aspiration with corticosteroid injections. Results: Patients who had both joint aspiration and injection reported an improvement in pain compared with those who had no injection (56.3%vs. 32.2%, P = 0.03). Those who had joint injections also did better than those without injection (62.7%vs. 32.2%, P = 0.001). Reduced analgesia use was noted in 12.5% of patients with aspiration and injection compared with 1.7% with no injection or aspiration (P = 0.03). Improved walking distance was noted in 22.4% of patients who had injections compared with 8.5% of patients with no injections (P = 0.03). No significant differences in MAPT scores among the different treatment groups were noted. Conclusion: This pilot study appears to show a beneficial trend in giving corticosteroid injections and to aspirate the knee in OA patients. Further studies are needed to address the mechanical benefits, quadriceps strengthening and pain reduction with knee aspiration, as well as the effects that different volumes of fluid may have on knee mechanics and symptoms.     

Methotrexate in the management of idiopathic granulomatous mastitis: review of 108 published cases and report of four cases

This study aimed to discuss the role of agents, such as steroids and methotrexate (MTX), in the treatment of patients with idiopathic granulomatous mastitis (IGM). Using Pubmed and Google Scholar data bases, a retrospective study was carried out on IGM cases treated with steroids and/or MTX between 1972 and 2010. Four IGM cases treated with MTX at our clinic were also summarized in this study. A total of 541 IGM cases since 1972, including ours, were retrospectively analyzed. Steroid treatment 5-85 mg was administered over 5 days-22 months to 112 patients aged 21-48 years. Recurrence occurred in 22 patients, steroid-induced diabetes mellitus in 5 patients, no response to treatment was observed in 4 patients, in 2 patients, the mass decreased in size, and static disease was observed in one. The steroid treatment was changed to MTX treatment in 4 patients who had recurrence, 5 with steroid-induced DM and in 4 who were nonrespondents. Three patients were started on steroid together with MTX as a primary treatment. Of the patients treated with MTX, a satisfactory result was obtained in 14 cases and in 2, mastectomy was performed because of recurrence despite the treatment with MTX. IGM is a troublesome condition that presents management problems due to the side effects of steroids. Our study demonstrates that the use of MTX in IGM cases has been effective in preventing complications, in resolving the inflammatory process, and in limiting side effects of corticosteroids.     

Intravitreal Triamcinolone Acetonide Injection for the Treatment of Posterior Uveitis

Purpose: To assess the efficacy and complications of intravitreal triamcinolone acetonide (IVTA) injection in the treatment of posterior uveitis and to compare the outcomes with patients who had received systemic corticosteroids. Methods: This prospective, interventional, clinical case series study included 11 eyes of 9 patients who received 8 mg/0.2 ml of IVTA injection for posterior uveitis that involved vitreous inflammation (group 1). Control group (group 2) consisted of 15 eyes of 12 patients who had received systemic corticosteroids for treatment of posterior uveitis with vitreous inflammation. The main outcome measures included best-corrected visual acuity, vitreous inflammation score and intraocular pressure. Results: In group 1, mean visual acuity improved significantly (P < 0.001) from a mean logarithm of the minimum angle of resolution (LogMAR) value of 2.05 ± 0.82 at baseline to a maximum of 0.33 ± 0.22 during the follow-up period of 5.0 ± 2.8 months. In control group, mean LogMAR visual acuity before systemic corticosteroid therapy was 1.82 ± 0.78, and it has reached a maximum of 0.40 ± 0.22 after treatment (P < 0.001). The mean inflammatory scores decreased significantly in both groups when compared with preinjection values (for each, P < 0.05). There were no statistically significant differences between group 1 and group 2 when pre-and posttreatment visual acuities and inflammatory scores at 1-, 3-, and 5-month follow-up examinations were compared (for each, P > 0.05). In group 1, mean intraocular pressure (IOP) increased significantly from 13.4 ± 2.6 mmHg to a mean maximal value of 19.3 ± 4.3 mmHg (P < 0.001), but there was no statistically significant difference between mean IOP at 5-month after IVTA injection and pretreatment value (P = 0.06). Cataract progression was observed in one eye. Conclusions: IVTA application may be an alternative therapeutic option for the treatment of acute posterior uveitis that involves vitreous inflammation, especially in patients who carry risks for systemic corticosteroid therapy.