玻璃体腔注射曲安奈德治疗黄斑水肿的临床研究

曲安奈德作为一种长效糖皮质激素,采用玻璃体内注射的给药方式,治疗各种原因所致的黄斑水肿,显示出良好的临床效果和较为广泛的应用前景。近年来,国内外学者对其进行了大量的研究,并取得了一些进展。本文就其治疗黄斑水肿的作用机制及其在临床应用中的安全性、有效性和远期疗效简要综述。     

Safety and efficacy ofEupatorium laevigatum paste as therapy for buccal aphthae: Randomized, double-blind comparison with triamcinolone 0.1% orabase

Eupatorium laevigatum Lam. is a plant common to the central region of Brazil, where it is a widely used remedy for lesions such as buccal aphthae. These painful inflammatory ulcers affect 50% of the general population. For the first part of this two-part study, a phytotherapeutic preparation fromE. laevigatum extracts was formulated into an orabase paste appropriate for use on the buccal mucosa. The study evaluated the toxicologic safety of this paste in 20 healthy volunteers, as determined by changes in biochemical and hematologic values and on urinalysis and intrabuccal examination. The second part of the study was a randomized, double-blind comparison of efficacy with triamcinolone 0.1% orabase in 60 patients. The healthy volunteers tolerated the phytotherapeutic paste well, and no adverse effects could be attributed to its use. In the clinical comparison, after 5 days of treatment, 40% of the patients who used the paste and 26.7% of those who used triamcinolone obtained complete cure of the ulcers. Pain was alleviated in 70% of the phytotherapeutic group and in 33.3% of the triamcinolone group. The phytotherapeutic paste ofE. laevigatum was a safe and effective treatment of buccal aphthae, the most common disease of the buccal mucosa     

β-胡萝卜素联合醋酸曲安奈德治疗口腔均质型白斑的临床应用

目的：探讨β-胡萝卜素加用醋酸曲安奈德注射液治疗口腔均质型白斑的效果。方法：将68例患者分成A、B两组，A组仅口服β-胡萝卜素，B组口服β-胡萝卜素，并在病损局部注射醋酸曲安奈德注射液，4周为一疗程，显效后药物减量巩固治疗一疗程，1个月后门诊随访。结果：在治疗的第四周和第八周，B组都较A组见效快，且B组有效率都明显高于A组，2组疗效差异有显著性（P〈0．05）；1个月后随访，A、B两组复发率比较，无显著性差异（P〉0．05）。结论：内服β-胡萝卜素联合醋酸曲安奈德注射液局部封闭治疗口腔均质型白斑优于β-胡萝卜素单独用药。     

A randomized-controlled trial to compare topical cyclosporin with triamcinolone acetonide for the treatment of oral lichen planus

BACKGROUND: Various treatments have been employed to treat symptomatic oral lichen planus (OLP), but a complete cure is very difficult to achieve because of its recalcitrant nature. Topical cyclosporin therapy of OLP has shown conflicting results in many reports. The purpose of this study was to compare the effectiveness of cyclosporin solution with triamcinolone acetonide 0.1% in orabase in the treatment of Thai patients with OLP. METHODS: Thirteen Thai patients with symptomatic OLP and proven by biopsy were randomly assigned treatment with cyclosporin (six) or triamcinolone acetonide 0.1% (seven). The patients were instructed to apply cyclosporin or triamcinolone acetonide 0.1% three times daily at the marker lesions and affected areas. The assessments were at weeks 0, 2, 4, 8 by clinical scoring and grid measurement of the target lesions. Cyclosporin levels were assessed at weeks 2 and 8 of treatment. Pain and burning sensation were evaluated by linear visual analogue scale (0-10). RESULTS: OLP patients in the triamcinolone acetonide group showed equal cases of clinical complete and partial remission (50%). Whereas, in the cyclosporin group, there was partial remission in only two cases (33.5%) and no response in four cases (66.7%). However, our study showed that there were no statistical differences in pain, burning sensation and clinical response in OLP patients between the two groups (P > 0.01). Moreover, five of six cases in the cyclosporin group developed side-effects such as transient burning sensation, itching, swelling lips, petechial haemorrhages and others. CONCLUSION: Our results indicated that topical cyclosporin did not provide any beneficial effect and was not more effective than triamcinolone acetonide 0.1% in the treatment of Thai patients with symptomatic OLP.     

新鲜芦荟外敷联合曲安奈德关节腔注射治疗急性痛风性关节炎疗效评价

目的 观察新鲜芦荟外敷联合曲安奈德关节腔注射对急性痛风性关节炎(AGA)患者疼痛程度、血尿酸(UA),血沉(ESR),C-反应蛋白(CRP)的影响,并评价其临床疗效.方法 选取2012年3月至2016年3月于南京中医药大学附属徐州中心医院骨科(由内分泌与代谢病科制定内科治疗方案)确诊为AGA的患者100例,按照入选先后顺序将其分为对照组与观察组,每组50例.对照组给予新鲜芦荟外敷+口服药物(秋水仙碱+布洛芬)治疗,观察组在此基础上加用关节腔内注射曲安奈德治疗,连续治疗14 d.治疗前后采用视觉模拟评分(VAS)法进行自我疼痛评价,比较两组患者治疗前后关节恢复情况(疼痛、压痛、关节肿胀及关节活动障碍),治疗过程中的疼痛缓解时间以及治疗前后外周血的UA、ESR、CRP水平.结果 治疗结束后,观察组患者的治疗有效率为32.43%,略高于对照组的30.77%,但差异无统计学意义(P>0.05);治疗第2、3、7、10天,观察组的疼痛VAS评分分别为(5.12±1.34)分、(4.08±0.76)分、(2.32±0.46)分、(1.56±0.32)分,均明显低于对照组的(5.43±1.23)分、(4.23±1.11)分、(2.76±0.38)分、(1.87±0.24)分,且差异均有统计学意义(P<0.05);观察组患者的疼痛缓解时间为(3.23±0.78)d,短于对照组的(4.43±1.02)d,差异有统计学意义(P<0.05);治疗结束后观察组患者的关节疼痛、压痛、红肿、活动障碍评分分别为(0.76±0.11)分、(0.52±0.08)分、(0.41±0.09)分、(0.56±0.12)分,均低于对照组的(0.92±0.13)分、(0.78±0.11)分、(0.73±0.13)分、(0.68±0.11)分,且差异均有统计学意义(P<0.05).此外,治疗结束后观察组患者的UA、ESR、CRP分别为(336.54±72.62)μmol/L、(18.43±3.45)mm/h、(9.32±2.12)mg/L,均低于对照组的(375.27±67.57)μmol/L、(24.54±5.43)mm/h、(12.32±2.21)mg/L,且差异均有统计学意义(P<0.05).结论 在新鲜芦荟外敷的基础上给予关节腔内注射曲安奈德能很好地减轻急性痛风性关节炎的疼痛程度、缩短疼痛时间、减轻炎症反应.     

单次大剂量曲安奈德局部封闭治疗外阴白色病变28例临床观察

[目的]探讨单次大剂量曲安奈德局部封闭治疗外阴白色病变安全性和可行性。[方法]随机选取28例治疗组和30例对照组外阴白色病变患者分别给与曲安奈德单次50mg皮下注射和5mg1次／周皮下注射,4—6次为1疗程,治疗后3—6个月随访局部皮颜色,搔痒症状改善情况。[结果]治疗组临床治愈18例,显效8例,好转2例,显效率92．85％,其中鳞状细胞增生型治愈9例,显效3例,好转1例;硬化苔藓型治愈9例,显效5例,好转1例,两者差异无显著性意义（P〉0．05）。停止治疗6个月后有2例患者又出现明显的外阴瘙痒,占7．14％。对照组临床治愈12例,显效14例,好转4例,显效率86．67％,其中鳞状细胞增生型治愈6例,显效7例,好转6例;硬化苔藓型治愈6例,显效8例,好转2例。停止治疗6个月,有8例又出现明显的外阴瘙痒,占20％。治疗组与对照组两组的治愈率差异无统计学意义,P〉0．05,治疗组的复发率低于对照组,P〈0．05。[结论]单次大剂量曲安奈德局部封闭治疗外阴白色病变安全可行,方法简便,无明显并发症出现,疗效可靠。     

曲安缩松剂量与瘢痕萎缩量的定量研究

目的 探讨瘢痕治疗中曲安缩松用量与瘢痕萎缩量的关系。方法 结合临床病例作定量研究。结果 对８２例增生性瘢痕作了定量研究。,定量观察了曲安缩松用量和增生性瘢痕的萎缩量。结论 瘢痕形成的时间越长治疗所需的曲安缩松剂量就越大;曲安缩松的总剂量随着瘢痕体积的增加而成比例也增加。     

玻璃体腔分别注射雷珠单抗与曲安耐德并联合黄斑格栅光凝治疗黄斑水肿的临床分析

目的 观察分析玻璃体腔分别注射雷珠单抗与曲安奈德并联合黄斑格栅光凝治疗黄斑水肿的临床疗效.方法 黄斑水肿患者共83例102眼,其中单眼64例,双眼19例.随机选取单、双眼42例共53眼行玻璃体腔注射雷珠单抗,3周后行黄斑格栅光凝治疗;选取单眼33例、双眼8例共49眼行玻璃体腔内注射曲安奈德,3周后黄斑格栅光凝治疗.治疗后3～12个月通过荧光素眼底血管造影、眼底、视力、光学相干断层扫描等检查来观察疗效.结果 玻璃体腔注射雷珠单抗联合黄斑格栅光凝治疗黄斑水肿,有效率为83.01％,较对黄斑水肿行玻璃体腔注射曲安奈德联合黄斑格栅光凝治疗有效率54.24％明显增高（P＜0.05）.结论 玻璃体腔注射雷珠单抗联合黄斑格栅光凝治疗黄斑水肿较为安全、有效且并发症少.     

不同方法治疗视网膜中央静脉阻塞黄斑水肿的对比观察

目的：鉴于视网膜中央静脉阻塞central retinal vein occlusion（CRVO）;所致持续性黄斑水肿persistent macular edema（ME）;治疗有很多争议,探讨更有效的治疗办法。方法：玻璃体腔注射曲安奈德（TA）3l例、注射抗血管内皮生长因子单克隆抗体（Ranibizumab）30例,和两组中注药加激光21例,通过测量视力、眼压,中央视网膜厚度等方面来探讨玻璃体腔注射Ranibizumab、TA和注药＋激光光凝治疗效果,并应用统计学方法进行分析对比。结果：注射Ranibizumab组和TA组：最佳矫正视力在注药前后对比,两组均有显著统计学差异。中央视网膜厚度在注药前后对比,两组亦均有统计学差异。结论：玻璃体腔注射TA与Ranibizumab在治疗CRVO继发黄斑水肿时,均在短期内能明显降低水肿的视网膜和改善视力,Ranibizumab反复注射的次数要比TA多一些;TA比Ranibizumab副作用多,安全性差。激光和注药相比并不能够改善视力,但对减轻水肿和防止新生血管性青光眼有作用,故在必须时要慎重选择。     

氮卓斯汀喷雾剂联合曲安奈德喷雾剂治疗季节性变应性鼻炎的临床观察

目的：探讨鼻用氮卓斯汀喷雾剂联合鼻用曲安奈德喷雾剂对季节性变应性鼻炎的治疗效果。方法：随机选取门诊120例季节性变应性鼻炎患者分为治疗A组和对照B、C组,治疗组42例应用鼻用氮卓斯汀喷雾剂联合鼻用曲安奈德喷雾剂联合治疗,对照B组38例,应用鼻用氮卓斯汀喷雾剂治疗;对照C组40例,应用鼻用曲安奈德喷雾剂治疗。疗程3个月,共120天。结果：A组治疗季节性变应性鼻炎效较好,总有效率达93.75%,明显优于对照组（P〈0.05）。结论：鼻用氮卓斯汀喷雾剂联合鼻用曲安奈德喷雾剂对季节性变应性鼻炎的治疗安全有效。