中西药结合治疗输卵管妊娠的疗效分析

目的探讨中西药结合治疗输卵管妊娠的临床效果。方法56例未破裂型输卵管妊娠患者,将其分成两组,中西药结合组40例给予甲氨喋呤(MTX)多次静脉注射,次日加四氢叶酸钙解毒,并辅以具有灭胚胎及活血化瘀作用的中药治疗。对照组16例,MTX多次静脉注射,次日加四氢叶酸钙解毒。治疗后定期检查血-βHCG及B超,注意患者的腹痛、阴道流血、腹泻、肛门坠胀感、黑色大便等及生命体征情况。结果中西药结合组38例治愈,治愈率95.00%,血-βHCG平均3.6 d开始下降,18.7 d下降为正常,47.5%呈现一过性上升;再次异位妊娠率2.5%;副反应发生率30.00%。对照组15例治愈,治愈率93.75%,血HCG平均9.9d开始下降,28.9 d下降为正常。两组相比,治愈率无显著性差异,血-βHCG下降时间和速度均有显著性差异(P<0.05)。结论符合保守治疗条件的输卵管妊娠患者采用中西药结合治疗效果良好,疗程缩短。     

氨甲蝶呤给药途径对异位妊娠的临床疗效的疗效评价

目的：评价不同给药途径氨甲蝶呤（MTX）治疗早期异何妊娠临床效果。方法：A和B组分别采用肌肉和静脉注射MTX：C组采用经阴道超声引导穿刺胚囊注射MTX。结果：C组临床治愈率（100％）明显高于A组和B组。结论：经阴道超声引导穿刺胚囊注射MTX是治疗异位妊娠最合适的给药途径。     

氨甲喋呤诱导的大鼠持续性肠黏膜损伤模型的建立与评价

摘要: 目的：建立一种大鼠肠黏膜持续损伤模型。方法：SD大鼠腹腔注射氨甲喋呤（MTX）建立肠黏膜炎模型。100只大鼠随机分为空白组(Control Group)、模型组Ⅰ（MTX Group Ⅰ）、模型组Ⅱ (MTX Group Ⅱ)和模型组Ⅲ (MTX Group Ⅲ),其中MTX Group Ⅰ10只大鼠,其余每组各30只。第0天,MTX Group Ⅰ大鼠注射MTX （20 mg/kg）,MTX Group Ⅱ和 MTX Group Ⅲ大鼠注射MTX（10 mg/kg）。第6天,MTX Group Ⅱ大鼠再次注射MTX 10 mg/kg,MTX Group Ⅲ大鼠注射MTX 5 mg/kg。Control Group在第0天和第6天均注射生理盐水。实验期间观察大鼠活动状态,并记录进食量和体重变化。MTX Group Ⅰ在第4天全部处死,其余每组于造模后第4、5、6、10、11、12天各处死5只大鼠,HE染色进行病理学分析,并检测血浆中的D-乳酸、二胺氧化酶(DAO)及小肠组织中的髓过氧化物酶(MPO)、丙二醛(MDA)水平。结果：在第4天时,三个模型组大鼠小肠组织损伤评分(Chiu评分)均明显高于Control Group (p<0.05),血浆中D-乳酸含量、DAO活力及小肠组织中MPO活力、MDA含量也均显著高于Control Group (p<0.05)。在第5天时MTX Group Ⅱ和 MTX Group Ⅲ大鼠小肠黏膜损伤程度开始恢复,Chiu评分、D-乳酸含量、DAO活力、MPO活力和MDA含量逐渐降低,在第6天时与Control Group基本无差异。二次注射后,在第10天,MTX Group Ⅱ和 MTX Group Ⅲ大鼠Chiu评分再次升高,血浆中D-乳酸含量、DAO活力及小肠组织中MPO活力、MDA含量也显著高于Control Group (p<0.05),之后逐渐降低,损伤再次恢复。与MTX Group Ⅱ相比,二次注射后MTX Group Ⅲ损伤程度较轻（p<0.05）。结论：20 mg/kg MTX诱发大鼠肠黏膜炎是一个急性损伤过程,整个病程大约为4至5天,适用于药物治疗评价;两次间歇式10 mg/kg注射MTX可以造成大鼠肠黏膜的持续损伤,该模型更加适合中长期的营养治疗评价。     

Tc-99m diethylenetriamine pentaacetic acid (DTPA): Is it reliable for assessment of methotrexate-induced cumulative effect on renal filtration in rheumatoid arthritis patients?

Methotrexate[MTX] is commonly employed as the initial DMARD used for treatment of Rheumatoid arthritis[RA]. We aimed to contribute to the safety profile of MTX by assessing its cumulative effect on renal filtration. Fifty two RA adult females with normal base-line serum creatinine and GFR at the initial diagnosis of the disease were included. Group-1[G1] included 30 patients[mean age 40.4 ± 4.4 years] on MTX and NSAIDS, while 22 RA patients[mean age 38.5 ± 8.2 years] who received NSAIDs only served as the control group[G2]. Renal function was assessed by GFR-measurement using Technetium diethylenetriamine-pentaacetic acid[Tc-99 m-DTPA] at the point of the study time corresponding to disease duration. 21/30[70%] in G1 showed reduced GFR compared to 6/22[27.3%] in G2[P0.007] with 3.3 ± 0.5% annual reduction of GFR. Reduced GFR in G1 showed significant negative correlation with age[r = ?0.396, P = 0.005], MTX-cumulative dose[r = ?0.263, P = 0.049], MTX-intake duration[r = ?0.293, P = 0.031] and NSAID-intake duration[r = ?0.344, P = 0.014]. Low dose MTX has a slow cumulative effect on renal filtration manifested by GFR reduction over time that could be monitored by Tc-99 m DTPA.     

Study protocol of a multicenter registry of patients with rheumatoid arthritis starting biologic therapy in Japan: Tsurumai Biologics Communication Registry (TBCR) Study

Abstract

Biologic agents have proven to be effective against rheumatoid arthritis (RA) in clinical trials and post-marketing surveillance (PMS) studies. However, limited follow-up periods and strict criteria for recruitment might lead to an underestimation of adverse events. To document the long-term course of patients with RA treated with biologics in clinical settings, we established the Tsurumai Biologics Communication Registry (TBCR). First, we retrospectively collected data of patients registered for any biologic PMS study or clinical trial at participating institutes. Thus far, thirteen institutes have joined the registry and 860 patients have been identified. Comparing baseline characteristics by age and initiation year of biologics, young patients had significantly less joint damage and dysfunction and a higher dose of concomitant methotrexate (MTX) compared to older patients. Older age and functional class were significantly related to the incidence of adverse events that resulted in discontinuation of the 1st biologic treatment. The TBCR is in its initial stages, and information on all patients newly starting biologic therapy at participating institutes is being collected prospectively. Differences in baseline characteristics by age and initiation year of biologics need to be carefully evaluated in order to report on drug-related survival and long-term prognosis, using follow-up data in the near future.     

Hemophagocytic syndrome in a patient with rheumatoid arthritis

Abstract

A 76-year-old man with rheumatoid arthritis, who had been treated with oral prednisolone and methotrexate, presented with high fever and generalized fatigability. Laboratory data demonstrated marked pancytopenia, which we first regarded as a side effect of methotrexate, and leucovorin was administered with granulocyte-colony stimulating factor and transfusions. Because no recovery was recognized, however, bone marrow aspiration was performed, by which hemophagocytic syndrome was diagnosed. After corticosteroid pulse therapy was initiated, the patient’s symptoms were rapidly attenuated and laboratory data rapidly normalized.     

应用人工神经网络评估大剂量甲氨蝶呤化疗后的骨髓抑制

目的：研究建立人工神经网络模型用于评估大剂量甲氨蝶呤(HDMTX)化疗后的骨髓抑制程度,促进个体化用药。方法：收集180例急性淋巴细胞白血病(ALL)患儿行HDMTX化疗的临床资料。将所有资料随机分成两组,训练组(n=150)：以化疗后中性粒细胞总数(NEU)减少率为输出目标,采用遗传算法配合动量法训练后建立人工神经网络;测试组(n=30)：用建立的人工神经网络预测测试组患儿的NEU减少率,通过计算平均预测误差(MPE)、权重残差(WRES)、平均绝对预测误差(MAE)、平均预测误差平方(MSE)和均方根预测误差(RMSE)来验证模型。结果：人工神经网络的MPE 为(-2.05±7.41)%,WRES为(23.20±29.74)%,MAE为(6.12±4.53)%,MSE为(57.26±64.46)(%)₂,RMSE为 7.57%,有76.67%的病例相对预测误差在±20%以内。人工神经网络预测的准确度及精密度均优于多元线性回归模型(逐步回归法)。结论：本研究建立的人工神经网络预测性能较好,可用于预测HDMTX化疗后骨髓抑制程度以指导个体化用药。     

Evidence-based use of methotrexate in children with rheumatic diseases: a consensus statement of the Working Groups Pediatric Rheumatology Germany (AGKJR) and Pediatric Rheumatology Austria

Juvenile idiopathic arthritis (JIA) is the most common diagnosis in children and adolescents with rheumatic disorders. In many children and adolescents, JIA is successfully treated with non-steroidal anti-inflammatory drugs (NSAID) and physiotherapy. However, in a significant number of cases the disease is resistant to this therapy, and treatment with second line disease-modifying antirheumatic drugs (DMARDs) is required. Methotrexate (MTX) is frequently referred to as first-choice second-line agent for the treatment of JIA. To increase drug safety, the Working Groups for Children and Adolescents with Rheumatic Diseases in Germany (AGKJR) and Pediatric Rheumatology Austria have initiated the formulation of evidence-based recommendations. Evidence is based on consensus expert meetings, a MEDLINE search with the key words Methotrexate and juvenile arthritis limited to age 0–18 years, standard textbooks and review articles, data from the central registry of the German Research Center for Rheumatic Diseases (Deutsches Rheumaforschungszentrum Berlin DRFZ), experience with MTX in adults with rheumatoid arthritis (RA), and recommendations of the German Society of Rheumatology (DGRh). Based on these data, evidence and recommendations are graded, and evidence-based recommendations for the use of MTX in children and adolescents with rheumatic disease are presented.Section Pharmacotherapy of the Working Group Pediatric Rheumatology Germany and Austria: I. Foeldvari; J.P. Haas, A. Haeffner, D. Hobusch,G. Horneff, A. Hospach, R. Keitzer, G. Klaus, M. Metzler, H. Michels, T. Niehues, I. Pilz, M. Sailer Höck, M. Schöntube, L. Schuchmann, K. Schumacher, H.W. Seyberth, E. Siemers, A. Urban, E. Weißbarth-Riedl. Working Group Pediatric Rheumatology North-Rhine-Westfalia: S. Benseler, G. Bürk, S. Fahl, I. Foeldvari, D. Föll, M. Frosch, G. Ganser, S. Kastner, I. Kleine, E. Lainka, K. Mönkemöller, J. Neubert, U. Neudorf, T. Niehues, J. Roth, S. Seeliger, N. Wagner, R. Wieland, H. Winowski.