甲基强的松龙对颅脑损伤后血清神经元特异性烯醇化酶变化的影响

目的探讨甲基强的松龙对颅脑损伤的治疗作用。方法将72只SD大鼠随机分为3组,正常组8只,对照组和治疗组大鼠各32只,采用Feeney法造成鼠脑挫裂伤模型后,用ELISA检测技术定量检测伤后不同时间点血清神经元特异性烯醇化酶(NSE)水。平结果伤后1、6和12h对照组和治疗组血清NSE水平均比正常组高(P<0.01),但治疗组则明显低于对照组低(P<0.05)。结论本结果提示甲基强的松龙对损伤的脑组织有治疗作用。     

大剂量维生素C与小剂量甲基强的松龙联合治疗大鼠急性脊髓损伤初步研究

目的:研究大剂量维生素C(VitC) 小剂量甲基强的松龙(MP)对大鼠急性脊髓损伤(SCI)的疗效。方法:SD成年大鼠64只,采用Allen法(7g×4cm)在T11造成急性SCI动物模型。动物随机分为:MP治疗组(A组)﹑VitC 1/2MP治疗组(B组)﹑VitC治疗组(C组)﹑对照组(D组)。伤后48h行脊髓形态学检查(HE染色 Olsiwski氏小体染色)、测定脊髓含水量,伤后2周进行行为学检查(斜板实验 Gale评分)。结果:B组SCI后48h脊髓坏死及出血范围明显轻于D组,伤后2周行为学指标优于D组(P<0.05),与A﹑C组相似(P>0.05);伤后48h脊髓含水量明显低于A组﹑C组﹑D组,神经元残存Olsiwski氏小体数量明显高于A组﹑C组及D组(P<0.05)。结论:大鼠急性SCI后早期使用大剂量VitC 小剂量MP具有治疗作用,效果优于单独应用大剂量MP或VitC治疗。     

皮质类固醇激素治疗顽固性斑秃的疗效评价

目的　评价得宝松皮损内注射及甲基强的松龙静脉内冲击治疗顽固性多灶性斑秃的疗效。方法　对 2 3例病程在 13个月至 6年的斑秃患者 ,于皮损内注射得宝松 (0 .1ml/cm2 ) ,治疗结束 2个月后判定疗效 ,对得宝松治疗无效的病例 ,予甲基强的松龙冲击治疗 ,5 0 0mg/日 ,每月静滴 3天 ,连续治疗 3个月。结果　得宝松治疗组痊愈及显效病例为 11例 (4 7.83 % ) ,甲基强的松龙组痊愈及显效病例为 4例 (5 7.14% )。结论　皮损内注射得宝松及甲基强的松龙静脉内冲击治疗对病程至少是 13个月的顽固性多灶性斑秃患者 ,有较好的疗效 ,对其他治疗手段抵抗的病例 ,只要掌握好适应证 ,皮质类固醇激素冲击治疗也是一种有效的治疗方法     

脑源性神经生长因子转基因细胞移植和大剂量甲基强的松龙对脊髓损伤后细胞凋亡的影响

目的：探讨大鼠脊髓损伤后腺病毒介导的脑源性神经生长因子（AxCA-BDNF）体外转基因成肌细胞移植和静脉内注射大剂量甲基强的松龙（MP）对大鼠脊髓损伤后细胞凋亡的影响。方法：120只Wistar大鼠分为：脊髓挫伤组（A组），脊髓挫伤后AxCA-BDNF基因转染的成肌细胞移植组（B组），脊髓挫伤后静脉内注射大剂量MP治疗组（C组），脊髓挫伤后同时应用AxCA-BDNF和MP组（D组）。手术后1、3、7、14、28d用行为学和电生理检查观察大鼠功能恢复情况，并用计算机图像分析技术对脊髓损伤区细胞凋亡（TUNEL法）和Bcl-2蛋白表达（免疫组化法）进行定量分析。结果：四组中均发现凋亡细胞及Bcl-2蛋白阳性表达细胞．图像分析发现四组凋亡细胞核数为A组〉B组〉C组〉D组；Bcl-2免疫反应阳性细胞表达顺序为D组〉C组〉B组〉A组。大鼠后肢功能恢复和电生理检查也有类似的变化趋势。结论：体外转基因成肌细胞移植和大剂量MP都能抑制大鼠脊髓损伤后的细胞凋亡，促进大鼠后肢功能恢复，两者联合应用具有协同作用。     

甲基泼尼松龙对狼疮小鼠肾脏细胞凋亡及ICE基因表达的影响

为了探讨肾脏细胞凋亡在糖皮质激素治疗狼疮性肾炎机制中的作用，采用甲基泼尼松龙（ＭＰＳ）和近交系纯合子ＭＲＬ－ｌｐｒ／ｌｐｒ自发狼疮小鼠进行体内实验，利用计算机图像分析系统观察了ＭＰＳ对狼疮小鼠肾脏细胞凋亡的诱导，并应用逆转录－巢式聚合酶链反应和Ｎｏｒｔｈｅｒｎ杂交技术观察了ＭＰＳ对哺乳动物凋亡相关基因白细胞介素－１β转化酶（ＩＣＥ）表达的影响。结果表明，ＭＰＳ冲击治疗组小鼠肾小球系膜区细胞的凋亡数目显著高于对照组（Ｐ＜０．０５），肾小管间质细胞和肾血管周浸润细胞的凋亡数目也明显高于对照组（Ｐ均＜０．０１），治疗组肾脏细胞ＩＣＥ基因的表达明显增强。研究提示，ＭＰＳ能够诱导狼疮小鼠的肾脏细胞发生凋亡，ＩＣＥ基因可能参与了狼疮小鼠肾脏细胞的凋亡机制。     

Decreased vitamin B12 and folate levels in cerebrospinal fluid and serum of multiple sclerosis patients after high-dose intravenous methylprednisolone

Twenty-one patients (15 women, 6 men) with definite multiple sclerosis (MS) were treated with 1000 mg intravenous methylprednisolone-succinate (MP) daily for 10 days. Before MP treatment there was a negative correlation (r = 0.59,P = 0.0084) between serum vitamin B₁₂ and progression rate, defined as the ratio of the score on Kurtzke's Expanded Disability Status Scale and disease duration. A significant decrease was demonstrated in the cerebrospinal fluid (CSF) and serum levels of folate and in the CSF level of Viamin B12 after MP treatment. The decrease in serum B12 was not statistically significant. After MP treatment all median levels of vitamin B₁₂ and folate were below the reference medians. We hypothesize that low or reduced vitamin B₁₂/folate levels found in MS patients may be related to previous corticosteroid treatments. Otherwise a more causal relationship between low Viamin B₁₂/folate and MS cannot be excluded. Further studies may be required to clarify the vitamin B₁₂ and folate metabolism in patients with MS.     

Intra-articular treatment of osteoarthritis of the knee: an arthroscopic and clinical comparison between sodium hyaluronate (500–730 kDa) and methylprednisolone acetate

Corticosteroids have long represented the drugs of choice for intra-articular treatment of osteoarthritis (OA), but their use has drawbacks, indicating the need for alternatives devoid of these effects. This comparative study examined the clinical efficacy and the structural effects of intra-articular injections of sodium hyaluronate (HA) of molecular weight (MW) 500–730 kDa (one injection weekly for 5 weeks) versus methylprednisolone acetate (MP) (one injection weekly for 3 weeks) in the treatment knee OA. We studied 99 patients with knee OA, primary or secondary to a traumatic event, classified according to criteria of the American College of Rheumatology. Pain assessments by VAS and arthroscopic examinations of synovial membrane and cartilage were performed at baseline and 180 days after the start of the treatment. Arthroscopic features were evaluated under blind conditions. Initially, MP showed a more immediate beneficial clinical effect in reducing pain than HA, but after 180 days the symptomatic effect of HA was more long lasting than that of MP. Arthroscopic findings at day 180, in comparison with baseline conditions, showed that both drugs were decreased synovial membrane inflammation but HA was superior to MP in reducing the grade and extent of cartilage damage. HA of 500–730 kDa represents a valid alternative to corticosteroids in the intra-articular treatment of OA with a beneficial effect on the structural alterations. This study supports previous data on a potential structure-modifying activity of HA in OA of the knee. Received: 10 May 2002, Accepted: 20 May 2002     

Methylprednisolone esters of hyaluronic acid in ophthalmic drug delivery: in vitro and in vivo release studies

Films and microspheres were prepared from various esters of hyaluronic acid. A model drug, methylprednisolone, was either physically incorporated into the polymer matrix or chemically bound to the polymer backbone through an ester linkage. In vitro release from films with covalently bound drug was much slower (t_50% = 71 h) than that for physically dispersed drug (t_50% = 2.5−17 h). Methylprednisolone concentrations in the tear fluid of New Zealand rabbits were measured after ocular application of drug (approx. 420 μg) in different dosage forms. When methylprenisolone was physically dispersed in the polymer matrix, in vivo drug release from matrices was slower than that observed in vitro. Compared with a suspension control, peak methylprednisolone concentrations in tear fluid were 9–14 times lower after administration of drug in polymer films and AUC_{0–8 h} values were 4–7 times higher. These results imply that hyaluronic acid ester preparations can increase the residence time of methylprednisolone in the tear fluid of rabbits.     

两种方案治疗小儿急性特发性血小板减少性紫癜疗效的对比研究

目的 :比较两种方案治疗小儿急性重度以上特发性血小板减少性紫癜 (ITP)的疗效。方法 :于 1998年 10月～ 2 0 0 2年 10月分别采用甲基强的松龙冲击或甲基强的松龙冲击 +HDIVIG两种方案抢救 98例急性重度以上ITP患儿 ,比较两种方案治疗反应。结果 :甲基强的松龙冲击或甲基强的松龙冲击 +HDIVIG治疗急性重度以上ITP疗效肯定 ,甲基强的松龙冲击 +HDIVIG治疗提升血小板计数达安全范围 ( >3 0× 10 9/L)的平均时间、血小板计数达正常的平均时间、血小板计数达峰值的平均时间优于单用甲基强的松龙冲击治疗者 ,两组血小板峰值无显著性差异。结论 :甲基强的松龙冲击或甲基强的松龙冲击 +HDIVIG治疗急性重度以上ITP疗效肯定 ,甲基强的松龙冲击 +HDIVIG疗效优于单用甲基强的松龙冲击者