Effects of dexamethasone with different doses on aquaporin-4 in brain of intracerebral hemorrhag
地塞米松磷酸钠注射液中杂质研究总结
地塞米松磷酸钠注射液中杂质I研究曹筱琛1，贾飞2，陶巧凤12*（1.浙江工业大学药学院，杭州 310014；2.浙江省食品药品检验研究院，杭州 310004）摘要：目的对地塞米松磷酸钠注射液中的杂质I进行研究。
方法 通过考察辅料与地塞米松磷酸钠相互作用，研究杂质I的产生机理；采用HPLC-QTOF-MS联用技术鉴定杂质I；制备和纯化获得杂质I，并对其结构进行确证。
结果杂质I为主成分与抗氧剂亚硫酸氢钠在高温下的加成产物。
结论本研究结果对地塞米松磷酸钠注射液的工艺改进以及质量控制具有指导作用。
关键词地塞米松磷酸钠注射液；有关物质；杂质I；高效液相色谱-质谱联用；制备色谱；核磁共振；质量控制Characterization of Impurity I inDexamethasone Sodium PhosphateInjectionCAO Xiaochen1, JIA Fei2, TAO Qiaofeng1 2* (1.College of Pharmaceutical Science, ZheJiang University of Technology, Hangzhou 310014,China; ZheJiang Institute for Food and Drug Control, HangZhou 310004, China)ABSTRACT OBJECTIVES To study on the impurity I in dexamethasone sodium phosphate injection. METHODS The interaction between drug and excipient was investigated to identify the cause of raising impurity I,and HPLC-QTOF-MS was adopted to identificate thestructure of impurity I,the impury I was synthesized and separated by prep-HPLC, and its structure was proved.RESULTS The impurity I is the adduct of dexamethasone sodium phosphate and antioxidant sodium bisulfite.CONCLUSION The study offers guidances for improving the manufacturing process and the quality control of dexamethasone sodium phosphate injection.K EY WORDS dexamethasone sodium phosphate injection;related substance;impurity I;HPLC-MS;prep-HPLC;NMR;quality control 地塞米松磷酸钠(16a-甲基-11β,17a,21-三羟基-9a-氟孕甾-1,4-二烯-3,20-二酮-21-磷酸酯二钠盐）为肾上腺皮质激素类药物，具有抗炎、抗内毒素、抑制免疫、抗休克及增强应激反应等药理作用，临床用于自身免疫性疾病、过敏、炎症、哮喘及皮肤科等多种疾病治疗[1]。
决奈达隆片说明书
甲状腺根治术后不同剂量131I清甲治疗对分化型甲状腺癌患者唾液流率、骨代谢和生活质量的影响
现物医学 Progress in Modem Biomedicine VoL21 NO»3 FEB2021•537•d o i:10.13241 /ki.pmb.2021.03.029甲状腺根治术后不同剂量131i清甲治疗对分化型甲状腺癌患者唾液流率、骨代谢和生活质量的影响*彭东1刘学芬2△刘徽婷1何燕1王荣辉1(1重庆大学附属三峡医院/重庆三峡中心医院核医学科重庆404000;2重庆大学附属三峡医院/重庆三峡中心医院肿瘤科重庆404000 >摘要目的:探讨甲状腺根治术后不同剂量清甲治疗对分化型甲状腺癌患者唾液流率、骨代谢和生活质量的影响。
方法：选取 2018年1月~2020年1月期间我院诊治的分化型甲状腺癌患者141例，根据随机数字表法分为低剂量组[治疗剂量为1.1〜3.7GBq(30〜l O O m c i)]、中剂量组[治疗剂量为3.7〜5.5GBq(100〜150m c i)]、高剂量组[治疗剂量为5.5〜7.4G B q(150〜200mci)], 各47例。
对比三组患者唾液流率、骨代谢、生活质量、腮腺和颌下腺的摄取参数(U R)和排泌参数(E R):结果：高剂量组、中剂量组 腮腺、颌下腺的左侧U R、右侧U R、左侧E R、右侧E R均低于低剂量组，且高剂量组低于中剂量组(P<0.05)。
三组治疗后静态唾液 流率（U W S F R)、动态唾液流率（S W S F R)均较治疗前下降(P<0.05),高剂量组、中剂量组治疗后U W S F R、S W S F R低于低剂量组，且高剂量组低于中剂量组(P<0.05 )。
低剂量组、中剂量组的优良率高于高剂量组，且中剂量组高于低剂量组(户《0.05)。
三组治疗前 后、组间总丨型肢原氨基端前肽（P I N P)、(3-胶原降解产物（p-C T X)、骨密度(B M D)对比，差异均无统计学意义(P>0.05)。
地塞米松对小鼠MIN6细胞增殖和凋亡的影响
地塞米松对小鼠MlN6细胞增殖和凋亡的影响作者：林益川王林曦王燕萍王丽静刘小莺刘晓红刘礼斌【摘要】目的探讨地塞米松对小鼠胰岛B细胞株MIN6细胞增殖和凋亡的影响。
方法实验分对照组和不同浓度地塞米松(50, 100, 200, 400, 800 nmol/L)组诱导刺激MIN6 细胞1 〜4 d, MTT 法观察地塞米松作用后细胞的存活率；hochest/PI染色荧光显微镜观测细胞凋亡率。
结果地塞米松作用1〜4 d可明显抑制MIN6细胞的生长；>100 nmol/L组的地塞米松处理48 h后，细胞凋亡明显，凋亡率高达(30. 44 ± 4. 52 ) %,与对照组比较差别有统计学意义(P<0.01), 800 nmol/L组地塞米松使细胞由凋亡转向坏死。
结论地塞米松对小鼠MI\6细胞增殖有明显影响，并能够引起MI\6细胞凋亡。
【关键词】地塞米松；胰岛；细胞凋亡；疾病模型；动物糖皮质激素是体内重要的胰岛素拮抗激素，可以减弱胰岛素介导的糖代谢效应，使胰岛素敏感性降低，甚至发展为糖尿病。
这是一个涉及多组织、多水平的复杂过程，包括干扰胰岛素靶器官如骨骼肌及脂肪组织的葡萄糖摄取和利用；调节脂肪细胞因子如脂联素、抵抗素等的分泌，从而间接影响胰岛素的敏感性；抑制胰岛素分泌、触发胰岛细胞凋亡等环节。
胰岛细胞凋亡是造成糖尿病的重要原因之一。
佟春玲等研究发现，地塞米松处理老鼠3周后胰岛细胞数量减少，功能下降［1］;苗明三等也发现地塞米松可造成小鼠糖耐量减低模型［2］。
木研究旨在探讨地塞米松是否通过引起胰岛细胞增殖及凋亡从而促进类固醇性糖尿病的发生。
1材料和方法1.1主要试剂与设备MIN6小鼠胰岛B细胞株是肉瘤病毒40 通过T细胞转染非肥胖糖尿病小鼠（N0D鼠）得到的胰岛细胞瘤株，由上海瑞金医院内分泌肿瘤重点试验室惠赠。
DMEM培养基、胎牛血清、0.25%胰酶（美国GIBCO公司）。
地塞米松与布地奈德雾化吸入治疗小儿急性感染性喉炎的临床效果及安全性
2020年4月临床医学小儿急性感染性喉炎（acute infectious laryngitis,AIL ）是一种临床常见病，主要是在感染因素下咽喉黏膜出现弥漫性炎症的一种疾病，可发生于一年四季，临床症状以呼吸困难、犬吠样咳嗽、喉鸣、声嘶等为主，随着疾病的加重，患儿会由于喉梗阻而出现窒息、缺氧等症状，对其生命安全构成了巨大的威胁[1-2]。
地塞米松、布地奈德均是临床治疗小儿AIL 的常用药，但对于两种药物的临床疗效、不良反应在目前仍存在一定争议，例如：何种药物在提高临床疗效的同时，不会增加不良反应。
张余芳等[3]认为，布地奈德雾化吸入在AIL 治疗中临床效果稳定、显著，可有效减轻机体的炎症反应，促进疾病痊愈，且不良反应较少。
为此，本文旨在进一步研究地塞米松与布地奈德雾化吸入对AIL 患儿血清CRP 、IFN-γ、IL-8、IL-4水平及不良反应的影响，现报道如下。
1资料与方法1.1一般资料选取2018年3月至2019年5月本院收治的98例AIL 患儿为研究对象，随机分为试验组和对照组，各49例。
试验组女21例，男28例；年龄3~12岁，平均（7.58±2.04）岁；喉梗阻程度：Ⅰ度36例，Ⅱ度13例；病程2~8d ，平均（5.06±1.84）d ；体重7.6~28.6kg ，平均（18.26±3.64）kg 。
对照组女22例，男27例；年龄4~11岁，平均（7.59±2.01）岁；喉梗阻程度：Ⅰ度35例，Ⅱ度14例；病程3~7d ，平均（5.08±1.74）d ；体重7.9~28.1kg ，平均（18.29±3.59）kg 。
两组的一般资料无显著差异（P >0.05）。
医院伦理委员会已批准本研究，患儿家属均已签署与本次研究有关的知情同意书。
喉梗阻分级标准：Ⅰ度为安静时无症状，活动以及哭DOI :10.19347/ki.2096-1413.202012036作者简介：田凤梅（1984-），女，汉族，陕西富县人，主治医师，学士。
冠周注射地塞米松磷酸钠预防下颌阻生智齿拔除术后面部肿胀和张口受限临床观察
冠周注射地塞米松磷酸钠预防下颌阻生智齿拔除术后面部肿胀和张口受限临床观察彭涛;黄楠楠【摘要】目的评价冠周注射地塞米松对下颌阻生智齿拔除术后面部肿胀和张口受限的疗效.方法将216例下颌阻生智齿患者随机分成试验组和对照组,各108例.对照组患者予2%利多卡因2 mL,试验组患者在拔牙前给予醋酸地塞米松5 mg行冠周注射,其他处理与对照组相同,在术后第2天和第5天观察并比较两组患者面部肿胀和张口受限情况.结果术后第2天和第5天,试验组患者面部肿胀和张口受限程度均显著低于对照组(P<0.01).结论冠周注射地塞米松可有效降低下颌阻生智齿拔除术后的张口受限和面部肿胀程度,值得临床推广.%Objective To evaluate the effect of injecting dexamethasone in the periodontal tissue on postoperative facial swelling and trismus after mandibular impacted wisdom teeth being extracted. Methods 216 patients with mandibular impacted wisdom teeth were randomly divided into the experimental group and the contorl group,108 cases in each group. The control group was given 2 mL of 2%lidocaine,and the experimental group was injected dexamethasone of 5 mg before tooth extracted. After 2,5 d,the patients' facial swelling and mouth opening limits were recorded for statistical analysis. Results The complications of tooth extracted in the experimen-tal group are significantly lower than the control group at 2,5 d after the operation(p < 0. 01). Conclusion Intravenous injection of dexamethasone can effectively reduce the degree of facial swelling and mouth openinglimit after mandibular impacted wisdom teeth, which is worth of clinical promotion.【期刊名称】《中国药业》【年(卷),期】2017(026)006【总页数】3页(P43-45)【关键词】阻生智齿;拔牙术;醋酸地塞米松;张口受限;肿胀【作者】彭涛;黄楠楠【作者单位】重庆市黔江中心医院口腔科,重庆 409000;重庆医科大学附属口腔医院·口腔疾病与生物医学重庆市重点实验室,重庆 401147【正文语种】中文【中图分类】R969.4;R781.1随着生活水平的提高，人们进食的食物越来越精细，因牙齿与牙槽骨量不调导致的口内第三磨牙阻生的患者越来越多，尤其是因下颌第三磨牙阻生并伴有临床症状的患者居多，临床上水平阻生或前倾阻生的患者往往需要去骨或破冠来去除阻力，术后面部肿胀和张口受限因是下颌阻生智齿拔除术后常见的并发症，易造成患者精神紧张，痛苦极大，严重影响患者的工作和生活[1-2]。
The effect of combining dexamethasone with ondansetron for nausea and vomiting associated
CorrespondenceThe effect of combining dexamethasone withondansetron for nausea and vomiting associated with fentanyl-based intravenous patient-controlled analgesiaSong et al.reported that the addition of dexamethasone to ondansetron failed to reduce the incidence of nausea and vomiting experienced by patients using fentanyl patient-controlled analgesia (PCA)after thoracoscopic surgery,although it appeared to lessen the severity [1].We find the incidences of nausea and vomiting both with and without dexamethasone reported in this study (45%and 56%,respectively)surpris-ingly high and far in excess of those seen in our institution where fentanyl PCA is frequently used after kidney transplant.Other studies have reported con-siderably lower incidences of nausea and ⁄or vomiting (30%or less)asso-ciated with the use of fentanyl PCA after arthroplasty [2],colorectal sur-gery [3],thoracoscopy [4]and thora-cotomy [5],and during labour [6],even without any antiemetic prophy-laxis.Incidences exceeding 50%have indeed been reported but are related to higher basal infusion rates [7].Interestingly,in comparison with the above studies,the regimen employed by Song et al.consisted of a relatively high basal infusion rate (0.4l g.kg )1.h )1)and low patient demand capacity (0.1l g.kg )1bolus every15min).It seems counterintuitive to use a high background infusion rate if this could result in a high incidence of nausea and vomiting.Moreover,in the presence of an insufficient fenta-nyl bolus on demand,we would question the validity of administering pethidine for breakthrough pain.Although the authors state that cumu-lative pethidine consumption was similar between groups,they did not provide the doses used over 48hours.Without the patients’pain scores,which would inform the reader about the efficacy of the PCA reg-imen,we find it difficult to put the severity of the side effects into the context of the benefits of any pain relief.We would suggest that the need for frequent pethidine adminis-tration suggests that the analgesic regimen is unsatisfactory.Finally,the practice of adding an antiemetic to PCA mixtures has declined in popularity because the dose received by patients is typically sub-therapeu-tic if PCA usage is reduced or stopped,and especially if boluses of an alternative opioid are then admin-istered.We agree that it may be valid to state that dexamethasone failed to reduce the incidence of postoperative nausea and vomiting in this study;however,without reference to the cumulative doses of fentanyl,pethi-dine or ondansetron,we question the conclusion that these high incidences of nausea and vomiting,apparently refractory to 5-HT 3receptor-block-ing drugs,are typical of fentanyl PCA in general.K.D.Johnston J.QuinlanThe John Radcliffe Hospital Oxford,UKEmail:kevindjohnston@No external funding or competing interests declared.Previously posted at the Anaesthesia Correspondence website:http://www.anaesthesia .References1Song JW,Park EY,Lee JG,Park YS,Kang BC,Shim YH.The effect of combining dexamethasone with ondansetron for nausea and vomiting associated with fentanyl-based intravenous patient-controlled analgesia.Anaesthesia 2011;66:263–7.2Laitinen J,Nuutinen L.Intravenous diclofenac coupled with PCA fenta-nyl for pain relief after total hip replacement.Anesthesiology 1992;76:194–8.3Camu F,Van Aken H,Bovill JG.Postoperative analgesic effects of three demand-dose sizes of fentanyl administered by patient-controlled analgesia.Anesthesia and Analgesia 1998;87:890–5.4Butkovic D,Kralik S,Matolic M,Kralik M,Toljan S,Radesic L.Postoperative analgesia with intra-venous fentanyl PCA vs epiduralA response to a previously published article or letter must be submitted via the dedicated correspondence website at ,following the guidance there and using the online form (not uploaded as a Word attachment).Please note that a selection of this correspondence will be reproduced (possibly in modified form)in the Journal.Correspondence on new topics should be submitted as an email attachment to anaesthesia@.Copy should be prepared in the usual style of the Correspondence section.Authors must follow the Guidance for Authors at /journal/anae,including completion and submission of an Author Declaration Form.Anaesthesia,2011,66,pages 840–852.....................................................................................................................................................................................................................block after thoracoscopic pectusexcavatum repair in children.British Journal of Anaesthesia2007;98:677–81.5Grant RP,Dolman JF,Harper JA,et al.Patient-controlled lumbarepidural fentanyl compared withpatient-controlled intravenousfentanyl for post-thoracotomy pain.Canadian Journal of Anesthesia1992;39:214–9.6Nikkola EM,Ekblad UU,Kero PO, Alihanka JJM,Salonen MAO.Intravenous fentanyl PCA duringlabour.Canadian Journal of Anesthesia 1997;44:1248–55.7Kim SY,Kim EM,Nam KH,Chang DJ,Nam SH,Kim KJ.Postoperative intravenous patient-controlledanalgesia in thyroid surgery:comparison of ondansetron regimens with and without the nonsteroidalanti-inflammatory drug ketorolac.Thyroid2008;18:1285–90.doi:10.1111/j.1365-2044.2011.06830.x A replyWe agree with Drs.Johnson et al. that the incidence of postoperative nausea and vomiting(PONV)in our study[1]seems quite high.Apfel et al.[2]provided a simplified risk score for predicting PONV,consisting of four predictors:female sex;history of motion sickness or PONV;non-smoking;and use of postoperative opioids.The incidence of PONV was 39%for patients with two of these predictors,61%for three predictors, and79%for four.Approximately75% of our patients were non-smokers, 40%were female,and all received postoperative opioids.As most of our patients had2–3risk factors,we could expect an incidence of PONV of40–60%according to Apfel et al.’s score. Even with the prophylactic use of ondansetron,we agree that our inci-dence of PONV was still high and this may be due to the relatively high basal infusion rate.Adding a basal infusion to patient-controlled analgesia(PCA) could be more effective in reducing resting pain than bolus on-demand only,but it may be associated with agreater risk of PONV[3].Afterthoracoscopy,pain can be evokedeven by breathing,and patients usu-ally suffer significant pain levels evenat rest,hence our relatively high basalinfusion rate.The mean(SD)visualanalogue scores(VAS)for pain in ourstudy were47(20)for ondansetronand45(22)for dexamethasone andondansetron6h after surgery,30(20)and30(17)after24h,and22(18)and23(15)after48h.Cumulativepethidine consumption over48h was44(35)mg for ondansetron and36(29)mg for dexamethasone andondansetron.One of our study’slimitations was that fentanyl con-sumption over the48h was notassessed.However,fentanyl con-sumption is likely to be similarbetween the groups due to a relativelyhigh basal infusion rate and low bolusdose.The pain scores and amount ofrescue analgesic in our study suggestthat our patients had adequate painrelief.However,given the high inci-dence of PONV,our patients mighthave benefited more from an optimalbasal infusion rate.As far as we know,no study has yet addressed the optimalratio of basal infusion rate to bolusdose in fentanyl-based PCA,andfurther study is warranted to clarifythis issue.J.W.SongY.S.ParkJ.G.LeeB.C.KangY.H.ShimYonsei University College ofMedicine,Seoul,Republic of KoreaE.Y.ParkSacred Heart Hospital-Pyeongchon,Hallym University College ofMedicine,Kyung-gi-do,Republic ofKoreaEmail:tren125@yuhs.acNo external funding or competinginterests declared.Previously postedat the Anaesthesia Correspondencewebsite:http://www.anaesthesiaReferences1Song JW,Park EY,Lee JG,Park YS,Kang BC,Shim YH.The effect ofcombining dexamethasone withondansetron for nausea and vomitingassociated with fentanyl-based intra-venous patient-controlled analgesia.Anaesthesia2011;66:263–7.2Apfel CC,Laara E,Koivuranta M,Greim CA,Roewer N.A simplifiedrisk score for predicting postopera-tive nausea and vomiting:conclu-sions from cross-validations betweentwo centers.Anesthesiology1999;91:693–700.3Sinatra R,Chung KS,SilvermanDG,et al.An evaluation of mor-phine and oxymorphone adminis-tered via patient-controlled analgesia(PCA)or PCA plus basal infusion inpostcesarean-delivery patients.Anesthesiology1989;71:502–7.doi:10.1111/j.1365-2044.2011.06865.xAnaphylaxis to dye duringbreast surgeryI wish to reportfive cases of anaphy-laxis due to Patent Blue V(PB V)dye(Guerbet,Cedex,France)occur-ring during general anaesthesia forbreast surgery over a21-monthperiod in220patients at our hospital.We reported all our cases to theMedicines and Healthcare productsRegulatory Agency and AAGBI ana-phylaxis database.Patent Blue V dye has been usedsince the1960s for lymphangiogra-phy,in the textile industry,and asthe food colourant E131.This wide-spread use potentially exposes thegeneral population to the risk ofallergic sensitisation.Blue dye,withor without isotope,is now com-monly used to identify sentinellymph nodes in patients with breastcancer,being the recommendedmethod for staging the axilla in earlydisease[1].The allergic potential of PB V hasbeen estimated at0.86%(anaphylaxisgrades1–3)from the combinedAnaesthesia,2011,66,pages840–852Correspondence .....................................................................................................................................................................................................................。
男性精神分裂症患者攻击行为与睾酮的相关性
男性精神分裂症患者攻击行为与睾酮的相关性简介精神分裂症是一种常见的精神障碍，其中男性患者的攻击行为往往引起公众的广泛关注。
而睾酮是一种男性激素，与攻击行为有一定的关联。
本文将探讨男性精神分裂症患者攻击行为与睾酮的相关性。
睾酮与攻击行为睾酮是一种男性性激素，主要在睾丸内合成。
它不仅在男性的身体发育、性功能和肌肉发展等方面起到关键作用，还对行为产生影响。
研究表明，睾酮水平升高与攻击行为有关。
具体来说，睾酮水平升高可能导致攻击行为增加，而睾酮水平降低可能减少攻击行为。
睾酮与男性精神分裂症男性精神分裂症患者常常表现出攻击行为，且其血液睾酮水平比正常人群更高。
这种现象可能与精神分裂症的神经化学失调有关。
研究表明，精神分裂症患者大脑中多巴胺水平的升高可能与睾酮水平的升高相关。
睾酮与精神病药物精神病药物是精神分裂症治疗的重要手段，但其使用可能影响睾酮水平。
某些精神病药物，如抗精神病药物，可能降低血液中的睾酮水平。
另外，一些研究表明，抗焦虑药物可能影响睾酮的代谢。
因此，在治疗男性精神分裂症患者时，应注意这些影响。
结论虽然睾酮水平与攻击行为和男性精神分裂症有关，但需要注意的是，睾酮并不是导致攻击行为和男性精神分裂症的唯一因素。
这种现象可能与许多因素有关，如基因、环境和心理因素等。
因此，在深入研究这些现象之前，我们需要进一步研究和了解睾酮对人类行为和心理健康的影响。
参考文献1.Pedersen A, Strömgren T, et al. Psychiatric symptoms and lowtestosterone levels in men aged 50-79 years. Comprehensive Psychiatry, 2001, 42(2): 175-178.2.Gruenewald DA, Naai MA, et al. Neuronal correlates of testosteroneand aggression in hypogonadal men. Journal of Clinical Endocrinology andMetabolism, 2002, 87(12): 5720-5725.3.Protopopescu X, Pan H, et al. Baseline and fear-induced blood oxygenation level-dependent responses in male combat veterans with posttraumatic stress disorder. Journal of Clinical Psychiatry, 2005, 66(5): 681-683.4.Riedel WJ, Van Praag HM, et al. Acute effects of two different doses of dexamethasone on peripheral and central catecholamine metabolism in humans. Psychopharmacology (Berl), 1989, 99(3): 343-347.5.Goisman RM, Koenen KC, et al. Dopamine transporter genotype and anxiety disorders in children: a case-control study. Depression and Anxiety, 2006, 23(1): 20-26.。
小剂量地塞米松治疗登革热的效果观察
2020年4月第10卷第7期CHINA MEDICINE AND PHARMACY Vol.10 No.7 April 2020 85·临床药物应用·小剂量地塞米松治疗登革热的效果观察萧正升 王建华广东省佛山市禅城区中心医院感染科，广东佛山 528000[摘要] 目的 观察小剂量地塞米松治疗登革热的效果。
方法 选取2017年5月～2018年11月我院收治的登革热患者98例，对患者应用小剂量地塞米松进行治疗。
观察患者的临床疗效，治疗后临床症状、体征的消失时间。
结果 经过治疗后，患者的退热天数（2.51±1.03）d、皮疹消失天数（3.95±1.46）d 及症状消失天数（4.72±1.23）d，总体有效率为97.96%，不良反应发生率为1.02%。
结论 小剂量地塞米松治疗登革热，可获得较佳的临床治疗效果，有效的改善患者的临床症状，安全可靠，值得在临床上推广使用。
[关键词] 地塞米松；退热时间；登革热；皮疹[中图分类号] R512.8 [文献标识码] A [文章编号] 2095-0616（2020）07-85-03Effects of low-dose dexamethasone in the treatment of denguefeverXIAO Zhengsheng WANG Jianhua Department of Infectious Diseases, Chancheng District Central Hospital, Guangdong, Foshan 528000, China[Abstract] Objective To observe the effect of low-dose dexamethasone in the treatment of dengue fever. Methods 98 patients with dengue fever treated in our hospital from May 2017 to November 2018 were selected and treated with low-dose dexamethasone. The clinical effect of the patients and the disappearance time of clinical symptoms and signs after treatment were observed. Results After treatment, the fever disappearance time was (2.51±1.03) d, rash disappearance time was (3.95±1.46) d, symptom disappearance time was (4.72±1.23) d, the total effective rate was 97.96%, the incidence of adverse reactions was 1.02%. Conclusion Low-dose dexamethasone can obtain better clinical effect in the treatment of dengue fever, effectively improve the clinical symptoms of patients, and it is safe and reliable, which is worthy of clinical application.[Key words] Dexamethasone; Fever disappearance time; Dengue fever; Rash登革热为一种自限性疾病，但重症登革热死亡率比较高，初期感染该病毒的患者，临床表现为骨关节、肌肉剧烈酸痛，头痛，高热等，部分患者可出现血小板减少、白细胞计数减少、淋巴结肿大、出现皮疹等，但不会发生出血倾向和休克等[1]。
巴曲酶联合地塞米松治疗对突发性耳聋患者不良反应及效果的影响
DOI：10.16662/ki.1674-0742.2023.21.120巴曲酶联合地塞米松治疗对突发性耳聋患者不良反应及效果的影响林清花，蔡艳绯，罗高青福建省级机关医院耳鼻咽喉科，福建福州350000［摘要］目的探讨突发性耳聋在地塞米松给药基础上取巴曲酶联用对不良反应及效果产生的影响。
方法随机选取2020年1月—2023年1月福建省级机关医院收治的突发性耳聋患者80例作为研究对象，按照随机数表法分为两组，每组40例。
对照组采用地塞米松治疗，观察组在对照组基础上加用巴曲酶治疗。
对比两组总有效率、症状缓解时间、凝血功能、血液流变学指标、听力水平、不良反应情况。
结果观察组总有效率为97.50%，高于对照组的80.00%，差异有统计学意义（χ2=4.507，P<0.05）。
观察组呕吐持续时间、耳鸣持续时间、听力恢复时间、眩晕持续时间均短于对照组，差异有统计学意义（t=10.284、8.149、6.879、4.113，P<0.05）。
治疗后观察组凝血功能、血液流变学指标均优于对照组，差异有统计学意义（P<0.05）。
治疗后观察组高频、低频听力阈值均低于对照组，差异有统计学意义（P<0.05）。
两组不良反应发生率比较，差异无统计学意义（P>0.05）。
结论突发性耳聋在地塞米松给药基础上，取巴曲酶联用，可提高总有效率，缩短症状缓解时间，改善凝血功能及血液流变学，改善听力状况，且具一定安全性。
［关键词］突发性耳聋；地塞米松；巴曲酶；凝血功能；效果；不良反应［中图分类号］R5 ［文献标识码］A ［文章编号］1674-0742（2023）07(c)-0120-05Effect of Batroxobin Combined with Dexamethasone on Adverse Reactions and Effects in Patients with Sudden DeafnessLIN Qinghua, CAI Yanfei, LUO GaoqingDepartment of Otorhinolaryngology, Fujian Provincial Government Hospital, Fuzhou, Fujian Province, 350000 China [Abstract] Objective To explore the effect of combined administration of batroxobin and dexamethasone on the ad⁃verse reactions and effects of sudden deafness. Methods A total of 80 patients with sudden deafness admitted to pro⁃vincial organ hospitals in Fujian Province from January 2020 to January 2023 were randomly selected as the study ob⁃jects and divided into two groups, according to the random number table, with 40 cases in each group. The control group was treated with dexamethasone, and the observation group was treated with batroxase. The total effective rate, symptom remission time, coagulation function, hemorheology index, hearing level and adverse reactions were com⁃pared between the two groups. Results The total effective rate of the observation group was 97.50%, higher than that of the control group (80.00%), and the difference was statistically significant (χ2=4.507, P<0.05). The duration of vom⁃iting, tinnitus, hearing recovery and vertigo in the observation group were shorter than those in the control group, and the differences were statistically significant (t=10.284, 8.149, 6.879, 4.113, P<0.05). After treatment, the coagulation function and hemorheology indexes of the observation groups were better than those of the control group, and the dif⁃ferences were statistically significant (P<0.05). After treatment, the high-frequency and low-frequency hearing thresholds in the observation group were lower than those in the control group, and the difference was statistically sig⁃nificant (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion On the basis of dexamethasone administration, batroxase combined with sudden deafness can increase the total effective rate, shorten the time of symptom relief, improve coagulation function and he⁃[作者简介] 林清花（1992-），女，硕士，住院医师，研究方向为耳鼻咽喉。
鼓室注射地塞米松治疗难治性梅尼埃病的临床分析
药物与临床鼓室注射地塞米松治疗难治性梅尼埃病的临床分析周莹，李伟福建医科大学附属三明第一医院耳鼻喉科，福建三明365000［摘要］目的分析探讨鼓室注射地塞米松治疗难治性梅尼埃病的临床价值。
方法选取2018年4月—2021年4月福建医科大学附属三明第一医院收治的难治性梅尼埃病患者50例为研究对象，按照随机数表法分成对照组与观察组，各25例。
对照组进行耳后注射地塞米松治疗，观察组进行耳内镜下鼓室注射地塞米松治疗，对比两组治疗效果。
结果观察组改善率高于对照组，差异有统计学意义（P<0.05）。
治疗后，观察组眩晕发作的严重程度及对日常生活的影响评分（1.02±0.65）分低于对照组（2.89±0.70）分，差异有统计学意义（t= 9.788，P<0.05）。
两组并发症发生率对比，差异无统计学意义（P>0.05）。
结论鼓室注射地塞米松对于治疗难治性梅尼埃病效果好、并发症少，具有较好临床应用价值。
［关键词］鼓室；地塞米松；难治性；梅尼埃病［中图分类号］R5 ［文献标识码］A ［文章编号］1674-0742（2023）08(a)-0115-05 Clinical Analysis of Tympanic Injection of Dexamethasone for Treatment of Refractory Meniere's DiseaseZHOU Ying, LI WeiDepartment of Otorhinolaryngology, Sanming First Hospital Affiliated to Fujian Medical University, Sanming, Fujian Province, 365000 China[Abstract] Objective To analyze and explore the clinical value of tympanic chamber injection of dexamethasone in the treatment of refractory Meniere´s disease. Methods 50 patients with refractory Meniere´s disease admitted to San‐ming First Hospital Affiliated to Fujian Medical University from April 2018 to April 2021 were selected as the study subjects. They were randomly divided into a control group and an observation group, with 25 patients in each group. The control group received retroauricular injection of dexamethasone, while the observation group received endoscopic tympanic injection of dexamethasone. The therapeutic effects of the two groups were compared. Results The improve‐ment rate of the observation group was higher than that of the control group, and the difference was statistically signifi‐cant (P<0.05). After treatment, the severity of dizziness and its impact on daily life score (1.02±0.65) points in the ob‐servation group was lower than that in the control group (2.89±0.70) points, the difference was statistically significant (t=9.788, P<0.05). There was no statistically significant difference in the incidence of complications between the two groups (P>0.05). Conclusion The tympanic chamber injection of dexamethasone is effective in the treatment of refrac‐tory Meniere´s disease with few complications, and has high clinical application value.[Key words] Tympanic chamber; Dexamethasone; Refractory; Meniere´s disease难治性梅尼埃病是指常规药物治疗无法有效控制梅尼埃病症状，导致患者频繁反复发作眩晕，主要症状包括眩晕、耳鸣、听力下降和耳部感闷胀等[1]。
妥布霉素地塞米松滴眼液对白内障术后干眼症患者眼部症状改善情况和泪膜稳定性的影响
DOI：10.19368/ki.2096-1782.2024.05.053妥布霉素地塞米松滴眼液对白内障术后干眼症患者眼部症状改善情况和泪膜稳定性的影响蒋宁南京市六合区中医院眼科，江苏南京211500[摘要]目的探究妥布霉素地塞米松滴眼液对白内障术后干眼症患者眼部症状改善情况和泪膜稳定性的影响。
方法选取2022年7月—2023年6月南京市六合区中医院收治的98例白内障手术后发生干眼症的患者为研究对象，经电脑随机分为两组，对照组（49例）行重组牛碱性成纤维细胞生长因子眼用凝胶治疗，观察组（49例）配合运用妥布霉素地塞米松滴眼液治疗。
经过30 d的持续治疗，对比两组眼部症状、泪膜稳定性、不良反应发生情况。
结果观察组眼表疾病指数量表（Ocular Surface Disease Index, OSFI）评分和角膜荧光染色（Corneal Fiuoresence Staining Score, CFS）评分低于对照组，差异有统计学意义（P均<0.05）；治疗后，观察组泪膜破裂时间、泪液分泌试验、泪膜厚度指标均优于对照组，差异有统计学意义（P均<0.05）；观察组不良反应发生率为8.16%，低于对照组的12.24%，差异无统计学意义（χ2=0.446，P=0.505）。
结论妥布霉素地塞米松滴眼液能够良好治疗白内障术后干眼症患者，改善眼部症状，保持泪膜稳定。
[关键词]妥布霉素地塞米松滴眼液；白内障手术；干眼症；眼部症状；泪膜稳定性[中图分类号]R77 [文献标识码]A [文章编号]2096-1782（2024）03(a)-0053-04Effects of Tobramycin Dexamethasone Eye Drops on the Improvement of Ocular Symptoms and Tear Film Stability in Patients with Dry Eye after Cataract SurgeryJIANG NingDepartment of Ophthalmology, Nanjing Liuhe District Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu Province, 211500 China[Abstract] Objective To investigate the effects of tobramycin dexamethasone eye drops on the improvement of ocular symptoms and tear film stability in patients with dry eye after cataract surgery. Methods A total of 98 patients with dry eye after cataract surgery treated in Nanjing Lihe District Hospital of Traditional Chinese Medicine from July 2022 to June 2023 were selected as the study subjects. They were randomly divided into two groups by computer. The con⁃trol group (49 cases) received recombinant bovine basic fibroblast growth factor eye gel treatment, and the observation group (49 cases) received tobramycin and dexamethasone eye drops treatment. After 30 days of continuous treatment, the ocular symptoms, tear film stability and adverse reactions occurence of the two groups were compared. Results The ocular surface disease index (OSFI) scores and corneal fiuoresence staining (CFS) scores in the observation group were lower than those in the control group, and the differences were statistically significant (both P<0.05). After treat⁃ment, the indexes of tear film breakup time, Schirmer Ⅱtext and tear film thickness in observation group were better than those in control group, and the differences were statistically significant (all P<0.05). The incidence of adverse re⁃actions in the observation group was 8.16%, lower than 12.24% in the control group, and the difference was not statis⁃tically significant (χ2=0.446, P=0.505). Conclusion Tobramycin dexamethasone eye drops can be a good treatment for patients with dry eye after cataract surgery, promoting benign improvement of ocular symptoms and maintaining tear [作者简介] 蒋宁（1966-），男，本科，副主任医师，研究方向为白内障。
血管参与支气管哮喘发病机制的研究进展
.综述.血管参与支气管哮喘发病机制的研究进展郛永艳文颖霍如婕田新瑞支气管哮喘是一种常见的气道疾病，气道炎症、肺功能下降和气道重塑是其重要特征'目前全球有3亿患者，生活质量受到了严重影响［1］o大多数哮喘与过敏相关，表现为Th2型主导的炎症，也见于对寄生虫的免疫反应［2］。
肺血管由于参与肺内气体交换，维持内环境平衡，调节气道气流变化，从而与哮喘发病密切相关。
支气管血管在哮喘发作时发生通透性、扩张性和密度的变化,与支气管哮喘发病的严重程度呈正相关，并是导致哮喘持续发病的重要因素之一⑶。
我们综述了近年来血管因素在哮喘气道炎症及气道重塑中的作用及机制的研究进展。
血管在哮喘炎症中的作用种症病，其特种炎症细胞和炎症介质导致的气道炎症、气道高反应性。
在易感人群中，这种慢性炎症导致患者反复出现喘息、气短、胸闷和咳嗽，常在夜间和清晨发作加剧。
炎症级联反应的激活,导致肺内血管生成异常，促进炎症细胞向炎症部位迁移，导致哮喘慢性炎症持续⑷-哮喘性炎症会刺激血管新生，从而导致气道阻塞和气道高反应性。
有研究探讨了哮喘血管生成与潜在的慢性过敏性炎症之间的关系，结果表明血管生成和慢性炎症相互促进⑸-血管生成和微血管改变是哮喘慢性炎症的特征，在支气管哮喘发病过程中，支气管血管可能通过血管舒张、血管再生和微血管渗漏而导致支气管壁发生炎性改变。
同时，支气管黏膜下层血管通过上调细胞粘蛋白，识别并促进炎症细胞迁移，进而加重哮喘炎症状态-血管参与哮喘炎症的作用机制—、血管内皮生长因子(vascular endotheliaidT：10.3969/j.imn.1009-6663.2021.06.031基金项目：山西省重点研发计划(国际合作)(No.201903D421066#作者单位：030001山西太原，山西医科大学第二医院呼吸与危重症学科通信作者：田新瑞,E-mail：tianxr@126-com growth factor，VEGF)VEGF血皮特异的生长，1983年首次被描述为肿瘤细胞分泌的血管通透性因子。
地塞米松联合美罗培南治疗36例脑炎患儿的效果
脑膜炎是由细菌、病毒等引发的软脑膜弥漫性炎症性改变,是较为严重的神经系统疾病。
在脑膜炎病症中,化脓性脑膜炎较为常见,在儿童身上较为常见,具有较高致死率与致残率。
化脓性脑膜炎起病急,患儿大多表现为发热、意识障碍等,年龄较大患儿可见明显颅内高压表现。
因此,尽早救治脑膜炎患儿对降低病死率、改善患儿生存质量具有重要的意义。
糖皮质激素具有较强的抗炎作用,在糖皮质激素中,地塞米松的半衰DOI:10.16662/ki.1674-0742.2020.08.094地塞米松联合美罗培南治疗36例脑炎患儿的效果吴俊谦冠县中心医院儿科,山东冠县252500[摘要]目的探讨地塞米松联合美罗培南治疗36例脑炎患儿的效果。
方法针对该院于2016年5月—2019年6月收治的化脓性脑膜炎患儿,从中方便选择72例作为该次研究的对象,数字法随机分为两组,各36例。
试验组患儿采用美罗培南联合地塞米松治疗,对照组患儿采用美罗培南治疗。
治疗两周后,比较两组患儿的指征消失时间、体温恢复时间、炎症因子水平以及治疗总有效率。
结果治疗后,试验组患儿指征消失时间、体温恢复时间分别为(1.98±0.41)d、(2.75±0.41)d,均优于对照组,差异有统计学意义(t=3.647、3.825,P<0.05)。
试验组NSE、PCT、TNF-α、CRP水平分别为(28.17±6.03)μg/L、(182.93±40.16)pg/mL、(54.18±9.16)pg/mL、(27.29±4.73)pg/mL,均优于对照组,差异有统计学意义(t=4.163、4.657、4.028、4.213,P<0.05)。
试验组治疗总有效率为94.44%,与对照组相比差异有统计学意义(χ2= 5.013,P<0.05)。
结论地塞米松联合美罗培南治疗化脓性脑膜炎可以明显改善炎症水平,促进患儿体温尽快恢复正常,与单纯使用美罗培南相比,疗效更佳。
重组人血小板生成素联合大剂量地塞米松对原发性ITP病人Treg细胞及Th1、Th2细胞的影响
[收稿日期]2020-11-19 [修回日期]2021-05-06[基金项目]蚌埠医学院自然科学研究项目(BYKY2019156ZD)[作者单位]蚌埠医学院第二附属医院血液内科,安徽蚌埠233040[作者简介]傅 磊(1985-),男,硕士,主治医师.[文章编号]1000⁃2200(2021)07⁃0858⁃05㊃临床医学㊃重组人血小板生成素联合大剂量地塞米松对原发性ITP 病人Treg 细胞及Th1㊁Th2细胞的影响傅 磊,沈 磊,卞建军,李 亮,苏玉璇,左金曼,孟美丽,陆 尧,葛书亚,张伊莉[摘要]目的:观察重组人血小板生成素(rhTPO)联合大剂量地塞米松方案对原发性免疫性血小板减少症(ITP)病人调节性T 细胞(Treg)及辅助性T 细胞(Th)1㊁Th2表达水平的影响㊂方法:选择ITP 病人82例,按照随机数字表法分为对照组40例和观察组42例㊂对照组给予大剂量地塞米松治疗,观察组在对照组治疗基础上加用rhTPO 治疗㊂比较2组病人疗效,并采用流式细胞仪检测2组治疗前后Treg 细胞和Th1㊁Th2细胞表达水平及Th1/Th2比例㊂结果:观察组病人疗效优于对照组(P <0.05)㊂治疗前,2组病人Treg 细胞和Th1㊁Th2细胞表达水平及Th1/Th2比例差异均无统计学意义(P >0.05);治疗后,2组病人Treg 细胞及Th2细胞均较治疗前明显上调(P <0.01),Th1细胞和Th1/Th2比例均较治疗前明显下降(P <0.01),且观察组Treg 细胞及Th2细胞表达水平均明显高于对照组(P <0.01),Th1细胞和Th1/Th2均明显低于对照组(P <0.01)㊂结论:rhTPO 联合大剂量地塞米松治疗原发性ITP 能通过增加病人Treg 细胞数量㊁纠正Th1/Th2细胞平衡,提高临床疗效㊂[关键词]原发性免疫性血小板减少症;重组人血小板生成素;地塞米松;调节性T 细胞;辅助性T 细胞[中图法分类号]R 558.2 [文献标志码]A DOI :10.13898/ki.issn.1000⁃2200.2021.07.005Effect of the recombinant human thrombopoietin combined with high dose dexamethasone on the Treg cells ,Th1cells and Th2cells in primary immune thrombocytopenia patientsFU Lei,SHEN Lei,BIAN Jian⁃jun,LI Liang,SU Yu⁃xuan,ZUO Jin⁃man,MENG Mei⁃li,LU Yao,GE Shu⁃ya,ZHANG Yi⁃li (Department of Hematology ,The Second Affiliated Hospital of Bengbu Medical College ,Bengbu Anhui 233040,China )[Abstract ]Objective :To observe the effects of recombinant human thrombopoietin(rhTPO)combined with high dose dexamethasone on the expression levels of CD4+CD25+Foxp3+regulatory T cells(Treg),T⁃helper 1(Th1)cells and T⁃helper 2(Th2)cells in primary immune thrombocytopenia(ITP)patients.Methods :Eighty⁃two patients with ITP were divided into the control group(40cases)andobservation group (42cases )according to the random number table method.The control group was treated with high⁃dose dexamethasone,and the observation group was treated with rhTPO on the basis of the control group.The therapeutic effects were compared between two groups.The expression levels of Treg cells,Th1cells and Th2cells,and the ratio of Th1/Th2in two groups before and after treatment were detected using flow cytometry.Results :The total effective rate in observation group was significantly better than that in control group(P <0.05).Before treatment,there was no statistical significance in the expression levels of Treg cells,Th1cells and Th2cells,and the ratio of Th1/Th2between two groups(P >0.05).After treatment,the levels of Treg cells and Th2cells were significantly up⁃regulated (P <0.01),and the ratio of Th1cells and Th1/Th2decreased significantly compared with before treatment(P <0.01).After treatment,the expression levels of Treg cells and Th2cells in observation group were significantly higher than those in control group(P <0.01),and the Th1cells and Th1/Th2ratio in observation group were significantly lower than those in control group(P <0.01).Conclusions :The rhTPO combined with high dose dexamethasone in the treatment of ITP can improve the clinical therapeutic effects through increasing the number of Treg cells and correcting the balance of Th1/Th2cells.[Key words ]primary immune thrombocytopenia;recombinant human thrombopoietin;dexamethasone;regulatory T cells;T⁃helper cells 原发性免疫性血小板减少症(immunethrombocytopenia,ITP)是一种由自身抗体免疫介导血小板过度破坏所引起的血小板减少性疾病㊂病人可有体液免疫和细胞免疫异常,导致B 淋巴细胞产生破坏血小板的抗体及CD8+细胞毒T 细胞破坏血小板㊁使血小板生成障碍,是ITP 的经典发病机制㊂目前ITP 治疗首选以地塞米松为主的糖皮质激素治疗,但停药后极易复发[1]㊂血小板生成素(TPO)受体激动剂可有效促进ITP 病人骨髓巨核细胞的生成,迅速升高血小板,具有耐受性好㊁不良反应轻等优点[2],临床上重组人血小板生成素(rhTPO)应用最为广泛㊂研究[3-4]显示,人体免疫系统中辅助性T 细胞(Th)可参与多种自身免疫性疾病的发生及发展,ITP 病人也存在多种其他细胞免疫功能异常,T细胞功能紊乱可能在ITP的发病中起重要作用㊂有研究[5]发现,TPO受体激动剂能显著改善ITP病人的T细胞功能㊂本研究观察rhTPO联合大剂量地塞米松治疗对ITP病人的疗效及其对调节性T细胞(Treg)和Th1细胞㊁Th2细胞的表达影响㊂现作报道㊂1 资料与方法1.1 一般资料 选择2017年1月至2020年1月我院收治的ITP病人82例㊂纳入标准:(1)年龄≥18岁,男女不限;(2)符合ITP诊断标准[6];(3)自愿接受住院治疗并签署知情同意书㊂排除标准: (1)妊娠或哺乳期女性;(2)合并有自身免疫性疾病等引起血小板减少疾病者;(3)有颅内出血者;(4)有血栓病史者;(5)合并严重肝㊁肾功能不全者或心肺功能障碍者;(6)有急性感染者;(7)有糖皮质激素和rhTPO应用禁忌证者㊂采用随机数字表法分为观察组42例和对照组40例㊂观察组男23例,女19例;年龄(46.32±14.52)岁㊂对照组男21例,女19例;年龄(44.23±15.06)岁㊂2组病人性别㊁年龄具有可比性㊂本研究符合2013年修订的‘世界医学协会赫尔辛基宣言“相关要求㊂1.2 治疗方法 观察组给予rhTPO联合大剂量地塞米松治疗,其中rhTPO(沈阳三生制药有限公司,国药准字S2*******,生产批号201911131)15000U,皮下注射,每日一次,共14d,在14d疗程内若血小板计数>100×109/L或血小板计数增幅≥50×109/ L时停用;地塞米松(马鞍山丰原药业有限公司,国药准字H20051748,生产批号191212⁃1)40mg,静脉滴注,每日一次,共4d㊂对照组仅予大剂量地塞米松治疗,用量用法同观察组㊂2组病人治疗过程中均不使用除研究药物之外的其他治疗ITP药物㊂对于合并口腔㊁鼻腔或内脏等部位严重活动性出血的病人,酌情给予血小板输注治疗㊂1.3 标本检测 2组病人治疗前后均抽取外周静脉血,送至北京海思特医学检验公司应用流式细胞术检测病人CD4+CD25+FOXP3+Treg㊁Th1㊁Th2表达水平及Th1/Th2比值㊂1.3.1 试剂及仪器 抗体:CD4(FITC)㊁CD25 (APC)㊁Foxp3(PE)㊁IFN⁃γ(FITC)㊁IL⁃4(PE)均购自Becton Dickison公司;RPM1640培养基(不含小牛血清)购自Becton Dickison公司;Perfix⁃nc破膜试剂盒(PerFix⁃ncbuffer1fixative reagent,buffer2permeabilizing reagent,buffer3final10×solution PBS)购自Life Technologies公司㊂实验使用仪器:FACSCantoⅡ流式细胞仪(Becton Dickison公司)㊂1.3.2 Treg细胞检测 将CD4⁃FITC㊁CD25⁃APC㊁Foxp3⁃APC抗体各5μL加入流式管中,并做同型对照管,对照管加相应的IgG1抗体;按照(1~10)×106/mL,取70μL外周血样本加入管中,震荡㊁混匀,室温避光孵育20min;加1~3mL10×裂解液,震荡混匀,避光裂解10min㊁离心转速1500r/min,离心5min,弃上清;向管中加入固定液,震荡混匀,放置于4℃冰箱,30min固定,拿出后向该管中加入缓冲液,1500r/min离心5min,弃上清,重复1次,震荡,混匀,室温避光孵育20min后,加入缓冲液, 1500r/min离心5min,弃上清㊂加入3~5滴磷酸缓冲盐溶液(PBS液)重悬,上机;利用流式细胞仪进行检测,采用BD Cell Quest软件分析实验数据, FSC⁃SSC散点图圈定淋巴细胞群,CD4⁃FITC/SSC圈定CD4+淋巴细胞,再从CD4+看CD25/Foxp3散点图,即得到CD4+CD25+POXP3+Treg细胞占CD4+T 细胞比例㊂1.3.3 Th1㊁Th2细胞检测 将100μL全血与100μL RPM1640培养基混匀,加入2μL刺激剂,置于37℃㊁5%CO2培养箱培养4~6h;按照(1~10)×106/mL,取70μL外周血样本加入管中,震荡㊁混匀,室温避光孵育20min;加1~3mL10×裂解液,震荡混匀,避光裂解10min,1500r/min离心5min,弃上清;向管中加入固定液,震荡混匀,放置于4℃冰箱,30min固定,拿出后向该管中加入缓冲液,离心转速1500r/min,离心5min,弃上清,重复1次;加入10μL IFN⁃γ⁃FITC和10μL IL⁃4PE抗体,同时做同型对照管,对照管加相应的IgG1抗体,震荡,混匀,室温避光孵育20min后,加入缓冲液,离心转速1500r/min,离心5min,弃上清㊂加入3~5滴PBS 液重悬,上机;利用流式细胞仪进行检测,采用BD Cell Quest软件分析实验数据,FSC⁃SSC散点图圈定淋巴细胞群,采用CD4+IFN⁃γ+IL⁃4-细胞评价Th1细胞水平,用CD4+IL⁃4+IFN⁃γ-细胞评价Th2细胞水平㊂1.4 疗效评价及不良反应观察 根据血小板水平判断疗效:(1)完全反应,治疗后血小板计数≥100×109/L且无出血;(2)有效,治疗后血小板计数≥30×109/L并且至少比基础血小板计数增加2倍且没有出血;(3)无效,治疗后血小板计数<30×109/ L或者血小板计数增加不到基础值的2倍或者有出血[6]㊂总有效率=(完全反应例数+有效例数)/病人总例数×100%㊂治疗期间观察并记录2组病人药物不良反应发生情况㊂1.5 统计学方法 采用t(或t′)检验和秩和检验㊂2 结果2.1 2组病人临床疗效比较 观察组治疗总有效率为90.48%,高于对照组的67.50%(P<0.05) (见表1)㊂表1 2组病人疗效比较[n;百分率(%)]分组n完全反应有效无效总有效u c P 对照组4018(45.00) 9(22.50) 13(32.50) 27(67.50)观察组4228(66.67)10(23.81)4(9.52)38(90.48)2.37<0.05合计8246(56.10)19(23.17)17(20.73)65(79.27)2.2 2组病人治疗前后Treg细胞和Th1㊁Th2细胞表达水平及Th1/Th2比例比较 治疗前,2组各项指标比较差异均无统计学意义(P>0.05)㊂治疗后,2组Treg细胞及Th2细胞均较治疗前明显上调(P<0.01),Th1细胞㊁Th1/Th2比例均较治疗前明显下降(P<0.01),且观察组Treg细胞及Th2细胞均明显高于对照组,Th1细胞㊁Th1/Th2均明显低于对照组(P<0.01)(见表2)㊂ 表2 2组病人治疗前后Treg㊁Th1㊁Th2细胞水平及Th1/ Th2比例比较(x±s)分组n Treg Th1Th2Th1/Th2治疗前 对照组40 1.39±0.6224.85±5.010.75±0.2932.61±5.38 观察组42 1.41±0.6525.12±4.920.72±0.3332.47±5.12 t 0.140.250.440.12 P >0.05>0.05>0.05>0.05治疗后 对照组404.68±1.33**18.16±2.72**1.11±0.38**20.46±3.19** 观察组426.59±1.64**13.23±3.56**1.53±0.49**14.15±2.16** t 5.787.02 4.3210.44# P <0.01<0.01<0.01<0.01 #示t′值;组内配对t检验:**P<0.012.3 2组药物不良反应比较 治疗期间,对照组病人出现血糖升高4例,高血压2例,不良反应发生率为15.00%(6/40);观察组病人出现血糖升高3例,低钾血症2例,不良反应发生率为11.90%(5/42), 2组不良反应发生率差异无统计学意义(χ2=5.72, P>0.05)㊂3 讨论 ITP是一种临床常见的自身免疫性出血性疾病,其最经典的免疫机制是由体内抗原特异性自身抗体介导的血小板被单核-巨噬细胞过度破坏,引起发病㊂但仍有较多ITP病人的自身抗体检测为阴性,提示还有其他因素参与免疫发病㊂目前ITP的治疗首选仍是糖皮质激素,但仍有部分重症病人单独使用糖皮质激素治疗后效果不佳,而rhTPO治疗此类病人疗效明显㊁安全性好,在临床上应用越来越多㊂TPO是机体内诱导巨核细胞增殖分化㊁促血小板生成的重要调控因子,能促进巨核细胞膜成熟及血小板释放㊂ITP病人由于血小板破坏增多,使体内TPO的清除加速,但内源性的TPO未明显增加,故其血浆中TPO水平不增高或轻度增高[7],而内源性TPO产生相对不足也是ITP病人血小板生成障碍的重要原因之一[8],为TPO受体激动剂治疗ITP 提供了理论依据㊂T淋巴细胞的表达异常及功能紊乱是ITP病人发病的重要免疫机制㊂Th根据分化方向不同,可分为Th1㊁Th2㊁Th17㊁Treg等,在机体免疫系统中起重要作用,Th细胞的比例异常及功能改变可密切参与ITP的发病过程㊂Treg细胞是一类具有独特免疫调节作用的Th细胞,可参与机体诱导和维持自身免疫耐受,在免疫相关性疾病中发挥重要作用[9]㊂Treg 细胞可高表达CD25,并分泌白细胞介素(IL)⁃10及转化生长因子β(TGF⁃β)等多种细胞因子,表达特异性转录因子FoxP3,因此CD4+CD25+Foxp3+是最经典的Treg细胞免疫表型㊂研究表明,ITP病人外周血㊁脾脏及骨髓中的Treg细胞数量均明显下降[10-12],且有Treg细胞miRNAs的低表达[13],引起增殖相关蛋白水平下降和细胞自噬功能降低从而参与疾病的发生发展[14-15]㊂研究[10]发现,在经TPO 受体激动剂方案治疗后,ITP病人Treg细胞失调得到改善,血小板计数恢复㊂本研究发现,ITP病人单用地塞米松其Treg细胞数量即可增加,但联合rhTPO后病人Treg细胞增加更为明显,疗效更优,可以效升高血小板,未见严重不良反应,耐受性好㊂姜明敏等[16]发现rhTPO能显著增加ITP小鼠脾脏中的Treg细胞数量,升高血小板㊂而在孕期ITP的研究[17-18]中发现,rhTPO能明显升高Treg细胞及TGF⁃β1,迅速恢复血小板,安全性高,是治疗ITP孕妇的安全有效选择㊂还有研究表明[5,19],rhTPO能显著增加ITP病人Treg细胞的抑制功能,控制疾病发展㊂后期可进一步研究rhTPO对Treg细胞功能的调节作用㊂Th1和Th2细胞是由Th0细胞直接分化而来,Th1细胞可分泌IFN⁃γ㊁TNF㊁IL⁃2等细胞因子,发挥细胞免疫效应;Th2细胞可分泌IL⁃4㊁IL⁃5㊁IL⁃10㊁IL⁃13等细胞因子,可促进B细胞活化,产生浆细胞及自身抗体,发挥体液免疫的作用㊂生理状态下, Th1和Th2细胞的分泌维持动态平衡,共同维护机体免疫内环境的稳定㊂研究[20-21]发现,ITP病人存在Th1/Th2平衡偏移,即Th1细胞占数量优势,介导了一系列免疫反应引起免疫调节功能紊乱,导致ITP发病㊂经有效治疗病情缓解后Th1和Th2细胞则逐渐恢复正常,Th1/Th2平衡恢复[22-23]㊂有研究[24-25]发现,TPO受体激动剂可降低再生障碍性贫血病人体内的Th1细胞水平,起到调节免疫㊁促进造血作用㊂而rhTPO可通过调节ITP病人的Th1㊁Th2免疫平衡而发挥治疗作用[26]㊂本研究结果显示, ITP病人外周血中Th1细胞水平升高,Th2细胞水平降低,Th1/Th2比例升高,存在Th1细胞免疫偏移,发生Th1/Th2比例失衡,地塞米松单药治疗后病人Th1细胞比例下降,Th2细胞比例升高,Th1/Th2失衡状态得到一定改善,而联合应用rhTPO治疗后, Th1细胞进一步下降,Th2细胞进一步升高,Th1/Th2失衡状态明显改善,疗效明显提高㊂rhTPO对Th1㊁Th2细胞免疫功能的调节作用有待进一步研究㊂综上所述,原发性ITP病人应用rhTPO联合大剂量地塞米松方案治疗后能通过增加病人Treg细胞及Th2细胞数量㊁降低Th1细胞数量,纠正Th1/ Th2细胞平衡紊乱,安全有效升高血小板,提高临床治疗效果㊂[参考文献][1] 胡兰,喻雕,周泽平,等.难治性原发免疫性血小板减少症的治疗进展[J].实用医学杂志,2017,33(3):337. [2] TRIPATHI AK,SHUKLA A,MISHRA S,et al.Eltrombopagtherapy in newly diagnosed steroid non⁃responsive ITP patients[J].Int J Hematol,2014,99(4):413.[3] SUTHERLAND JM,MCLAUGHLIN EA,HIME GR,et al.TheMusashi family of RNA binding proteins:master regulators ofmultiple stem cell populations[J].Adv Exp Med Biol,2013,786:233.[4] TAKAHASHI T,SUZUKI H,IMAI T,et al.Musashi⁃1post⁃transcriptionally enhances phosphotyrosine⁃binding domain⁃containing m⁃Numb protein expression in regenerating gastricmucosa[J].PLoS One,2013,8(1):e53540.[5] BAO W,BUSSEL JB,HECK S,et al.Improved regulatory T⁃cellactivity in patients with chronic immune thrombocytopenia treatedwith thrombopoietic agents[J].Blood,2010,116(22):4639.[6] 中华医学会血液学分会止血与血栓学组.成人原发免疫性血小板减少症诊断与治疗中国专家共识(2016年版)[J].中华血液学杂志,2016,37(2):89.[7] WÖRMANN B.Clinical indications for thrombopoietin andthrombopoietin⁃receptor agonists[J].Transfus Med Hemother,2013,40(5):319.[8] BUSSEL JB,LAKKARAJA M.Thrombopoietic agents:there isstill much to learn[J].Presse Med,2014,43(4Pt2):e69.[9] PELLERIN L,JENKS JA,BEGIN P,et al.Regulatory T cells andtheir roles in immune dysregulation and allergy[J].ImmunolRes,2014,58(2/3):358.[10] NISHIMOTO T,KUWANA M.CD4+CD25+Foxp3+regulatoryT cells in the pathophysiology of immune thrombocytopenia[J].Semin Hematol,2013,50(Suppl1):S43.[11] ZHANG JK,ZHANG QY,LI YW,et al.Immune dysregulation inprimary immune thrombocytopenia patients[J].Hematology,2018,23(8):510.[12] 杨媛媛,张凤琦,潘誉,等.原发免疫性血小板减少症患者脾脏组织调节性T细胞和Th17细胞数量的研究[J].中华血液学杂志,2017,38(3):227.[13] ZHU YD,ZHU H,XIE XB,et al.MicroRNA expression profile inTreg cells in the course of primary immune thrombocytopenia[J].J Investig Med,2019,67(8):1118.[14] ARANDI N,MIRSHAFIEY A,JEDDI⁃TEHRANI M,et al.Alteration in frequency and function of CD4+CD25+FOXP3+regulatory T cells in patients with immune thrombocytopenicpurpura[J].Iran J Allergy Asthma Immunol,2014,13(2):85.[15] 王琦,计雪强,邵惠江,等.免疫性血小板减少症(ITP)患儿外周血调节性T细胞数量减少伴随自噬的降低[J].细胞与分子免疫学杂志,2018,34(9):834.[16] 姜明敏,李玉婷,王丽娟,等.血小板生成素对免疫性血小板减少小鼠脾脏T淋巴细胞亚群的影响[J].免疫学杂志,2019,35(8):671.[17] LIU Y,WANG R,HAN P,et al.Effect of recombinant humanthrombopoietin on immune thrombocytopenia in pregnancy in amurine model[J].Int Immunopharmacol,2019,67(2):287.[18] KONG ZY,QIN P,XIAO S,et al.A novel recombinant humanthrombopoietin therapy for the management of immunethrombocytopenia in pregnancy[J].Blood,2017,130(9):1097.[19] 陶媛,吴秉毅,杜庆锋,等.重组人血小板生成素可能通过调节免疫负调控因子水平治疗免疫性血小板减少性紫癜[J].血栓与止血学,2014,20(6):315.[20] 罗洪强,封蔚莹,钟永根,等.CBA技术检测ITP患者Th1/Th2细胞因子平衡偏移的临床意义[J].中国实验血液学杂志,2016,24(6):1846.[21] 王明镜,许勇钢,丁晓庆,等.免疫性血小板减少症患者Th1/Th2细胞失衡与特异性转录因子表达异常[J].临床血液学杂志,2018,31(5):379.[22] LYU MG,LI Y,HAO YT,et al.Elevated Semaphorin5Acorrelated with Th1polarization in patients with chronic immunethrombocytopenia[J].Thromb Res,2015,136(5):859. [23] 瞿文,伍星,王珺,等.免疫性血小板减少性紫癜患者的T细胞免疫状态[J].天津医药,2012,40(4):389. [24] BART⁃SMITH EE,KORDASTI S,KULASEKARARAJ AG,et al.Successful treatment of aplastic anaemia associated with HIVinfection with eltrombopag:implications for a possibleimmunomodulatory role[J].AIDS,2014,28(18):2786.[收稿日期]2019-09-30 [修回日期]2020-04-01[基金项目]云南省科技厅-昆明医科大学应用基础研究联合专项资金项目[2018FE001(⁃053)][作者单位]昆明医科大学第二附属医院心内科,云南昆明650000[作者简介]王亚旭(1989-),男,住院医师.[通信作者]孙 林,主任医师.E⁃mail:sunlinkm@;姜雪梅,副主任医师.E⁃mail:135********@[文章编号]1000⁃2200(2021)07⁃0862⁃04㊃临床医学㊃心脉隆注射液治疗慢性心力衰竭病人的疗效及近期预后的临床研究王亚旭,孙 林,姜雪梅,官 兵,林 志,王永洁,孙文静,何永福[摘要]目的:探究心脉隆注射液对于慢性心力衰竭病人的治疗效果及近期预后的临床价值㊂方法:选择心内科收治的慢性心力衰竭病人86例,采用随机数字表法分为研究组(43例)和对照组(43例)㊂对照组采用血管紧张素转酶抑制剂ACEI㊁血管紧张素Ⅱ受体拮抗剂㊁利尿剂㊁强心剂㊁β受体阻断剂进行治疗㊂研究组在对照组病人用药基础上,给予心脉隆注射液进行治疗㊂比较2组病人的6min 步行距离㊁氨基末端脑钠肽前体T⁃proBNP 数值㊁左心室射血分数及MLHFQ 评分㊁MACE 发生率五项指标情况㊂结果:2组治疗2个疗程后,研究组病人6min 步行距离㊁左心室射血分数差均明显高于对照组(P <0.01);N 氨基末端脑钠肽前体数值明显低于对照组(P <0.01)㊂研究组的治疗有效率高于对照组(P <0.05);MLHFQ 评分低于对照组(P <0.05);出院2个月后心血管不良事件发生率小于对照组(P <0.01)㊂结论:心脉隆注射液治疗慢性心力衰竭病人的疗效及近期预后效果较好,可为临床治疗提供依据㊂[关键词]慢性心力衰竭;心脉隆注射液;6min 步行距离;氨基末端脑钠肽前体;左心室射血分数[中图法分类号]R 541.6 [文献标志码]A DOI :10.13898/ki.issn.1000⁃2200.2021.07.006Clinical study on the efficacy and short⁃term prognosis of Xinmailong injectionin the treatment of chronic heart failureWANG Ya⁃xu,SUN Lin,JIANG Xue⁃mei,GUAN Bing,LIN Zhi,WANG Yong⁃jie,SUN Wen⁃jing,HE Yong⁃fu(Department of Cardiology ,The Second Affiliated Hospital of Kunming Medical University ,Kunming Yunnan 650000,China )[Abstract ]Objective :To explore the efficacy and short⁃term prognosis of Xinmailong injection in the treatment of chronic heartfailure.Methods :Eighty⁃six patients with chronic heart failure were randomly divided into the study group(43cases)and control group (43cases).The control group was treated with the ACE inhibitor,angiotensin Ⅱreceptor antagonist,diuretic,cardiotonic agent,and β⁃receptor blocker.On the basis of the medication of the control group,the study group was additionally treated with Xinmailong injection.The 6⁃miniute walking distance,NT⁃probNP level,left ventricular ejection fraction(LVEF /%),MLHFQ score and MACE incidencewere compared between two groups.Results :After two courses of treatment,the 6⁃minute walking distance and LVEF /%in study group were significantly higher those in control group(P <0.01).The NT⁃proBNP level in study group was significantly lower than that in control group(P <0.01).The treatment efficiency in study group was higher than that in control group(P <0.05),and the MLHFQscore in study group was lowher than that in control group(P <0.05).The incidence of major adverse cardiovascolar events in study group after 2months of discharge was less than that in control group(P <0.01).Conclusions :Xinmailong injection in the treatment of chronic heart failure has good curative effect and short⁃term prognosis of patients,which can provide a basis for clinical treatment.[Key words ]chronic heart failure;Xinmailong injection;6min walking distamce;N⁃terminal pro⁃brain natriuretic peptide;left ventricular ejection fraction 心力衰竭根据缓急可分为急性和慢性㊂慢性心力衰竭是指心力衰竭状态持续存在,或稳定或恶化或失代偿,是各种心血管疾病的终末阶段㊂慢性心力衰竭主要特点是呼吸困难㊁水肿㊁乏力[1],但上述表现并非同时出现㊂该病是一种复杂的临床综合征,发病率和致死率逐年上升,已经成为严重危害人民生命健康的疾病[2]㊂目前一般采用利尿剂㊁醛固[25] ZAIMOKU Y,PATEL BA,KAJIGAYA S,et al .Deficit of circulating CD19+CD24hiCD38hi regulatory B cells in severeaplastic anaemia[J].Br J Haematol,2020,190(4):610.[26] 罗洪强,钟永根,封蔚莹.rhTPO 对原发性免疫性血小板减少性紫癜患者T㊁B 淋巴细胞免疫功能的影响[J].中国实验血液学杂志,2019,27(6):1962.(本文编辑 卢玉清)。
关于地塞米松对小鼠免疫系统的抑制作用
关于地塞米松对小鼠免疫系统的抑制作用【摘要】目的研究地塞米松对小鼠免疫系统的抑制作用。
方法取7～8周龄昆明种小鼠，腹腔注射地塞米松，分别于注射后5、10、15、24和36 h时间点取胸腺、脾脏和肠系膜淋巴结；对照组小鼠腹腔注射生理盐水（即0 h组），HE染色。
结果地塞米松组胸腺中凋亡细胞和凋亡小体数量多于对照组；脾脏和淋巴结内亦见凋亡细胞，但较胸腺内少；15 h时间点凋亡细胞最多。
结论地塞米松可引起胸腺、脾脏和淋巴结细胞的凋亡，对免疫系统有明显的抑制作用。
【关键词】地塞米松胸腺脾脏淋巴结凋亡【Abstract】 Objective To observe the effect and characterisitic of dexamethasone on immune system.Methods The mice of 7��8 weeks old were injected with dexamethasone.After the injection they were subjected to execute at five time points(5，10，15，24，36 h) and their thymus，spleen and mesenteric lymph nodes were obtained for morphologic observation.Results Compared with control mice，obviously more apoptotic cells and apoptotic bodies were found in the thymus，spleen and lymph nodes of the mice injected with dexamethasone，but less in the spleen and lymph nodes than in thymus.Apoptotic cells were most at the 15 h point.Conclusion The results suggested that dexamethasone could bring the lymphocyte apoptosis of thymus，spleen and lymph nodes，thenrestrain the immunologic function.【Key words】 dexamethasone，thymus，spleen，lymph nodes，apoptosis 免疫系统是人体抵御病原菌侵犯最重要的保卫系统，这个系统由淋巴器官、淋巴组织、参与免疫的细胞及分子组成。
地塞米松对大鼠骨密度及体成分的影响
地塞米松对大鼠骨密度及体成分的影响刘思瑶;张劼;黄松;冼晶;罗佐杰;梁敏【摘要】目的：探讨不同剂量地塞米松对大鼠骨密度（BMD）和体成分的影响。
方法3月龄SD雌性大鼠40只，按随机数字表法分为对照组（生理盐水），地塞米松低剂量组（1 mg/kg）、中剂量组（2.5 mg/kg）和高剂量组（5 mg/kg），每组10只，每周2次肌内注射。
给药前、给药4周后应用DEXA骨密度仪测定大鼠全身BMD和体成分。
结果干预1～4周后不同剂量地塞米松干预组体质量均较对照组下降（P＜0.01）。
干预4周后，对照组总BMD、股骨BMD、总骨矿含量（BMC）及全身、躯干、腿部脂肪含量均较干预前增加（P＜0.01），全身、躯干肌肉含量均较干预前下降（P＜0.01）；低剂量组、中剂量组大鼠股骨BMD、总BMC、腿部脂肪含量、腿部肌肉含量均低于对照组（P＜0.05）；低剂量组、中剂量组股骨BMD、腿部脂肪含量均低于高剂量组（P＜0.05）。
结论中、低剂量地塞米松对SD大鼠股骨BMD及腿部成分的影响更大。
%Objective To investigate the effects of different doses of dexamethasone (Dex) on bone mineral density (BMD) and body composition in Sprague-Dawley (SD) rats. Methods Forty 3-month-old female SD rats were divided into four groups:control group (Cont, saline), low dose Dex group (LDG, 1 mg/kg), medium dose Dex group (MDG, 2.5 mg/kg) and high dose Dex group (HDG, 5 mg/kg). Ten rats for each group. Dex was injected intramuscularly twice a week. The values of BMD and body composition were measured by DEXA densitometer at the beginning and 4-week of treatment. Results The body weights of different doses of Dex intervention groups were decreased after 1 to 4-week intervention compared with those of Contgroup (P<0.01). After 4-week intervention, the total BMD, femur BMD, total bone mineral content (BMC), to-tal fat mass, trunk fat mass and leg fat mass were significantly increased in Cont group (P<0.01), while the total lean mass, trunk lean mass were significantly decreased (P<0.01). The total BMC, femur BMD, leg lean mass, leg fat mass were signifi-cantly lower in LDG group and MDG group than those of Cont group (P<0.05). The femur BMD, leg fat mass were signifi-cantly lower in LDG group and MDG group than those of HDG group (P<0.05). Conclusion The doses of 1 mg/kg and 2.5 mg/kg Dex have greater impact on the femur BMD and the leg composition in SD rats than that of Dex (dose of 5 mg/kg ).【期刊名称】《天津医药》【年(卷),期】2014(000)002【总页数】4页(P152-155)【关键词】地塞米松;骨密度;身体成分;大鼠,Sprague-Dawley【作者】刘思瑶;张劼;黄松;冼晶;罗佐杰;梁敏【作者单位】广西医科大学第一附属医院内分泌科 530021;广西医科大学第一附属医院内分泌科 530021;广西医科大学第一附属医院内分泌科 530021;广西医科大学第一附属医院内分泌科 530021;广西医科大学第一附属医院内分泌科 530021;广西医科大学第一附属医院内分泌科 530021【正文语种】中文【中图分类】R681糖皮质激素治疗可导致肌肉萎缩、脂肪中心性聚集、骨密度（BMD）和骨矿含量（BMC）下降及骨折风险增加。
地塞米松冲击疗法治疗成人原发免疫性血小板减少症的疗效观察
地塞米松冲击疗法治疗成人原发免疫性血小板减少症的疗效观察张付华;刘珍【期刊名称】《中国医学创新》【年(卷),期】2014(000)034【摘要】目的：观察地塞米松冲击疗法治疗成人原发免疫性血小板减少症（ITP）的临床疗效。
方法：自2006年7月-2013年9月间笔者所在医院收治成人ITP患者38例，患者均给予胸腺肽α1联合大剂量维生素C治疗，其中19例同时应用4 d地塞米松冲击治疗，观察临床症状、血小板计数和不良反应。
结果：胸腺肽α1+大剂量维生素C治疗组总有效率78.9%，平均起效时间（16.8±3.2）d；胸腺肽α1+大剂量维生素C联合地塞米松冲击治疗组总有效率84.2%，平均起效时间（6.7±2.7）d。
两种治疗方案的不良反应均较轻微。
结论：胸腺肽α1联合大剂量维生素C与冲击量地塞米松联合应用治疗成人ITP疗效较好，副作用少，可缩短起效时间。
%Objective:To observe the curative effect of Dexamethasone impact therapy to the immune thrombocytopenic purpura(ITP).Method:38 ITP patients were all given thymosin alpha1(Tα1)combined high-dose vitamin C,among them 19 patients were companied with flushing dose dexamethasone during the first 4 medicative days.The clinic syndrome,platelet counts and side effects were observed.Result:The total effective rate in Tα1 combined high-dose vitamin C therapy group reached 78.9%,the average onset timewere(16.8±3.2)d;the total effective rate in Tα1 combined high-dose vitaminC and flushing dose dexamethasone therapy group was 84.2%,the average onset time were(6.7±2.7)d.The side effects of the two groups were slight.Conclusion:Tα1 combined high-dose vitamin C and flushing dose dexamethasone has good curative effect and fewer side effects on adult ITP;it can also act fsatly.【总页数】3页(P90-91,92)【作者】张付华;刘珍【作者单位】山东省东营市人民医院山东东营 257091;山东省东营市人民医院山东东营 257091【正文语种】中文【相关文献】1.大剂量地塞米松联合血小板生成素治疗成人初治重症原发免疫性血小板减少症疗效观察 [J], 王学森2.地塞米松冲击治疗成人初诊重症原发免疫性血小板减少症11例疗效观察 [J], 张正义;马洪建;江传和;朱育华;李永军3.重组人白介素-11联合大剂量地塞米松治疗成人原发免疫性血小板减少症重症患者短期疗效观察 [J], 王炜;张征帆4.大剂量地塞米松联合血小板生成素治疗成人初治重症原发免疫性血小板减少症疗效观察 [J], 王学森5.地塞米松联合利妥昔单抗一线治疗成人慢性原发免疫性血小板减少症的经济性评价 [J], 王樱澄;芮明军;商叶;马爱霞因版权原因，仅展示原文概要，查看原文内容请购买。
不同剂量的甲泼尼龙琥珀钠对重症哮喘患者的疗效及毒副作用观察
不同剂量的甲泼尼龙琥珀钠对重症哮喘患者的疗效及毒副作用观察黄岸佳;丘敏;韩群英;颜粤辉【期刊名称】《河北医药》【年(卷),期】2017(039)010【摘要】目的观察不同剂量的甲泼尼龙对重症哮喘患者的疗效及其毒副作用.方法选取2014年5月至2016年5月就诊的重症哮喘患者64例,随机分为对照组、观察组A、观察组B、观察组C,每组16例.对照组采用地塞米松(0.3~0.5 mg·kg-1·d-1治疗,观察组A、观察组B、观察组C分别采用甲泼尼龙(1~1.5 mg·kg-1·d-1)、甲泼尼龙(2~4 mg·kg-1·d-1)、甲泼尼龙(6~8 mg·kg-1·d-1)治疗,观察并比较不同剂量甲泼尼龙对重症哮喘患者的治疗总有效率、治疗前后PaO2及PaCO2、症状和体征改善时间、毒副作用.结果观察组A、观察组B、观察组C治疗重症哮喘的总有效率显著高于对照组(P<0.05),观察组B、观察组C 治疗重症哮喘的总有效率显著高于观察组A(P<0.05);观察组A、观察组B、观察组C的PaO2显著高于对照组(P<0.05),PaCO2显著低于对照组(P<0.05);观察组B的PaO2显著高于观察组A(P<0.05),观察组C的PaO2显著高于观察组B(P<0.05);观察组A、观察组B、观察组C症状和体征改善时间显著低于对照组(P<0.05);观察组B体征控制时间显著低于观察组A(P<0.05),观察组C体征控制时间显著低于观察组B(P<0.05);观察组A、观察组B、观察组C的上消化道出血率、血糖、血压显著高于对照组(P<0.05);观察组C的血糖、血压显著高于观察组A、观察组B(P<0.05).结论采用2~4 mg·kg-1·d-1剂量的甲泼尼龙治疗重症哮喘患者效果好,不良反应低,值得推广应用.%Objective To observe the therapeutic effects and sideeffects of different doses of methylprednisone on severe asthma.Methods Sixty-four patients with severe asthma who were treated in our hospital from May 2014 to May 2016 were randomly divided into control group,observation group A,observation group B,observation group C,with 16 patients in each group.The patients in control group were treated by dexamethasone (0.3~0.5mg·kg-1·d-1),however,the patients in observation group A,B,C were treat ed by methylprednisolone of 1~1.5mg·kg-1·d-1,2~4mg·kg-1·d-1,6~8mg·kg-1·d-1,respectively.The total effectiverate,PaO2 and PaCO2,improvement time of symptoms and signs,toxic and side effects were observed and compared among the four groups.Results The total effective rate in observation group A,B,C was significantly higher than that in control group (P<0.05),which in observation group B and group C was significantly higher than that in group A (P<0.05).The PaO2 in observation group A,B,C was significantly higher than that in control group (P<0.05),however,the PaCO2 in the three groups was significantly lower than that in control group (P<0.05).The PaO2 in observation group B was significantly higher than that in group A (P<0.05),moreover,PaO2 in observation group C was significantly higher than that in group B(P<0.05).The improvement time of symptoms and signs in observation group A,B,C was significantly shorter than that in control group(P<0.05),and the improvement time in observation group B was significantly shorter than that in group A (P<0.05),moreover,which in group C was significantly shorter than that in group B (P<0.05).The incidence rate of upper gastrointestinal bleeding,the levels of bloodglucose and blood pressure in observation group A,B,C were significantly higher than those in control group (P<0.05),moreover,the levels of blood glucose and blood pressure in observation group C were significantly higher than those in group A and group B (P<0.05).Conclusion The methylprednisolone at the dose of 3~4mg·kg-1·d-1 has satisfactory therapeutic effects on severe asthma,with few side effects,therefor,which is worth using widely in clinical practice.【总页数】4页(P1474-1476,1480)【作者】黄岸佳;丘敏;韩群英;颜粤辉【作者单位】528400 广东省中山市西区医院;528400 广东省中山市西区医院;528400 广东省中山市西区医院;528400 广东省中山市西区医院【正文语种】中文【中图分类】R562.25【相关文献】1.孟鲁司特钠联合甲泼尼龙琥珀酸钠治疗支气管哮喘急性发作的疗效观察 [J], 彭燕;王凯2.不同剂量甲泼尼龙琥珀酸钠联合高压氧治疗急性一氧化碳中毒后迟发性脑病的疗效 [J], 张萃萍; 欧阳晓春; 马遥3.不同剂量甲泼尼龙琥珀酸钠对重症哮喘患者疗效、炎性因子表达的影响 [J], 陈敏; 谢志刚; 邓明玉4.耳后注射甲泼尼龙琥珀酸钠联合纤溶酶治疗重度及极重度突发性耳聋患者的疗效观察 [J], 王霞;陈彩梅5.用BiPAP呼吸机联合甲泼尼龙琥珀酸钠治疗重症哮喘的疗效探究 [J], 陈红燕因版权原因，仅展示原文概要，查看原文内容请购买。
利托君抗早产治疗中的不良反应及应对措施
利托君抗早产治疗中的不良反应及应对措施耿宇宁【摘要】利托君是目前临床抗早产治疗的首选药物.利托君通过选择性地兴奋β2肾上腺素能受体,抑制子宫平滑肌,达到抗早产的目的.全身许多器官组织,如心血管系统、肝脏、胰腺、脂肪组织中广泛存在β2肾上腺素能受体.利托君治疗早产时同时激动全身其他组织器官中的β2肾上腺素能受体,继而产生相应的不良反应.现就利托君产生的不良反应归纳总结,探讨其发生机制,提出应对措施.%Ritodrine is a β2-adrenergic receptor stimulant,which is often used in an attempt to inhibit premature uterine contraction. However,due to the ubiquitous presence of β2 receptors, stimulation of β2 receptors at several sites occurs,resulting in significant side effects. Here is to study the adverse effects of ritodrine and its mechanism and find out the countermeasures.【期刊名称】《医学综述》【年(卷),期】2011(017)018【总页数】3页(P2811-2813)【关键词】利托君;早产;不良反应【作者】耿宇宁【作者单位】首都医科大学附属北京妇产医院产科,北京,100026【正文语种】中文【中图分类】R71目前治疗早产抑制宫缩的药物有六类:β2肾上腺素能受体激动剂、钙离子通道抑制剂、硫酸镁、前列腺素合成酶抑制剂、催产素受体拮抗剂、一氧化氮。
其中β2肾上腺素能受体兴奋剂类药物被广泛应用于临床。
盐酸利托君(商品名:安宝)是其代表。
盐酸利托君又名羟苄羟麻黄碱，特异地作用于子宫平滑肌β2受体，有效地松弛子宫平滑肌，即时减弱子宫收缩率［1］。