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安徽医科大学学报 2010年第3期45卷 390-392页

作者：罗厚江潘家华倪陈计明红陈云龙王珅陈伟安徽医科大学附属省立医院儿科合肥230001 蚌埠医学院第二附属医院儿科蚌埠233040

目的观察结核感染对儿童支气管哮喘吸入糖皮质激素(ICS)疗效的影响,为人工结核感染辅助治疗儿童哮喘提供依据。方法 62例有结核感染的哮喘患儿作为观察组,58例结核菌素纯蛋白衍生物(TB-PPD)皮试阴性哮喘患儿为对照组,两组均使用储雾罐... 详细信息

目的观察结核感染对儿童支气管哮喘吸入糖皮质激素(ICS)疗效的影响,为人工结核感染辅助治疗儿童哮喘提供依据。方法 62例有结核感染的哮喘患儿作为观察组,58例结核菌素纯蛋白衍生物(TB-PPD)皮试阴性哮喘患儿为对照组,两组均使用储雾罐吸入丙酸氟替卡松,有哮喘急性发作时,加用沙丁胺醇气雾剂,病情较重时加用强的松口服。观察组另外加用抗结核药物治疗。比较两组治疗效果。结果治疗3、6个月后沙丁胺醇、强的松平均个人使用剂量观察组小于对照组,差异有统计学意义(P<0.05);呼吸道感染次数、急诊次数、3个月后两组差异无统计学意义(P>0.05),6个月后,观察组明显少于对照组,差异有统计学意义(P<0.05);住院次数两组差异无统计学意义(P>0.05);两组潮气量(VT/KG)、达峰时间比(TPTEF/TE)、达峰容积比(VPTEF/VE)3个月后均有增加,但差异无统计学上意义(P>0.05),6个月后观察组增加明显好于对照组,差异有统计学上意义(P<0.05)。结论支气管哮喘合并结核感染患儿吸入ICS治疗,临床疗效优于无结核感染的哮喘患儿,为人工结核感染辅助治疗儿童支气管哮喘提供科学依据。

关键词：结核哮喘/治疗糖皮质激素类/投药和剂量投药吸入

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Antenatal glucocorticoids and programming of the developing CNS

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PEDIATRIC RESEARCH 2000年第3期47卷 291-300页

作者： Matthews, SG Univ Toronto Fac Med Dept Physiol Toronto ON M5S 1A8 Canada Univ Toronto Fac Med Dept Obstet & Gynecol Toronto ON M5S 1A8 Canada

Glucocorticoids (GCs) are essential for many aspects of normal brain development. However, there is growing evidence from a number of species that exposure of the fetal brain to excess GC, at critical stages of development, can have life-long effects on behavior and neuroendocrine function. The hypothalamo-pituitary-adrenal axis, which is central to the integration of the individual's endocrine and behavioral response to stress, appears highly sensitive to excess GC exposure during development. A number of animal studies have shown that exposure to synthetic GCs in utero results in adult offspring that exhibit hyperactivity of the hypothalamo-pituitary-adrenal axis. This will have a long-term impact on health, inasmuch as increased life-long exposure to endogenous GC has been linked to the premature onset of diseases associated with aging. The mechanisms involved in the permanent programming of hypothalamopituitary-adrenal function and behavior are not well understood. Synthetic GCs are used extensively to promote pulmonary maturation in fetuses at risk of being delivered before term. Therefore, it is important that we understand the potential long-term consequences of prenatal GC exposure on brain development as well as the underlying mechanisms involved. This review will explore the current state of knowledge in this rapidly expanding field.

关键词：行为/药物作用中枢神经系统/胚胎学糖皮质激素类/投药和剂量产前保健成年人动物人类

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Effects of adding a leukotriene antagonist or a long-acting beta₂-agonist in asthmatic patients with the glycine-16 beta₂-adrenoceptor genotype

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AMERICAN JOURNAL OF MEDICINE 2000年第2期109卷 114-121页

作者： Lipworth, BJ Dempsey, OJ Aziz, I Wilson, AM Univ Dundee Ninewells Hosp & Med Sch Dept Clin Pharmacol & Therapeut Asthma & Allergy Res Grp Dundee DD1 9SY Scotland

PURPOSE: In the United Kingdom, about 40% of patients with asthma are homozygous for the glycine-16 beta(2)-adrenoceptor polymorphism, which predisposes them to agonist-induced down-regulation and desensitization of the beta(2)-adrenoceptor. We assessed the effects of adding treatment with either a long-acting beta(2)-agonist (inhaled formoterol, 12 mu g twice daily) or a leukotriene receptor antagonist (oral zafirlukast, 20 mg twice daily) to inhaled corticosteroid therapy in patients with this genotype. SUBJECTS AND METHODS: We enrolled 24 patients with mild to moderate asthma who were being treated with inhaled corticosteroids. Patients were randomly assigned to receive one of three treatments (placebo, zafirlukast, or formoterol in addition to inhaled corticosteroids) for 1 week each in a crossover fashion, separated by a 1-week placebo run-in and washout period. Measurements of bronchoprotection (measured as the provocative dose of methacholine that produced a 20% decline in forced expiratory volume in 1 second [FEV1]), exhaled nitric oxide (a surrogate marker of airway inflammation), and symptoms were made before each treatment and 12 hours after the last dose of each treatment. RESULTS: Both formoterol and zafirlukast were equally effective in maintaining asthma control compared with placebo: the geometric mean-fold difference in the methacholine provocative dose was 1.5-fold (95% confidence interval [CI]: 1.1- to 2.2-fold) for zafirlukast and 1.9-fold (95% CI: 1.2- to 2.9-fold) for formoterol. As compared with placebo, zafirlukast caused a significant suppression in exhaled nitric oxide (1.7-fold difference in geometric mean values, 95% CT: 1.1- to 2.6-fold) but formoterol did not (1.2-fold difference, 95% Cl: 0.8- to 1.9-fold). Diary cards showed significant (P < 0.05) improvements in the peak flow with formoterol (morning and evening) and zafirlukast (evening) as compared with placebo. CONCLUSIONS: Formoterol and zafirlukast maintained asthma control in pa

关键词：投药吸入肾上腺素能β激动剂/投药和剂量肾上腺素能β激动剂/治疗应用抗哮喘药/投药和剂量抗哮喘药/治疗应用哮喘/药物疗法哮喘/遗传学倍氯米松/投药和剂量倍氯米松/治疗应用支气管高反应性/药物疗法支气管扩张药/投药和剂量支气管扩张药/治疗应用置信区间交叉研究乙醇胺类/投药和剂量乙醇胺类/治疗应用用力呼气量/药物作用基因型糖皮质激素类/投药和剂量糖皮质激素类/治疗应用甘氨酸/遗传学纯合子白三烯拮抗剂/投药和剂量白三烯拮抗剂/治疗应用一氧化氮/代谢安慰剂多态现象遗传/遗传学受体肾上腺素能β2/遗传学甲苯磺酰化合物/投药和剂量甲苯磺酰化合物/治疗应用成年人老年人女(雌)性人类男(雄)性中年人

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Altered immune function in human newborns after prenatal administration of betamethasone: Enhanced natural killer cell activity and decreased T cell proliferation in cord blood

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PEDIATRIC RESEARCH 1999年第3期45卷 306-312页

作者： Kavelaars, A van der Pompe, G Bakker, JM van Hasselt, PM Cats, B Visser, GHA Heijnen, CJ Univ Utrecht Het Wilhelmina Kinderziekenhuis Dept Immunol NL-3508 AB Utrecht Netherlands Univ Utrecht Het Wilhelmina Kinderziekenhuis Dept Neonatol NL-3508 AB Utrecht Netherlands Univ Utrecht Het Wilhelmina Kinderziekenhuis Dept Obstet & Gynecol NL-3508 AB Utrecht Netherlands

During the course of human pregnancy, glucocorticoid (GC) treatment is given when preterm delivery is expected. This treatment is successful in stimulating the development of the fetal lung. However, in animal studies, a number of side effects of perinatal GC treatment have been described. The aim of the present study was to evaluate in humans the effects of antenatal GC treatment on development of the immune system. In addition, we examined the development of immune reactivity in infants born preterm and at term who did not receive GC treatment antenatally. We tested mitogen-induced T cell proliferation, natural killer cell activity, and lipopolysaccharide-induced IL-6 production in cord blood samples. We found that there is a significant effect of gestational age on the capacity of T cells to proliferate and of natural killer cells to kill K562 tumor cells. The capacity to produce IL-6 does not change between gestational age 26 and 41 wk. Moreover, our results show that antenatal treatment with GC does have immunomodulatory effects: T cell proliferation is decreased in infants born very preterm (gestational age 26-31 wk) as well as in infants born between 32 and 36 wk of gestation. In contrast, the activity of natural killer cells is only increased in CC-treated infants born between 26 and 31 wk. We did not observe a significant effect of antenatal GC treatment on the capacity to produce IL-6.

关键词：倍他米松/投药和剂量细胞分裂胚胎和胎儿发育/药物作用胚胎和胎儿发育/免疫学胎血/免疫学糖皮质激素类/投药和剂量免疫系统/药物作用免疫系统/胚胎学注射肌肉内杀伤细胞天然/免疫学淋巴细胞活化/药物作用产前暴露迟发效应 T淋巴细胞/免疫学女(雌)性人类婴儿新生妊娠

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The effectiveness of inhaled corticosteroids in the emergency department treatment of acute asthma: A meta-analysis

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ANNALS OF EMERGENCY MEDICINE 2002年第2期40卷 145-154页

作者： Edmonds, ML Camargo, CA Pollack, CV Rowe, BH Penn Hosp Dept Emergency Med Philadelphia PA 19107 USA Massachusetts Gen Hosp Dept Emergency Med Boston MA 02114 USA Capital Hlth Author Edmonton AB Canada Univ Alberta Fac Med & Dent Div Emergency Med Walter Mackenzie Ctr 1G163 Edmonton AB T6G 2B7 Canada

Study objective: Inhaled corticosteroids (ICSs) are of proven benefit in the treatment of chronic asthma;however, their role in the management of acute asthma is unclear. Methods: We performed a systematic review of randomized controlled trials involving children or adults treated in the emergency department for acute asthma with or without the addition of ICSs. Outcome measures included hospital admission, pulmonary function tests, and side effects. Results: Seven trials were selected for inclusion in the primary analyses. ICSs versus placebo were compared;data were not available on 1 of these trials. In the remaining 6 trials, a total of 352 patients were studied (179 ICS-treated and 173 non-ICS-treated patients). Two trials compared ICSs plus systemic corticosteroids versus placebo plus systemic corticosteroids;4 trials compared ICSs versus placebo. Patients treated with ICSs were less likely to be admitted to the hospital (odds ratio 0.30;95% confidence interval [CI] 0.16 to 0.57) and showed small improvements in peak expiratory flows (weighted mean difference 8%;95% CI 3% to 13%) Overall, the treatment was well tolerated, with few reports of adverse side effects. A secondary analysis compared ICSs alone versus systemic corticosteroids alone;in the 4 included trials, significant heterogeneity between the study results for admission rates precluded meaningful pooling of admission data. Conclusion: There is evidence of decreased admission rates for patients with acute asthma treated with ICSs. However, there is insufficient evidence that ICS therapy results in clinically important changes in pulmonary function when used in acute asthma, and there is insufficient evidence that ICSs alone are as effective as systemic corticosteroids.

关键词：急性病投药吸入肾上腺皮质激素类/投药和剂量肾上腺皮质激素类/治疗应用抗哮喘药/投药和剂量抗哮喘药/治疗应用消炎药/投药和剂量消炎药/治疗应用哮喘/药物疗法急诊室医院糖皮质激素类/投药和剂量随机对照试验(主题) 甾类成年人儿童人类

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Multifocal eosinophilic granuloma of the jaw: Long-term follow-up of a novel intraosseous corticoid treatment for recalcitrant lesions

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ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY ORAL RADIOLOGY AND ENDODONTICS 2000年第3期90卷 317-322页

作者： Watzke, IM Millesi, W Kermer, C Gisslinger, H Univ Vienna Dept Oral & Maxillofacial Surg Vienna Austria Univ Vienna Dept Hematol & Hemostaseol Vienna Austria

Eosinophilic granuloma of the jaws is a rather benign and localized form of Langerhans' cell histiocytosis. Treatment is usually required in larger lesions that cause local pain and swelling and pose the risk of spontaneous fractures. There are several accepted forms of treatment, which include surgery, radiation therapy, systemic and local therapy with corticoids, and systemic chemotherapy. No studies exist that compare the effectiveness of these treatment modalities. We report a novel therapeutic regimen that uses repeated intraosseous injections of triamcinolone-1 16 alpha 21-diacetat, a synthetic corticoid, which led to a rapid, complete, and durable treatment. The patient had a multilocal eosinophilic granuloma of the mandible in which radiation therapy, systemic corticoid therapy, and systemic chemotherapy had failed.

关键词：酶抑制剂/投药和剂量嗜酸细胞肉芽肿/药物疗法嗜酸细胞肉芽肿/放射摄影术糖皮质激素类/投药和剂量注射下颌骨下颌疾病/药物疗法下颌疾病/放射摄影术治疗结果曲安西龙/投药和剂量曲安西龙/类似物和衍生物成年人人类男(雄)性

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Inhaled corticosteroids: 1. Local toxicity

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HOSPITAL PRACTICE 2000年第4期35卷 37-+页

作者： Kuritzky, L Univ Florida Coll Med Dept Community Hlth & Family Practice Gainesville FL 32611 USA

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关键词：投药吸入念珠菌病口腔/化学诱导念珠菌病口腔/诊断念珠菌病口腔/药物疗法咳嗽/化学诱导糖皮质激素类/投药和剂量免疫抑制法机会致病菌感染/化学诱导机会致病菌感染/诊断机会致病菌感染/药物疗法咽疾病/化学诱导咽疾病/诊断咽疾病/预防和控制味觉障碍/化学诱导语音障碍/化学诱导人类

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Low-dose oral pulse methotrexate as monotherapy in elderly patients with bullous pemphigoid

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JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY 1999年第5期40卷 741-749页

作者： Heilborn, JD Ståhle-Bäckdahl, M Albertioni, F Vassilaki, I Peterson, C Stephansson, E Karolinska Hosp Dept Dermatol & Venereol S-17176 Stockholm Sweden Karolinska Hosp Dept Clin Pharmacol S-17176 Stockholm Sweden

Background: Prednisone alone or in combination with an immunosuppressive drug is usually effective in controlling bullous pemphigoid. However, corticosteroids often cause potentially hazardous side effects, especially in elderly patients. Objective: Our purpose was to evaluate low-dose treatment with methotrexate in elderly patients with generalized bullous pemphigoid. Methods: Oral methotrexate, at an initial dosage of 5 mg/wk, was given to 11 consecutive patients older than 70 years of age who were not responding to potent topical steroids. If the response was insufficient, the methotrexate dose was increased by 2.5 mg/wk to a maximum of 12.5 mg/wk. Results: All patients responded with a marked and rapid decrease in disease activity. The disease was controlled in the majority of patients (8 of 11) with 5 to 7.5 mg of methotrexate per week. Three patients required a weekly dose of 10 to 12.5 mg. At 24 months of follow-up 7 patients were in complete remission and did not require methotrexate. Conclusion: Our study suggests that low-dose oral pulse methotrexate constitutes an effective therapeutic alternative in elderly patients with generalized bullous pemphigoid.

关键词：投药口服贫血/化学诱导皮肤科用药/投药和剂量皮肤科用药/副作用皮肤科用药/分析皮肤科用药/血液皮肤科用药/治疗应用渗出液和滤出液/化学随访研究糖皮质激素类/投药和剂量糖皮质激素类/治疗应用免疫抑制剂/投药和剂量免疫抑制剂/副作用免疫抑制剂/分析免疫抑制剂/血液免疫抑制剂/治疗应用甲氨蝶呤/投药和剂量甲氨蝶呤/副作用甲氨蝶呤/分析甲氨蝶呤/血液甲氨蝶呤/治疗应用类天疱疮大疱性/药物疗法类天疱疮大疱性/病理学泼尼松/投药和剂量泼尼松/治疗应用缓解诱导安全老年人老年人 80以上女(雌)性人类男(雄)性

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High concentration of dexamethasone in aqueous and vitreous after subconjunctival injection

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AMERICAN JOURNAL OF OPHTHALMOLOGY 1999年第2期128卷 192-197页

作者： Weijtens, O Feron, EJ Schoemaker, RC Cohen, AF Lentjes, EGWM Romijn, FPHTM van Meurs, JC Rotterdam Eye Hosp NL-3011 BH Rotterdam Netherlands Ctr Human Drug Res Leiden Netherlands Leiden Univ Med Ctr Clin Chem Lab Leiden Netherlands

PURPOSE: To determine the dexamethasone concentration in aqueous, vitreous, and serum of patients after a subconjunctival injection with dexamethasone disodium phosphate and to compare the effectiveness of a subconjunctival injection as a method of delivering dexamethasone into the vitreous with that of two previously tested routes: peribulbar injection and oral administration. METHODS: In a prospective study, 50 phakic patients who underwent a pars plana vitrectomy received a single subconjunctival injection with 2.5 mg of dexamethasone disodium phosphate, aqueous solution (after topical anesthesia and a subconjunctival injection with lidocaine) at varied intervals before surgery. An aqueous and a vitreous sample were taken from each patient, and serum samples were collected at multiple time points from nine of 50 patients Dexamethasone concentrations were measured by radioimmunoassay. RESULTS: The estimated maximum dexamethasone concentration in the aqueous was 858 ng per mi at 2.5 hours after injection, and in the vitreous, 72.5 ng per ml at 3 hours. In serum, a mean maximum concentration of 32.4 ng per mi was measured at approximately 30 minutes after injection. CONCLUSIONS: Subconjunctival injection of 2.5 mg of dexamethasone disodium phosphate resulted in an estimated vitreous dexamethasone peak concentration three and 12 rimes higher, respectively, than after a peribulbar injection of 5 mg of dexamethasone disodium phosphate and an oral dose of 7.5 mg of dexamethasone, Thus, a subconjunctival injection is the most effective method of delivering dexamethasone into both the anterior and posterior segments of the eye. Systemic drug absorption is considerable and is of the same order of magnitude as after peribulbar injection, (C) 1999 by Elsevier Science Inc. All rights reserved.

关键词：眼房水/代谢结膜地塞米松/投药和剂量地塞米松/药代动力学眼疾病/血液眼疾病/代谢眼疾病/外科学糖皮质激素类/投药和剂量糖皮质激素类/药代动力学注射手术后并发症/预防和控制前瞻性研究放射免疫测定玻璃体切除术玻璃体/代谢玻璃体/外科学成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Antenatal glucocorticoids alter postnatal preterm lamb renal and cardiovascular responses to intravascular volume expansion

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PEDIATRIC RESEARCH 2000年第5期47卷 622-627页

作者： Smith, LM Ervin, MG Wada, N Ikegami, M Polk, DH Jobe, AH Univ Calif Los Angeles Harbor UCLA Med Ctr Sch Med Martin Res CtrDept PediatPerinatal Res Labs Torrance CA 90502 USA Univ Calif Los Angeles Harbor UCLA Med Ctr Sch Med Dept Obstet & Gynecol Torrance CA 90502 USA

We assessed renal and cardiovascular function in preterm newborn lambs after antenatal glucocorticoid exposure. Pregnant ewes were randomly assigned to receive betamethasone or saline via either direct fetal or maternal injection at 122 d gestation. Lambs were delivered 15 h later, and cardiovascular and renal function was assessed. Two hours after delivery, baseline urine flow, urinary sodium excretion, and urinary osmolar clearance were similar in all groups. Volume expansion (saline, 2.58 of body weight, for 10 min) increased values for urine flow (0.23 +/- 0.04 to 0.58 +/- 0.09 ***(-1).kg(-1)), urinary sodium excretion (29.7 +/- 5.8 to 76.2 +/- 12.3 mu ***(-1).kg(-1)), and osmolar clearance (12.2. +/- 1.2 to 24.3 +/- 1.6 mL/100 mL GFR) in the fetal group. Increases in urine values were also observed in the maternal group, but control values did not change significantly. Mean arterial pressure was increased in both betamethasone-treated groups relative to controls. Short-term antenatal betamethasone exposure I) augments preterm newborn kidney adaptive responses to acute volume expansion, and 2) increases postnatal blood pressure in preterm newborn lambs.

关键词：醛固酮/血液血管紧张素Ⅱ/血液倍他米松/投药和剂量血量/生理学心血管系统/胚胎学乙醇胺类/血液胎血/化学肾小球滤过率/药物作用糖皮质激素类/投药和剂量血流动力学/药物作用输注静脉内注射肌肉内肾/药物作用肾/胚胎学肾/生理学分娩过早/药物疗法产前暴露迟发效应肾循环/药物作用肾素/血液绵羊氯化钠/投药和剂量尿动力学/药物作用水电解质平衡/药物作用动物女(雌)性妊娠

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