Efficacy of prednisone combined with mycophenolate mofetil for immunoglobulin A nephropathy with moderate-to-severe renal dysfunction

BACKGROUND Immunoglobulin A nephropathy(IgAN)is a common form of chronic glomer-ulonephritis.Currently,IgAN is one of the main causes of chronic renal failure in China;its prognosis varies greatly between patients,with renal function at the time of diagnosis and prognosis being strongly correlated.Mycophenolate mofetil(MMF)is a drug with a good immunomodulatory effect and is commonly used clinically.However,its effects in IgAN have not yet been clearly demonstrated.Therefore,herein,we retrospectively compared the effectiveness and safety of prednisone alone or combined with MMF for the treatment of primary IgAN with moderate-to-severe renal impairment.METHODS Between January 2011 and December 2020,200 patients with moderate-to-severe IgAN were included in this study,all of whom were admitted to Wuxi People's Hospital affiliated with Nanjing Medical University.All patients underwent a renal puncture biopsy,which revealed primary IgAN with a glomerular filtration rate(GFR)of 30–60 mL/min.The patients were divided into a glucocorticoid therapy group(GTG)and an immunosuppressive therapy group(ITG)according to the different treatment regimens,with 100 patients in each group.Based on general treatments,such as angiotensin-converting enzyme inhibitors/angiotensin receptor blockers,patients in the GTG were administered prednisone 0.5–0.8 mg/(kg·d^(-1))for 4–8 wk,which was reduced by 5 mg every two weeks until the maintenance(30 mg/d)dose was reached and maintained for 12 mo.In the ITG,MMF was administered at 1.0 g/d for 6–12 mo,followed by a maintenance dosage of 0.5 g/d for 12 mo.Age,sex,blood pressure,24-h urinary egg white measurement,serum creatinine(Scr),blood uric acid,blood albumin,blood potassium(K),hemoglobin,GFR,alanine aminotransferase,total cholesterol(T-CHO),fasting blood glucose,and body mass index were recorded.The 24-h urinary protein,Scr,and GFR levels were recorded 3,6,9,and 12 mo after treatment.Follow-up data were also collected.RESULTS No discernible differences existed between the two groups in terms of age,sex,blood pressure,creatinine,24-h urinary protein level,GFR,or other biochemical indicators at the time of enrollment.Both regimens significantly reduced the 24-h urinary protein quantitation and stabilized renal function.Nine months after treatment,the 24-h urinary protein and Scr of the ITG decreased more significantly than those of the GTG.By the 12th month of treatment,the 24-h urinary protein and Scr in both groups continued to decrease compared to those by the 9th month.In addition,the overall response rate in the ITG was significantly higher than that in the GTG.The occurrence of side effects did not vary significantly between the two regimens;however,endpoint events were significantly more common in the GTG than in the ITG.The follow-up time for the GTG was noticeably lower than that for the ITG.CONCLUSION Prednisone combined with MMF was effective for the treatment of IgAN with moderate-to-severe renal dysfunction.

Electrochemiluminescence immunoassay method underestimates cortisol suppression in ulcerative colitis patients treated with oral prednisone

AIM: To evaluate cortisolemia by using conventional electrochemiluminescence immunoassay (ECLIA) method compared to liquid chromatography-tandem mass spectrometry (LC-MS/MS) method in active ulcerative colitis (UC) patients treated with oral prednisone (PD).

Hypoglycemia Controlled by Prednisone in an Occult Insulinoma or a Nesidioblastosis

Insulinoma is a pancreatic endocrine tumor lower in size than 20 mm in 80% of the cases and his treatment is chirurgical. However, in certain circumstances such as an occult location or circumstances of metastases, medical treatment is called for. Observation: A 29 years old patient with no specific pathological antecedents has presented severe hypoglycemia mainly in the morning. A patient was in a generally good condition. The fasting test revealed an inappropriate secretion of insulin at a venous glycemia of 0.35 g/l;which was corroborated by Turner index and altered glucose insulin index that we calculated. Moreover, the 8 h cortisolemia was normal at 90.13 ng/l, the TSH was normal at 1.44 μui/l, anti-insulin antibodies were negative at 6.7 U/l;the search of hypoglycemic sulfonamides was negative. Morphologically, she had three pancreatic tomodensitometry these were normal. She also had echo-endoscopy which showed a normal pancreas. The surgical exploration with preoperative echo is advised only after surgeon’s assessment when the technical conditions are not put together. The diagnosis of the occult insulinoma or of nesidioblastosis was retained. The medical treatment was retained. Due to the unavailability of diazoxide in our pharmacies and the high cost of analogs of somatostatine, she was provided with prednisone 0.5 mg/kg/24h which was 40 mg/day after common agreement. The evolution was favorable. Conclusion: It should be noticed that medical treatment can be suggested if insulinoma is not localized. This observation proves that the localization of the insulinoma can be unsuccessful. It should also be noticed that our experience is the fourth described in literature, where hypoglycemia in insulinomas is controlled by prednisone.

Comparison of High-Dose Dexamethasone and Prednisone for Initial Treatment of Adult Primary Immune Thrombocytopenia

Prednisone is the most common first-line treatment for adult primary immune thrombocytopenia (ITP). However, the best initial therapeutic approach is still a matter of debate. Prior studies have shown that high-dose dexamethasone (HD-DXM) produces a high sustained efficacy not achieved by conventional prednisone therapy. However, the definition of response widely differs between individual reports, and this heterogeneity makes comparison of the efficacy difficult. The aim of our study was to compare the therapeutic outcomes of a conventional dose of prednisone with HD-DXM for adult ITP patients as initial therapy. Thirty patients treated with prednisone and 22 patients treated HD-DXM were retrospectively analyzed. No significant differences between the HD-DXM and prednisone groups were observed for the rates of complete response (68% vs. 70%) and response (18% vs. 17%). However, 1 year probability of sustained response was significantly greater in the HD-DXM group than in the prednisone group (78% vs. 38%;P = 0.008). No adverse events necessitating discontinuation of treatment were observed in either group. Our retrospective analysis showed that initial treatment with HD-DXM produced longer response duration compared to a conventional dose of prednisone. Randomized clinical trials are warranted to establish the optimal initial steroid therapy for adult ITP.

Glucose metabolism profile recorded by flash glucose monitoring system in patients with hypopituitarism during prednisone replacement

BACKGROUND Commonly used glucocorticoids replacement regimens in patients with hypopituitarism have difficulty mimicking physiological cortisol rhythms and are usually accompanied by risks of over-treatment,with adverse effects on glucose metabolism.Disorders associated with glucose metabolism are established risk factors of cardiovascular events,one of the life-threatening ramifications.AIM To investigate the glycometabolism profile in patients with hypopituitarism receiving prednisone(Pred)replacement,and to clarify the impacts of different Pred doses on glycometabolism and consequent adverse cardiovascular outcomes.METHODS Twenty patients with hypopituitarism receiving Pred replacement[patient group(PG)]and 20 normal controls(NCs)were recruited.A flash glucose monitoring system was used to record continuous glucose levels during the day,which provided information on glucose-target-rate,glucose variability(GV),period glucose level,and hypoglycemia occurrence at certain periods.Islet β-cell function was also assessed.Based on the administered Pred dose per day,the PG was then regrouped into Pred>5 mg/d and Pred≤5 mg/d subgroups.Comparative analysis was carried out between the PG and NCs.RESULTS Significantly altered glucose metabolism profiles were identified in the PG.This includes significant reductions in glucose-target-rate and nocturnal glucose level,along with elevations in GV,hypoglycemia occurrence and postprandial glucose level,when compared with those in NCs.Subgroup analysis indicated more significant glucose metabolism impairment in the Pred>5 mg/d group,including significantly decreased glucose-target-rate and nocturnal glucose level,along with increased GV,hypoglycemia occurrence,and postprandial glucose level.With regard to islet β-cell function,PG showed significant difference in homeostasis model assessment(HOMA)-β compared with that of NCs;a notable difference in HOMA-βwas identified in Pred>5 mg/d group when compared with those of NCs;as for Pred≤5 mg/d group,significant differences were found in HOMA-β,and fasting glucose/insulin ratio when compared with NCs.CONCLUSION Our results demonstrated that Pred replacement disrupted glycometabolic homeostasis in patients with hypopituitarism.A Pred dose of>5 mg/d seemed to cause more adverse effects on glycometabolism than a dose of≤5 mg/d.Comprehensive and accurate evaluation is necessary to consider a suitable Pred replacement regimen,wherein,flash glucose monitoring system is a kind of promising and reliable assessment device.The present data allows us to thoroughly examine our modern treatment standards,especially in difficult cases such as hormonal replacement mimicking delicate natural cycles,in conditions such as diabetes mellitus that are rapidly growing in worldwide prevalence.

Effect of Bufei Huaxian Decoction combined with prednisone on idiopathic pulmonary fibrosis

Objective:To explore the therapeutic effect of Bufei Huaxian Decoction plus prednisone on patients with idiopathic pulmonary fibrosis. Methods:80 patients with idiopathic pulmonary fibrosis treated in our hospital from January 2018 to January 2019 were randomly divided into prednisone group and combination group, 40 cases in each group. Prenisone group was treated with prednisone, while Bufei Huaxian Decoction plus prednisone was used in combination group. Maximum expiratory flow (PEF), forced expiratory volume (FEV1) and forced vital capacity (FVC) were measured. Hyaluronidase (HA), laminin (LN), procollagen type Ⅲ (PCIII), transforming growth factor-β1 (TGF-β1) and hypersensitive C-reactive eggs were detected by enzyme-linked immunosorbent assay (ELISA). The levels of hs-CRP, TNF-α and glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), malondialdehyde (MDA) were measured by immunoturbidimetry. The levels of T lymphocyte subsets and therapeutic effects were compared between the two groups. Results:After treatment, the levels of PEF, FEV1 and FVC in the combined group were higher than those in the prednisone group (P<0.05). After treatment, the levels of HA, LN and PC-Ⅲ in the combined group were lower than those in the prednisone group (P<0.05). After treatment, the serum levels of TGF-β1, hs-CRP and TNF-α in the combined group were lower than those in the prednisone group (P<0.05). After treatment, the serum GSH-Px and SOD levels in the combined group were higher than those in the prednisone group, and MDA levels were lower than those in the prednisone group (P<0.05). After treatment, the levels of CD8 + in the combined group were lower than those in the prednisone group, and the levels of CD4 + and CD3 + were higher than those in the prednisone group (P<0.05). The total effective rate of combined group 95.00% was higher than that of prednisone group 80.00% (P<0.05). Conclusions:Bufei Huaxian Decoction plus prednisone can improve the pulmonary function of patients with idiopathic pulmonary fibrosis, reduce the severity of pulmonary fibrosis, and enhance the antioxidant capacity and immune function of patients. The therapeutic effect is remarkable.

Effect of Prednisone and Cyclophosphamide combine with ligustrazine injection on immunologic function and other related factors in patients with systemic lupus erythematosus

Objective:To investigate the effect of prednisone and cyclophosphamide combine with ligustrazine injection on immunologic function and other related factors in patients with systemic lupus erythematosus (SLE).Methods: The subjects selected 70 patients with SLE who diagnosed and treated in our hospital from March 2014 to May 2018, divided into control group and observation group randomly, 35 cases in each group. The patients in the control group were treated with prednisone combined with cyclophosphamide, and the patients in the observation group was given intravenous drip of ligustrazine injection on the basis of the control group. Before and after treatment, detected and compared the immunologic indexes (IgG, C3, ANA), matrix metalloproteinases (MMP-3, MMP-9, TIMP1), chemotactic factor (CXCL9, CXCL10, CXCL11) and serum levels of IL-10, PRL, S100 protein and EET between the two groups.Results: Before treatments, the immunologic indexes(IgG, C3, ANA), matrix metalloproteinases(MMP-3, MMP-9, TIMP1),chemotactic factor(CXCL9, CXCL10, CXCL11) and serum levels of IL-10, PRL, S100 protein and EET between the two groups had no statistical significance(P>0.05);After treatments, the immunologic indexes (IgG, C3, ANA), matrix metalloproteinases(MMP-3, MMP-9), chemotactic factor (CXCL9, CXCL10, CXCL11) and serum levels of IL-10, PRL, S100 protein and EET between the two groups had statistical significances (P<0.05).Conclusion: Ligustrazine injection was added to SLE patients on the basis of prednisone combined with cyclophosphamide therapy, it not only could significantly improve the immunologic function of patients, but also improve the levels of matrix metalloproteinases, chemokines and related serum factors, it's worthy of clinical research and application.

Clinical Observation of Chuanbai Antipruritic Lotion"Water Film"Wet Compress Combined with Chloramphenicol Prednisone Liniment in the Treatment of Acute Eczema

[Objectives]To observe and analyze the clinical efficacy and possible mechanism of Chuanbai antipruritic lotion"water film"wet compress combined with chloramphenicol prednisone liniment in the treatment of acute eczema.[Methods]A total of 76 acute eczema cases admitted to Shiyan Taihe Hospital from January 2022 to March 2023 were divided into Western medicine treatment group and integrated traditional Chinese and Western medicine group.In the Western medicine treatment group,chloramphenicol and prednisone liniment was applied to the skin lesions and oral administration of cetirizine hydrochloride.The course of treatment in both groups was 2 weeks(w).The levels of interferon-γ(IFN-γ),interleukin-4(IL-4)and the ratio of IFN-γ/IL-4 in the peripheral blood of patients before and 2 weeks after treatment,as well as serum immunoglobulin E(IgE),anti-IgE antibody and histamine(HA)level,and with skin lesions disappearing time,skin oil,transepidermal water loss(TEWL),eczema area and severity index(EASI)score,total effective rate,degree of pruritus and traditional Chinese medicine quality of life scale(EPQOLS)score to evaluate the efficacy.[Results]Compared with the Western medicine treatment group at 2 w,the disappearance time of skin lesions in the integrated traditional Chinese and Western medicine group was shortened,TEWL,itching degree and EASI score,serum IgE and HA,and peripheral blood IL-4 levels were all decreased(P<0.05).IFN-γand IFN-γ/IL-4 ratio,anti-IgE antibody,EPQOLS score and total effective rate were all increased(P<0.05),and the difference was statistically significant.[Conclusions]Chuanbai antipruritic lotion"water film"wet compress combined with chloramphenicol prednisone liniment is an optimized and safe and efficient method for the treatment of acute eczema,which can quickly relieve the symptoms of inflammatory damage of eczema and restore the skin barrier function,dry dampness and relieve itch.Inhibition of the release of histamine active substances and regulation of immunity may be the main mechanisms.

Effects of methotrexate combined with hydroxychloroquine sulfate and prednisone acetate on inflammatory response, immune function and liver and renal function in patients with systemic lupus erythematosus

Objective: To investigate the effects of methotrexate and hydroxychloroquine sulfate and prednisone on inflammatory response, immune function, liver and renal function in patients with systemic lupus erythematosus (SLE). Methods: A total of 80 cases of SLE patients according to the random data table were divided into the control group (n=40) and observation group (n=40), the control group were treated with hydroxychloroquine sulfate and prednisone treatment, on the basis of treatment of the control group, patients in the observation group in the control group were treated with methotrexate, the levels of inflammatory factors, immune function, liver and kidney function indexes in the two groups between the before treatment and after treatment were compared. Results: Comparison of the levels before treatment, the difference of the CRP, WBC, ESR, IgA, IgG, complement C3, complement C4, ALT, AST, SCr and BUN levels were not statistically significant. After treatment, the levels of CRP, ESR, IgA, IgG, ALT, AST, SCr and BUN in the observation group were significantly lower than those in the control group, and the difference was statistically significant. The levels of WBC and complement C4 in the observation group [(5.18±1.08)×109 /L, (0.22±0.05) g/L] were significantly higher than those in the control group [(4.51±0.52)×109 /L, (0.18±0.03) g/L], and there was no significant difference in the level of complement C3 between the two groups after treatment. Conclusion: Methotrexate combined with hydroxychloroquine sulfate and prednisone for the treatment of SLE can effectively reduce inflammation, improve immune function, has little effect on kidney function, high safety, which has an important clinical value.

肾脏受累的Cockayne综合征临床特点、治疗及随访观察

目的探讨Cockayne综合征肾脏受累的临床特征及其治疗和随访。方法回顾分析1例经基因检测确诊的Cockayne综合征伴肾脏损伤患儿的临床资料,并复习文献,总结Cockayne综合征肾脏受累的临床特征。结果患儿男性,3岁8个月,主要临床表现为精神运动发育迟滞、生长发育障碍、特殊面容、光敏性皮炎,肾脏受累表现为肾病综合征;头颅CT显示双侧基底节对称性钙化。靶向二代测序结果显示,患儿ERCC8基因(NM_000082)c.394_398 del,p.Leu 132 Asnfs Ter 6,纯合突变,患儿父母均检测到相同杂合突变(父母非近亲婚配)。诊断肾病综合征后,给予足量泼尼松试验性治疗,患儿尿蛋白减少但未转阴,符合激素耐药,联合环孢素治疗4个月后尿蛋白转阴,随访20个月,尿蛋白持续阴性,肾功能维持稳定。Cockayne综合征肾病受累的文献报道少,临床表现异质性大。结论需注意Cockayne综合征患儿表现为肾病综合征等的肾脏受累。

沙美特罗氟替卡松联合噻托溴铵与低剂量强的松联合氨茶碱对COPD肺心病患者心功能的影响

目的 :比较吸入沙美特罗氟替卡松联合噻托溴铵与口服低剂量强的松联合氨茶碱对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肺心病患者心功能的影响。方法:选取稳定期COPD合并肺心病患者111例随机分为3组,每组37例,常规治疗(利尿剂、血管扩张剂、强心剂)相同。对照组:未使用任何支气管扩张剂及激素类药物;吸入剂组:沙美特罗氟替卡松粉雾剂(50/500μg)1吸,2次/d、噻托溴铵1吸,1次/d,吸入;口服药组:强的松5 mg,1次/d,缓释型氨茶碱100 mg,2次/d,口服。分别于治疗前、治疗48周后测定患者的右心室流出道内径、右心室内径、右肺动脉干内径、平均肺动脉压、射血分数(LVEF)、钠尿肽(BNP)并比较分析,同时分析患者的空腹血糖、血浆皮质醇、骨密度。结果:与治疗前相比,治疗后吸入剂组、口服药组患者的心功能指标均有改善(P<0.05),且较对照组均有改善(P<0.05);吸入剂组在改善患者的右心室流出道内径、右心室内径、右肺动脉干内径、射血分数、钠尿肽方面稍优于口服药组(P<0.05),在改善平均肺动脉压方面差异无统计学意义(P>0.05)。治疗前后,3组患者空腹血糖、血浆皮质醇及骨密度对比均无显著性差异(P>0.05),且3组患者治疗前后血浆皮质醇水平均在正常值范围内。结论:在稳定期COPD合并肺心病的治疗中,吸入沙美特罗氟替卡松联合噻托溴铵与口服低剂量强的松联合氨茶碱均可改善患者心功能,其中吸入剂效果更佳。

R±BEACOP方案对预后不良淋巴瘤的疗效研究

目的:研究环磷酰胺、表阿霉素、长春新碱、强的松联合依托泊苷/替尼泊苷和/或博来霉素,有或无美罗华(cyclophosphamideplus,epirubicin,vincristine,prednisone plus etoposide and/or bleomycin,with or without rituximab,R±BE ACOP)方案对预后不良淋巴瘤的有效性。方法:收集北京大学第三医院2002年至2012年间接受1次以上R±BEACOP方案治疗的89例预后不良淋巴瘤患者,采用回顾性分析的方法对其疗效进行分析。结果:治疗总反应率为62.9%(56例),对于霍奇金淋巴瘤及T/NK细胞非霍奇金淋巴瘤的疗效较好。有效率在不同年龄、分期、国际预后指数的患者中差异均无统计学意义(均P>0.05)。结论:R±BEACOP方案对部分预后不良患者依然有效,尤以霍奇金淋巴瘤患者为著,可开展前瞻性大样本临床试验进一步评价其疗效。

雾化吸入布地奈德混悬液治疗COPD急性加重期的临床观察

目的:探讨雾化吸入布地奈德(普米克令舒)治疗慢性阻塞性肺疾病急性加重期(AECOPD)的疗效,并与使用口服糖皮质激素(强的松)的疗效和安全性比较.方法:通过随机分组,92例患者分为A、B、C 3组.3组均采用抗感染、茶碱平喘、吸氧、吸痰等常规治疗,A组为布地奈德混悬液(普米克令舒)雾化吸入组(n=31);B组口服强的松组(n=31);C组对照组(n=30)仅以常规治疗为主.对治疗前(H0)、治疗开始后24 h(H24)、7 d(D7)临床症状评分、St George's呼吸问卷(SGRQ)生命质量评分、最大峰值流速(PEF)占预计值百分比、FEV1/用力肺活量(FVC)、血气分析进行对比,同时观察激素相关不良反应.结果:3组病例在治疗前(H0)差异无统计学意义(P>0.05);在治疗开始后24h(H24)、7 d(D7)A组和B组均有明显改善,但两组之间差异无统计学意义(P>0.05).A组副作用明显少于B组.相对前两组而言,C组对照组上述观察指标治疗后较治疗前有所改善,但与A组或B组比较差异有统计学意义(P<0.05).结论:布地奈德混悬液雾化吸入治疗慢性阻塞性肺疾病,可缩短病程,疗效确切,且方便、安全,可作为治疗慢性阻塞性肺疾病的主要药物.布地奈德混悬液雾化吸入和口服强的松均能改善AECOPD的肺功能,布地奈德混悬液雾化吸入治疗AECOPD的安全性较口服强的松好.

COTPE方案联合沙利度胺治疗双打击淋巴瘤疗效观察

目的探讨COTPE方案联合沙利度胺治疗双打击淋巴瘤疗效及不良反应。方法 23例经病理和FISH诊断为双打击淋巴瘤的患者使用COTPE方案(环磷酰胺750 mg/m2,d1;长春新碱1.4 mg/m2,d1;吡柔比星50mg/m2,d1;泼尼松100 mg,d1~5;依托泊苷50 mg/m2,d1~5)联合沙利度胺(100 mg/d)治疗,治疗6个周期。结果23例中获CR 11例(47.8%),PR 6例(26.1%),SD 5例(21.7%),PD 1例(4.3%),总有效率(CR+PR)为73.9%,2年生存率为91.3%,3年生存率为65.2%。Ⅰ~Ⅱ度骨髓抑制5例(21.7%),转氨酶升高2例(8.7%),脱发19例(82.6%),消化道反应14例(60.9%),Ⅲ~Ⅳ度不良反应少。结论 COTPE方案联合沙利度胺治疗"双打击"B细胞淋巴瘤取得较好的疗效,不良反应少,患者可耐受。

机械通气的AECOPD患者合理使用糖皮质激素方法的研究

目的研究机械通气的急性加重慢性阻塞性肺疾病（AECOPD）患者糖皮质激素合理使用方法。方法选择2013年7月~2015年4月我院ICU收治机械通气的AECOPD患者81例,分为甲泼尼松龙（ME）组42例和泼尼松（PR）组39例。分别静脉给予甲泼尼龙琥珀酸钠和口服醋酸泼尼松,评价各组疗效和治疗期间的副反应。结果两组患者在机械通气时间、无创机械通气失败率、入住ICU时间、ICU死亡率比较差异无统计学意义（P〉0.05）。ME组较PR组住院时间延长,高血糖比例明显增高（P〈0.05）。两组在二次感染、高血压、谵妄的发病率比较差异无统计学意义（P〉0.05）。结论机械通气的AECOPD患者使用大剂量糖皮质激素会导致血糖升高,住院时间延长,口服糖皮质激素同样适用于机械通气的患者。

泼尼松对MCP-1及IL-8在COPD大鼠气道表达的影响

目的研究单核细胞趋化蛋白-1(MCP-1)及白细胞介素8(IL-8)在慢性阻塞性肺疾病(COPD)大鼠气道的表达及泼尼松对其的影响。方法Wistar大鼠随机分为3组:正常对照组(A组)、COPD模型组(B组)和泼尼松干预组(C组)。采用单纯熏香烟法建立COPD模型,泼尼松隔日灌胃,计数支气管肺泡灌洗液(BALF)中细胞数,以酶联免疫吸附法(ELISA)测定BALF和血清中的MCP-1及IL-8浓度。肺组织切片观察形态学改变,采用图像分析系统分析肺气肿程度。结果B组气管及支气管的慢性炎症改变及肺气肿改变较C组明显。B组BALF中MCP-1I、L-8浓度、细胞计数及血清中IL-8浓度均高于A组,但血清MCP-1的升高无统计学差异。与B组相比,C组BALF中MCP-1I、L-8浓度及细胞计数均下降,但血清中MCP-1及IL-8的浓度下降无统计学意义。B组BALF中MCP-1浓度与肺泡巨噬细胞(AM)数目及BALF中IL-8与中性粒细胞数目呈正相关(r=0.861,P<0.01;r=0.735,P<0.05),但血清中MCP-1、IL-8浓度与BALF中的细胞数目均无相关性。结论MCP-1和IL-8与COPD的气道炎症密切相关。泼尼松早期干预可通过对MCP-1I、L-8及AM、中性粒细胞的抑制而减轻COPD气道炎症。

Fecal microbiota transplantation and prednisone for severe eosinophilic gastroenteritis

Eosinophilic gastroenteritis is a rare disease of unknown etiology. It is characterized by patchy or diffuse eosinophilic infiltration of the bowel wall to a variable depth and various gastrointestinal manifestations. We describe a case of severe eosinophilic gastroenteritis presenting as frequent bowel obstruction and diarrhea in a 35-year-old man. The patient was misdiagnosed and underwent surgery because of intestinal obstruction when he was first admitted to a local hospital. Then he was misdiagnosed as having Crohn&#x02019;s disease in another university teaching hospital. Finally, the patient asked for further treatment from our hospital because of the on-going clinical trial for treating refractory Crohn&#x02019;s disease by fecal microbiota transplantation. Physical examination revealed a slight distended abdomen with diffuse tenderness. Laboratory investigation showed the total number of normal leukocytes with neutrophilia as 90.5%, as well as eosinopenia, monocytopenia and lymphocytopenia. Barium radiography and sigmoidoscopy confirmed inflammatory stenosis of the sigmoid colon. We diagnosed the patient as having eosinophilic gastroenteritis by multi-examinations. The patient was treated by fecal microbiota transplantation combined with oral prednisone, and was free from gastrointestinal symptoms at the time when we reported his disease. This case highlights the importance of awareness of manifestations of a rare disease like eosinophilic gastroenteritis.

Beh et's disease complicated by multiple aseptic abscesses of the liver and spleen

Aseptic abscesses are an emergent entity and have been described in inflammatory bowel disease,especially in Crohn's disease,and in other diseases.However,aseptic abscesses associated with Beh et's disease are extremely rare.We report a Japanese male diagnosed with an incomplete type of Beh et's disease who developed multiple aseptic abscesses of the spleen and liver.In 2002,the spleen abscesses were accompanied by paroxysmal oral aphthous ulcers and erythema nodosum.As the patient's response to antibiotic treatment was inadequate,a splenectomy was performed.Severe inflammatory cell infiltration,largely of polymorphonuclear neutrophils,was observed without evidence of bacterial or fungal growth.Although the patient had no history of ocular symptoms or genital ulcers,a diagnosis of incomplete Beh et's disease was made according to the Japanese diagnostic criteria because of the presence of paroxysmal arthritis and epididymitis since 2002.In 2005,multiple liver abscesses developed with right hypochondrial pain and seemed to be attributed to Beh et's disease because the abscesses yielded negative results during a microbiologic investigation and failed to go into remission under antibiotic therapy.Oral prednisone(15 mg/d) was started in May 2006,and the abscesses dramatically disappeared 4 wk after treatment.Although the patient had a relapse of the liver abscesses in association with the tapering of prednisone,the augmentation of prednisone dosage yielded a response.The abscesses of the liver and spleen were strongly suggested to be attributed to Beh et's disease.Clinician should be aware of the existence of aseptic abscesses as uncommon manifestations of Beh et's disease.

Gutuo Jiejiu decoction improves survival of patients with severe alcoholic hepatitis: A retrospective cohort study

AIM To verify the value of Gutuo Jiejiu decoction in improving the survival of patients with severe alcoholic hepatitis(SAH).METHODS We performed a retrospective cohort study in consecutive patients diagnosed with SAH at the Teaching Hospital of Chengdu University of Traditional Chinese Medicine and Shuguang Hospital, Shanghai University of Traditional Chinese Medicine. The traditional Chinese medicine formula Gutuo Jiejiu decoction was employed as an exposure factor. Patients from the Teaching Hospital of Chengdu University of Traditional Chinese Medicine who had been treated with Gutuo Jiejiu decoction + prednisone were assigned to an observation group, and patients from Shuguang Hospital, Shanghai University of Traditional Chinese Medicine who had been treated with prednisone alone were selected as a control group. A retrospective analysis was performed by comparing age, alcohol intake, and clinical parameters of liver injury beforeand after treatment. Additionally, the 3-and 12-mo survival rates and the occurrence of complications were analyzed.RESULTS One hundred and twenty-eight eligible patients were selected from 175 cases with SAH, of which 68 were assigned to the observation group and the other 60 to the control group. No significant difference was found in the patients' baseline characteristics(P > 0.05). However, significant improvements of 90-d survival rate [56/68(82.4%) vs 27/60(45.0%), P = 0.0000] and 365-d survival rate [48/68(70.6%) vs 13/60(21.7%), P = 00000] were observed in the observation group after treatment. After the first 3 mo of treatment, more improvements in the clinical parameters and scoring systems related to liver injury occurred in the observation group than in the control group(P < 0.05). After treatment for 12 mo, the differences in the clinical parameters and scoring systems related to liver injury between the two groups were more significant(P < 0.05). No significant differences in complications and adverse effects were found between the two groups.CONCLUSION Gutuo Jiejiu decoction could improve the survival rates and clinical parameters of liver injury in patients with SAH, and may represent a new option for treating SAH.

Oral higher dose prednisolone to prevent stenosis after endoscopic submucosal dissection for early esophageal cancer

BACKGROUND Esophageal stenosis is one of the main complications of endoscopic submucosal dissection(ESD)for the treatment of large-area superficial esophageal squamous cell carcinoma and precancerous lesions(≥3/4 of the lumen).Oral prednisone is useful to prevent esophageal stenosis,but the curative effect remains controversial.AIM To share our experience of the precautions against esophageal stenosis after ESD to remove large superficial esophageal lesions.METHODS Between June 2019 and March 2022,we enrolled patients with large superficial esophageal squamous cell carcinoma and high-grade intraepithelial neoplasia experienced who underwent ESD.Prednisone(50 mg/d)was administered orally on the second morning after ESD for 1 mo,and tapered gradually(5 mg/wk)for 13 wk.RESULTS In total,14 patients met the inclusion criteria.All patients received ESD without operation-related bleeding or perforation.There were 11 patients with≥3/4 and<7/8 of lumen mucosal defects and 1 patient with≥7/8 of lumen mucosal defect and 2 patients with the entire circumferential mucosal defects due to ESD.The longitudinal extension of the esophageal mucosal defect was<50 mm in 3 patients and≥50 mm in 11 patients.The esophageal stenosis rate after ESD was 0%(0/14).One patient developed esophageal candida infection on the 30th d after ESD,and completely recovered after 7 d of administration of oral fluconazole 100 mg/d.No other adverse events of oral steroids were found.CONCLUSION Oral prednisone(50 mg/d)and prolonged prednisone usage time may effectively prevent esophageal stricture after ESD without increasing the incidence of glucocorticoid-related adverse events.However,further investigation of larger samples is required to warrant feasibility and safety.