The standard therapy for episodes of severe acute inflammatory demyelinating disease of the central nervous system is high dose intravenous corticosteroids. A small proportion of patients fail to improve with this reg...The standard therapy for episodes of severe acute inflammatory demyelinating disease of the central nervous system is high dose intravenous corticosteroids. A small proportion of patients fail to improve with this regime and their prognosis can become grave. A recent sham controlled double blind crossover trial in this group of patients demonstrated a significant benefit from plasma exchange. We report six patients with severe acute steroid- insensitive inflammatory demyelinating disease of the central nervous system treated with plasma exchange. We observed a clear improvement in five of these six patients. Whilst complications of plasma exchange occurred these did not outweigh the benefits. Our study supports the use of plasma exchange in severe acute steroid- insensitive inflammatory disease of the central nervous system.展开更多
目的:探讨地塞米松(DEX)对大鼠中央髓鞘溶解症(CPM)的预防作用及机理。方法:通过皮下注射长效尿崩停针和腹腔注射2.5%葡萄糖液诱导大鼠低钠血症3 d,第4天腹腔注射1 m o l/L氯化钠液(高渗盐水)快速补钠的方法诱导大鼠CPM模型。DEX早期治...目的:探讨地塞米松(DEX)对大鼠中央髓鞘溶解症(CPM)的预防作用及机理。方法:通过皮下注射长效尿崩停针和腹腔注射2.5%葡萄糖液诱导大鼠低钠血症3 d,第4天腹腔注射1 m o l/L氯化钠液(高渗盐水)快速补钠的方法诱导大鼠CPM模型。DEX早期治疗组大鼠在注射高渗盐水同时肌注5 m g/kg DEX;DEX延迟治疗组大鼠在注射高渗盐水后24 h肌注5 m g/kg DEX;生理盐水治疗组大鼠在注射高渗盐水同时肌注生理盐水;另设正常对照组。观察大鼠脑组织脱髓鞘病变发生情况;测定脑内伊文思兰(EB)的含量变化;W estern b lot印迹法测定脑内一氧化氮合酶(iN-OS)的表达变化。结果:通过诱导低钠血症、快速补钠的方法成功建立了大鼠CPM模型。DEX早期治疗组、DEX延迟治疗组、生理盐水治疗组3组大鼠在快速补钠后0 h时点,脑内EB含量与正常对照组无明显差异(P>0.05)。生理盐水治疗组大鼠在快速补钠后6 h,脑内EB含量比0 h时点明显增加(P<0.05),24 h达高峰,同时脑内iNOS在快速补钠后3 h开始表达增强,36 h仍呈较强表达,脱髓鞘发生率为66.7%。DEX早期治疗组大鼠快速补钠后脑内EB含量及iNOS表达,均较同时点生理盐水治疗组明显下降,未见明显脱髓鞘病变。DEX延迟治疗组脱髓鞘病变发生率为75%,与生理盐水治疗组无明显差异(P>0.05)。结论:早期应用DEX能够通过保护血脑屏障和抑制脑内iN-OS表达,起到预防CPM的作用。展开更多
文摘The standard therapy for episodes of severe acute inflammatory demyelinating disease of the central nervous system is high dose intravenous corticosteroids. A small proportion of patients fail to improve with this regime and their prognosis can become grave. A recent sham controlled double blind crossover trial in this group of patients demonstrated a significant benefit from plasma exchange. We report six patients with severe acute steroid- insensitive inflammatory demyelinating disease of the central nervous system treated with plasma exchange. We observed a clear improvement in five of these six patients. Whilst complications of plasma exchange occurred these did not outweigh the benefits. Our study supports the use of plasma exchange in severe acute steroid- insensitive inflammatory disease of the central nervous system.
文摘目的:探讨地塞米松(DEX)对大鼠中央髓鞘溶解症(CPM)的预防作用及机理。方法:通过皮下注射长效尿崩停针和腹腔注射2.5%葡萄糖液诱导大鼠低钠血症3 d,第4天腹腔注射1 m o l/L氯化钠液(高渗盐水)快速补钠的方法诱导大鼠CPM模型。DEX早期治疗组大鼠在注射高渗盐水同时肌注5 m g/kg DEX;DEX延迟治疗组大鼠在注射高渗盐水后24 h肌注5 m g/kg DEX;生理盐水治疗组大鼠在注射高渗盐水同时肌注生理盐水;另设正常对照组。观察大鼠脑组织脱髓鞘病变发生情况;测定脑内伊文思兰(EB)的含量变化;W estern b lot印迹法测定脑内一氧化氮合酶(iN-OS)的表达变化。结果:通过诱导低钠血症、快速补钠的方法成功建立了大鼠CPM模型。DEX早期治疗组、DEX延迟治疗组、生理盐水治疗组3组大鼠在快速补钠后0 h时点,脑内EB含量与正常对照组无明显差异(P>0.05)。生理盐水治疗组大鼠在快速补钠后6 h,脑内EB含量比0 h时点明显增加(P<0.05),24 h达高峰,同时脑内iNOS在快速补钠后3 h开始表达增强,36 h仍呈较强表达,脱髓鞘发生率为66.7%。DEX早期治疗组大鼠快速补钠后脑内EB含量及iNOS表达,均较同时点生理盐水治疗组明显下降,未见明显脱髓鞘病变。DEX延迟治疗组脱髓鞘病变发生率为75%,与生理盐水治疗组无明显差异(P>0.05)。结论:早期应用DEX能够通过保护血脑屏障和抑制脑内iN-OS表达,起到预防CPM的作用。
