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.

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.

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.

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.

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).

Prednisone on the threshold of rational use in the treatment of rheumatoid arthritis

This is a review of the evolution of the use prednisone in the treatment of rheumatoid arthritis (RA). Cortisone was introduced in 1949 and shortly thereafter, the Mayo investigators found that low divided doses with slow tapering were effective and caused fewer side effects. In 1959, a British double blind 2 year study of prednisolone treatment in early RA demonstrated effectiveness and reduced bony erosions. This experience was lost over time and empiricism and efforts to reduce side effects dominated practice for the next 35 years. Since 1995, a number of controlled studies of low single daily doses of prednisone in early RA have been reported by European investigators. They have shown clinical improvement, reduced bony erosions, augmentation of the effect of dmards and few side effects. During the last 25 years, the molecular actions of glucocorticoids have been elucidated. The time relationship of the dose to the biologic and clinical effects has been established. As a result of the information on the diurnal effect of glucocorticoids and the documentation of the effect occurring 5-6 hours after the dose and dissipating by 24 hours, a delayed release preparation of prednisone has been developed. With the rediscovery of the effectiveness of low single daily morning dose of prednisone in early RA by controlled studies and the demonstration of the onset and duration of the clinical effect of low dose of prednisone, it is now possible to use low doses of prednisone rationally and effectively in the treatment of RA. It remains to be determined whether a single morning, single evening or a twice a day low dose is the most effective and safe. It is doubtful if the new delayed release prednisone is any more effective than the usual immediate release prednisone if given at the same time.

Dexamethasone versus Prednisone in Childhood Acute Lymphoblastic Leukemia Treatment: Results of the Indonesian Randomized Trial

Background: Randomized trials report that, compared to prednisone, dexamethasone has reduced CNS relapse and improved event-free survival (EFS), despite a trend toward a higher risk for induction death. Because toxic death is a specific problem in the Indonesian setting, this study compares the outcome of dexamethasone versus prednisone. Methods: In the period 2006 - 2011, 196 patients with childhood acute lymphoblastic leukemia (ALL) treated on the Indonesia-ALL-2006 protocol [first standard risk (SR) and later high risk (HR) patients] were randomized to receive dexamethasone or prednisone as steroid. Patients in the dexamethasone arm (n = 102: 68 SR, 34 HR) received dexamethasone 4 mg/m2/day (SR) or 6 mg/m2/day (HR), while the prednisone arm (n = 94: 66 SR, 28 HR) received prednisone 40 mg/m2/day (SR and HR). Results: Patients in the dexamethasone arm showed no significant difference compared to the prednisone arm in abandonment rate (24.5% vs. 25.5%, P = 0.91), death rate (17.7% vs. 14.9%, P = 0.54), or leukemic events (13.7 vs. 11.7%, P = 0.59). After stratification for risk group, a trend towards a higher death rate was found in the dexamethasone arm of SR patients (16.2 vs. 6.1%, P = 0.06). The 3-year survival for EFS in SR and HR patients for dexamethasone versus prednisone was 31.5% ± 6.6% vs. 41.5% ± 5.9% (P = 0.51), for leukemia-free survival (LFS) it was 63.7% ± 9.3% vs. 74.5% ± 7.6% (P = 0.47), and for overall survival (OS) it was 49.5% ± 7.7% vs. 69.3% ± 6.1% (P = 0.09). Conclusions: In our setting, a trend toward higher induction deaths was observed in the dexamethasone arm of SR patients and the 3-year EFS;LFS and OS rates were lower in the dexamethasone group;however, these differences were not significant.

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.

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.

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.

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.

Cyclosporine,prednisone,and high-dose immunoglobulin treatment of angioimmunoblastic T-cell lymphoma refractory to prior CHOP or CHOP-like regimen

Angioimmunoblastic T-cell lymphoma(AITL) is a rare,distinct subtype of peripheral T-cell lymphoma,possessing an aggressive course and poor prognosis with no standard therapy.Twelve patients who have failed at least two initial CHOP or CHOP-like regimens were enrolled in this study and treated with individualized cyclosporine(CsA),prednisone(PDN),and monthly,high-dose intravenous immunoglobulin(HDIVIG).The dose of CsA was adjusted individually based on the blood trough concentration of CsA and renal function.All patients were examined for response,toxicity and survival.The most significant toxicities(≥ grade 2) were infection(16.7%),renal insufficiency(8.3%),hypertension(8.3%),diabetes(8.3%) and insomnia(16.7%).Discontinuation of treatment occurred in one patient(8.3%) due to grade 3 renal toxicity and subsequent grade 4 pulmonary infection.Treatment-related death was not observed.The overall response rate was 75.0%(complete response,33.3%;partial response,41.7%).With a median follow-up of 25.5 months,the median duration of response was 20 months(range,12 to 49 months) and the median progression-free survival(PFS) was 25.5 months(range,10 to 56 months).The 2-year PFS rate was 81.5%.Our findings indicate the combination of CsA,PDN and HDIVIG is an effective salvage regimen for refractory or relapsed AITL with predictable and manageable toxicity.

Chidamide plus prednisone,cyclophosphamide,and thalidomide for relapsed or refractory peripheral T-cell lymphoma:A multicenter phase II trial

Background:Although the treatment of peripheral T-cell lymphoma(PTCL)has undergone advancements during the past several years,the response rate and long-term effects with respect to patients with PTCL remain unsatisfactory—particularly for relapsed or refractory(R/R)patients.This phase II trial was designed to explore the efficacy and safety of an all-oral regimen of chidamide plus prednisone,cyclophosphamide,and thalidomide(CPCT)for R/R PTCL patients who could not tolerate the standard chemotherapy for a variety of reasons.Methods:We conducted a multicenter phase II clinical trial in which we combined chidamide(30 mg twice weekly)with prednisone(20 mg daily after breakfast),cyclophosphamide(50 mg daily after lunch),and thalidomide(100 mg daily at bedtime)(the CPCT regimen)for a total of fewer than 12 cycles as an induction-combined treatment period,and then applied chidamide as single-drug maintenance.Forty-five patients were ultimately enrolled from August 2016 to April 2021 with respect to Chinese patients at nine centers.Our primary objective was to assess the overall response rate(ORR)after the treatment with CPCT.Results:Of the 45 enrolled patients,the optimal ORR and complete response(CR)/CR unconfirmed(CRu)were 71.1%(32/45)and 28.9%(13/45),respectively,and after a median follow-up period of 56 months,the median progression-free survival(PFS)and overall survival(OS)were 8.5 months and 17.2 months,respectively.The five-year PFS and OS rates were 21.2%(95%confidence interval[CI],7.9-34.5%)and 43.8%(95%CI,28.3-59.3%),respectively.The most common adverse event was neutropenia(20/45,44.4%),but we observed no treatment-related death.Conclusion:The all-oral CPCT regimen was an effective and safe regimen for R/R PTCL patients who could not tolerate standard chemotherapy for various reasons.Trial Registration:ClinicalTrials.gov,NCT02879526.

Activation of the PGC-1α-mediated mitochondrial glutamine metabolism pathway attenuates female offspring osteoarthritis induced by prenatal excessive prednisone

Osteoarthritis is a chronic,age-related joint disease.Previous studies have shown that osteoarthritis develops during intrauterine development.Prednisone is frequently used to treat pregnancies complicated by autoimmune diseases.However,limited research has been conducted on the enduring effects of prednisone use during pregnancy on the offspring.In this study,we investigated the effect of excessive prednisone exposure on cartilage development and susceptibility to osteoarthritis in the offspring.We found that prenatal prednisone exposure(PPE)impaired cartilage extracellular matrix(ECM)synthesis,resulting in poor cartilage pathology in female offspring during the adult period,which was further exacerbated after long-distance running stimulation.Additionally,PPE suppressed cartilage development during the intrauterine period.Tracing back to the intrauterine period,we found that Pred,rather than prednisone,decreased glutamine metabolic flux,which resulted in increased oxidative stress,and decreased histone acetylation,and expression of cartilage phenotypic genes.Further,PGC-1α-mediated mitochondrial biogenesis,while PPE caused hypermethylation in the promoter region of PGC-1αand decreased its expression in fetal cartilage by activating the glucocorticoid receptor,resulting in a reduction of glutamine flux controlled by mitochondrial biogenesis.Additionally,overexpression of PGC-1α(either pharmacological or through lentiviral transfection)reversed PPEand Pred-induced cartilage ECM synthesis impairment.In summary,this study demonstrated that PPE causes chondrodysplasia in female offspring and increases their susceptibility to postnatal osteoarthritis.Hence,targeting PGC-1αearly on could be a potential intervention strategy for PPE-induced osteoarthritis susceptibility.

托珠单抗联合泼尼松和甲氨蝶呤治疗难治性中重度类风湿关节炎临床评价

目的探讨托珠单抗联合泼尼松、甲氨蝶呤治疗难治性中重度类风湿关节炎(RA)的临床疗效。方法选取医院2020年3月至2022年3月收治的难治性中重度RA患者145例,采用分层随机法分为观察组(72例)和对照组(73例)。两组患者均口服醋酸泼尼松片、甲氨蝶呤片,观察组患者加用托珠单抗注射液静脉滴注。两组均连续治疗3个月。结果治疗后,两组患者的关节疼痛评分、肿胀评分均显著降低,晨僵持续时间均显著缩短,疾病活动指数28量表评分均显著降低,Fugl-Meyer运动功能评价量表评分均显著升高,类风湿因子、C反应蛋白水平及红细胞沉降率均显著降低,基质金属蛋白酶-3水平均显著降低,金属蛋白酶组织抑制因子-1水平均显著升高(P<0.05);且观察组患者上述指标改善程度均更显著(P<0.05)。观察组与对照组不良反应发生率相当(11.11%比8.22%,P>0.05)。结论托珠单抗联合泼尼松、甲氨蝶呤治疗难治性中重度RA,可有效缓解患者的关节炎性症状,降低血清炎性指标水平,改善关节活动能力和关节损伤。

滋阴凉血方联合泼尼松对免疫性血小板减少性紫癜小鼠免疫功能及ST2/IL-33通路的影响

目的:探讨滋阴凉血方联合泼尼松对免疫性血小板减少性紫癜小鼠免疫功能及ST2/IL-33通路的影响。方法:40只BALB/c小鼠,其中32只采用注射抗血小板血清构建免疫性血小板减少性紫癜小鼠模型,造模成功后,随机分为模型、滋阴凉血方(0.2 ml/10 g)、泼尼松(0.2 ml/10 g)和滋阴凉血方+泼尼松(0.2 ml/10 g)共4组,每组8只,剩余8只小鼠设为空白组。分别按剂量灌胃给药,模型组与空白组灌胃等量生理盐水,1次/d×2周。采集血样和脾脏组织,使用全自动血液分析仪测定外周血小板数;HE染色观察脾脏组织病理学变化;酶联免疫吸附法检测血清转化生长因子β、白细胞介素(IL)-17及外周血血小板生成素水平;Western blot检测脾脏组织IL-33、s ST2、ST2表达;流式细胞术检测外周血Th17、Treg细胞数。结果:与空白组相比,模型组小鼠血小板数、血小板生成素、转化生长因子β水平及Treg细胞均明显降低(P<0.05),IL-17水平、Th17细胞及IL-33、s ST2、ST2蛋白表达明显增加(P<0.01);与模型组相比,滋阴凉血方+泼尼松组血小板数、血小板生成素、转化生长因子β水平及Treg细胞均明显上升(P<0.05),IL-17水平、Th17细胞及IL-33、s ST2、ST2蛋白表达明显降低(P<0.01)。结论:滋阴凉血方+泼尼松可有效地调节Th17/Treg平衡,进而有效改善免疫性血小板减少性紫癜,其机制可能与调节ST2/IL-33信号通路有关。

吗替麦考酚酯联合泼尼松对IgA肾病患者尿β2-MG、U-mAlb及α1-MG水平的影响

目的 观察吗替麦考酚酯联合泼尼松治疗免疫球蛋白A(IgA)肾病对患者尿β2微球蛋白(β2-MG)、尿微量白蛋白(U-mAlb)及尿液α1微球蛋白(α1-MG)水平的影响。方法 选取秦皇岛市第一医院肾内科2019年1月至2022年1月收治的89例IgA肾病患者为研究对象,采用信封随机法分为泼尼松组(n=43)和联合组(n=46)。泼尼松组给予常规治疗联合小剂量泼尼松治疗,联合组在泼尼松组基础上联合吗替麦考酚酯治疗。比较两组尿β2-MG、U-mAlb、α1-MG、N-乙酰-β-D氨基葡萄糖苷酶(NAG)及尿足细胞蛋白的水平,检测两组肾功能、血管内皮生长因子(VEGF)、转化生长因子-β1(TGF-β1)、转化生长因子-α(TGF-α)、血尿酸、血红蛋白的差异,统计两组疗效。结果 治疗后,两组尿液β2-MG、U-mAlb、α1-MG、NAG下降,且联合组低于泼尼松组,差异有统计学意义(P<0.05)。治疗后,两组尿NPHS1蛋白、Podocin蛋白下降,且联合组低于泼尼松组,差异有统计学意义(P<0.05)。治疗后,两组VEGF、TGF-β1、TGF-α下降,且联合组低于泼尼松组,差异有统计学意义(P<0.05)。治疗后,两组Scr、BUN、24hU-TP、eGFR下降,且联合组24hU-TP、e GFR下降后水平低于泼尼松组,差异有统计学意义(P<0.05)。结论 吗替麦考酚酯联合小剂量泼尼松治疗IgA肾病可保护患者足细胞,减轻肾损伤,提高疗效。

加强随访管理对系统性红斑狼疮患者预后的影响

目的 探讨加强随访管理对系统性红斑狼疮(SLE)患者预后的影响。方法 收集2021年10月至2022年10月就诊于河南省人民医院的SLE患者,研究的主要终点是随访12个月患者的疾病改善情况。将患者随机分为常规随访组和加强随访组,其中加强随访组干预内容如下:在常规随访基础上,建立患者随访登记表,提醒患者按时复诊,定期科普宣教,加强患者对疾病、药物及日常护理等相关知识的了解,分析两组患者在随访期间系统性红斑狼疮疾病活动度评分2000(SLEDAI-2K)评分、复发率、泼尼松使用剂量以及不良事件发生率等的差异。结果 本研究共纳入98例SLE患者,其中常规随访组48例,加强随访组50例,两组患者在年龄、性别、病程、基线SLEDAI-2K评分、药物应用等方面差异无统计学意义(P>0.05)。随访12个月后,常规随访组患者的复诊次数低于加强随访组(P<0.05);加强随访组SLEDAI-2K评分、复发率、泼尼松的使用剂量均低于常规随访组(P<0.05);两组继发感染、药物服用不规范、自行减停药、新发并发症的发生率差异无统计学意义(P>0.05),但加强随访组均低于常规随访组。结论 加强随访管理可以改善SLE患者疾病控制情况,降低复发率以及泼尼松使用剂量。此外,加强随访管理可在一定程度上降低SLE患者继发感染、自行减停药等发生率。

犀角地黄汤联合来氟米特对系统性红斑狼疮的改善作用

目的观察犀角地黄汤联合来氟米特对系统性红斑狼疮(systemic lupus erythema,SLE)的改善及对Th1/Th2失衡的影响。方法选取123例急性活动期热毒炽盛证SLE患者,用随机数字表法分为对照组(n=61)和试验组(n=62)。对照组采用醋酸泼尼松片联合来氟米特治疗,试验组在对照组治疗的基础上用犀角地黄汤治疗。比较治疗前、治疗后1个月和治疗后3个月2组疾病活动度评分、中医证候评分、补体C3水平和Th1/Th2值;比较2组抗ds-DNA抗体阳性率、临床疗效和不良反应。结果治疗前2组SLE疾病活动度评分(SLE disease activity score,SLEDAI)、中医证候评分、补体C3水平和Th1/Th2值比较,差异无统计学意义;治疗后1、3个月试验组SLEDAI评分、中医证候评分、Th1/Th2值和抗ds-DNA抗体阳性率均明显低于对照组,补体C3水平和临床总有效率均明显高于对照组(P<0.05);试验组不良反应发生率明显低于对照组(P<0.05)。结论犀角地黄汤可改善急性活动期热毒炽盛证SLE患者疾病活动度及中医证候、实验室指标,提升临床疗效,减少糖皮质激素及免疫抑制剂所致的不良反应。