Objective To systematically evaluate the effectiveness of N-acetylcysteine (NAC) combined with low-dose glucocorticoid for patients with idiopathic pulmonary fibrosis (IPF). Methods Such databases as The Cochrane Library (Issue 12, 2012), EMbase (January 1974 to July 2012), PubMed (January 1966 to July 2012), CHEST (January 1995 to July 2012), CNKI (January 1994 to July 2012), CBM (January 1978 to July 2012), VIP (January 1989 to July 2012) and WanFang Data (January 1995 to July 2012) were searched to collect the randomized controlled trials (RCTs) about NAC combined with low-dose glucocorticoid versus glucocorticoid alone for IPF patients. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality, and then the meta-analysis was performed using RevMan 5.1 software. Results A total of seven RCTs including 264 IPF patients were included. The results of meta-analysis demonstrated that, compared with the glucocorticoid used alone, a) NAC combined with low-dose glucocorticoid could significantly improve PaO2 (SMD=0.82 mmHg, 95%CI 0.30 to 1.35, P=0.002) and DLco (SMD=0.59 mmHg, 95%CI 0.16 to 1.03, P=0.008) with a significant difference. b) NAC combined with low-dose glucocorticoid could significantly improve all clinical symptoms (RR=1.56, 95%CI 1.26 to 1.92, Plt;0.000 1). Conclusion NAC combined with low-dose glucocorticoid for IPF patients can significantly improve PaO2, DLco, and the clinical symptoms such as cough, difficulty breathing after activities, cyanosis, and Velcro rales. Due to the quantity and quality limitation of included studies, this conclusion still needs to be further proved by more high quality and double blind RCTs.
Objective To formulate an evidence-based treatment for a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Methods According to the principles of evidencebased clinical practice, we searched The Cochrane Library (Issue 2, 2008), Ovid-Reviews (1991 to 2008), MEDLINE (1950 to 2008), and http://www.guideline.org. to identify the best evidence for treating a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Results Nine guidelines, 2 systematic reviews, and 11 randomized controlled trials were included. The evidence showed that corticosteroids could help reduce the risk of death and disabling residual neurological deficiencies in patients with tuberculous meningitis. After adjusting for age and gender, the overall death rate of patients with tuberculous pericarditis was significantly reduced by prednisolone (P=0.044), as well as the risk of death from pericarditis (P=0.004). But for patients with pulmonary tuberculosis, there was still a controversy about the use of corticosteroids. Given the evidence, the patient’s clinical conditions, and his preferences, dexamethasone was used for the boy in question. After 7 weeks of treatment, his cerebrospinal fluid returned to normal and pericardial effusion disappeared. Conclusion Corticosteroids should be recommended in HIV-negative people with tuberculous meningitis or/and tuberculous pericarditis. The difference in the effectiveness of various corticosteroids such as dexamethasone, prednisolone, or methylprednisolone and the optimal duration of corticosteroid therapy is still unknown.
目的 探讨颅内动脉瘤破裂后，患者血清促肾上腺皮质激素、甲状腺激素水平的变化情况。 方法 监测2010年3月－6月共51例动脉瘤患者术前、术后2～3、4～5 d促肾上腺皮质激素（ACTH）、甲状腺激素水平的变化情况，并对监测结果进行统计学处理。 结果 ACTH、促甲状腺激素、甲状腺素、血清游离甲状腺素在术前、术后2～3、4～5 d差异无统计学意义（P＞0.05），三碘甲状腺原氨酸（T3）、血清游离三碘甲状腺原氨酸（FT3）在术前、术后2～3、4～5 d差异有统计学意义（P＜0.05）；不同部位动脉瘤患者的T3、FT3在术前、术后2～3、4～5 d差异无统计学意义（P＞0.05）；Fisher、Hunt分级不同级别的动脉瘤患者的T3、FT3在术前、术后2～3、4～5 d差异有统计学意义（P＜0.05）。 结论 动脉瘤破裂患者的血清T3、FT3的变化水平情况，可以作为判断患者病情的轻重与预后的一项重要指标。
目的：本研究通过观察经地塞米松处理前后培养的人小梁细胞的变化,探讨激素性青光眼房水排出阻力增加的机制。方法：将人类小梁细胞培养至接近体内的高分化状态，用地塞米松处理后,观察细胞形态的变化，并检测以下蛋白的分布和表达：(1)myocilin/TIGR蛋白；(2)纤连蛋白；(3)肌动蛋白交联网的形成；(4)血清淀粉样物质A蛋白。结果：人小梁细胞经地塞米松处理后(1)胞体变大，排列不规则，边界模糊，呈“融合”状；(2)细胞内外myocilin/TIGR蛋白表达均明显增加，其胞外表达与纤连蛋白位置一致,提示相互作用；(3)纤连蛋白表达增加；(4)CLANs形成，细胞间连接增强；(5)血清淀粉样物质A蛋白表达增加。结论：人类小梁细胞经地塞米松处理后形态发生变化，可能与应力纤维变化及myocilin蛋白在细胞内积聚有关。细胞间边界不清，与细胞外基质蛋白过度表达、沉积有关。小梁细胞外基质沉积以及异常的细胞间连接等改变与房水排出阻力增加的病理过程有关。
肺癌是全球范围内肿瘤致死的最常见原因，其死亡率超过了结肠癌、乳腺癌和前列腺癌之和[1]。虽然肺癌已成为全球最主要的死因之一，然而在其治疗方面仍然缺乏根本有效的方法。肿瘤的化学预防（chemoprevention）是一项有效的措施[2]，其含义是：应用天然或人工合成化合物阻断、逆转或预防侵袭性肿瘤的发生，降低具有侵袭性或有临床表现的癌症的发生率。肿瘤化学预防药物研究已成为目前肿瘤学和药学的研究热点之一。
Objective To examine the levels of nitrite /nitrate( NO2 /NO3 ) , IL-4 and IFN-γin exhaled breath condensates( EBCs) in patients with asthma, and to investigate the effect of corticosteroid treatment. Methods Forty patients diagnosed as mild to moderate asthma were recruited. Among them, twenty were newly diagnosed and steroid naive( non-treatment group) . The other 20 patients had been treated with corticosteroid treatment( treatment group) . Twenty healthy volunteers were enrolled as normal control.EBC samples were taken for measurement of NO2 /NO3, IL-4 and IFN-γlevels. Serum IL-4 and IFN-γ concentrations were also measured. Results NO2 /NO3 level in EBC of the non-treatment group was significantly higher than that of the normal controls and the treatment group[ ( 48. 55 ±27. 37) μmol / L vs( 24. 51 ±18. 22) μmol /L, ( 36. 06 ±25. 13) μmol /L, respectively, both P lt; 0. 05] , and no significant difference was found between the treatment group and the normal controls( P gt;0. 05) . The IL-4 and IFN-γ levels in both EBC and serum had no significant difference between the three groups ( all P gt; 0. 05) . Conclusion NO2 /NO3 in EBCs increases in asthmatic patients, and decreases after corticosteroid treatment. Whether IL-4 and IFN-γlevels can be used for reflecting airway inflammation need further study.
COPD 和肺癌均为最常见的吸烟相关呼吸道疾病。吸入性糖皮质激素( ICS) 近年来被推荐用于重度COPD 的治疗, 同时也被发现在肺癌的化学预防中起重要作用。本文通过综述ICS、COPD 和肺癌之间的关系, 特别是吸入糖皮质激素在肺癌中的化学预防作用, 以期进一步明确ICS 在COPD和肺癌中的作用。
Objective To determine if the therapeutic response to an inhaled corticosteroid is attenuated in individuals with asthma who smoke.Methods 38 outpatients with chronic stable asthma who visited during March 2008 and January 2009 were enrolled in the study. 23 cases were nonsmokers and 15 cases were smokers. All of them were treated by daily inhaled budesonide, and β2 agonist when necessary.They were required to record symptoms and peak expiratory flow every day on an asthmatic diary card. Thepatients were followed 28 days. ACT score, asthma-symptom score, Asthma Control Test ( ACT) score,pulmonary function, and peak expiratory flow were compared between the non-smoking and the smoking asthmatic patients. Results All of the patients had statistically significant increases in ACT score, mean morning and night PEF, mean forced expiratory volume in 1 second, and a significant decrease in asthmasymptom score after budesonide treatment compared with before. There were significantly greater changes inany of these parameters in the non-smokers than in the smokers. Conclusions Active cigarette smoking impairs the efficacy of short term inhaled corticosteroid treatment in asthma. This finding has important implications for the management of patients with asthma who smoke.
糖皮质激素在甲型H1N1流感中的应用探讨
Objective To investigate the percentage of CD4 + CD25 + Treg cells and expression of Foxp3 mRNA in asthmatic patients and the impacts of inhaled steroids.Methods The percentages of CD4 +CD25 + Treg cells was assayed by flow cytometry and the expression of Foxp3 mRNA was detected by RT-PCR in peripheral blood mononuclear cells from the patients with chronic persistent asthma before and after steroids inhalation in comparison with healthy control. The forced expired volumin one second/predicted value( FEV1% pred) and peak expired flow( PEF) were measured by spirometry. Results The level of CD4 + CD25 + Treg cells and the expression of Foxp3 mRNA were lower in asthmatics before steroids treatment than those in control ( P lt; 0. 05) which were increased significantly after steroids treatment ( P lt; 0. 05) .FEV1% pred and PEF were declined significantly than those in control but improved markedly after treatment ( P lt; 0. 05) . Conclusions The insufficiency of amount and function of immue-suppressive CD4 + CD25 +Treg cells may play a role in the pathogenesis of asthma. Inhaled steroids can improve the lung function of asthmatics by upregulating the level of CD4 + CD25 + Treg and Foxp3.