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口服与静脉注射大剂量类固醇治疗肾移植排斥反应。该用大剂量还是不用?

Oral versus intravenous high-dose steroid treatment of renal allograft rejection. The big shot or not?

作者信息

Gray D, Shepherd H, Daar A, Oliver D O, Morris P J

出版信息

Lancet. 1978 Jan 21;1(8056):117-8. doi: 10.1016/s0140-6736(78)90417-8.

Abstract

50 episodes of renal allograft rejection were treated by oral prednisolone and 49 by intravenous methylprednisolone. Both treatments achieved reversal of rejection in approximately 60% of episodes. Morbidity-rates, as assessed by hypertension, oliguria, fluid retention, and infection, tended to be greater after oral treatment. When the results were reexamined for accelerated, acute, and chronic rejection episodes the only difference demonstrated was an increased frequency of fluid retention in patients treated by oral prednisolone for an acute rejection episode. There was no evidence that intravenous methylprednisolone was nephrotoxic.

摘要

50例同种异体肾移植排斥反应采用口服泼尼松龙治疗,49例采用静脉注射甲泼尼龙治疗。两种治疗方法在约60%的病例中均使排斥反应得到逆转。通过高血压、少尿、液体潴留和感染评估的发病率,口服治疗后的发病率往往更高。当对加速性、急性和慢性排斥反应发作的结果进行重新检查时,唯一显示出的差异是口服泼尼松龙治疗急性排斥反应发作的患者中液体潴留的频率增加。没有证据表明静脉注射甲泼尼龙具有肾毒性。

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