1.Observation on the therapeutic effect of methylprednisolone combined with mycophenolate mofetil in the treatment of moderate to severe active Graves eye disease
Xuanlu WANG ; Ying HU ; Nianchun PENG ; Jing XU ; Juan HE ; Banghui XIAO ; Rui WANG ; Yi XU ; Miao ZHANG
The Journal of Practical Medicine 2024;40(21):3067-3075
Objective To assess the effectiveness and safety of combining methylprednisolone with myco-phenolate mofetil in managing moderate to severe active Graves'ophthalmopathy(GO),and to compare its efficacy against methylprednisolone monotherapy.Methods A retrospective study was conducted to select patients with moderate to severe active GO who received treatment at the Department of Endocrinology and Metabolism,Guizhou Medical University Affiliated Hospital,from January 2019 to January 2024.The patients were divided into two groups:a combination group receiving methylprednisolone combined with mycophenolate mofetil,and a mono-therapy group receiving methylprednisolone alone.The objective was to compare changes in visual score,appearance score,clinical activity score(CAS),eye protrusion,eye fissure width,and eye movement between the two groups of patients while documenting any adverse events.Results A total of 98 patients were enrolled in the study,comprising 32 patients in the combination group and 61 patients in the monotherapy group.Both groups exhibited improvements in quality of life scores,CAS,and degree of protrusion following treatment compared to baseline.However,at the end of the 12-week treatment period,there was no statistically significant difference(P>0.05)observed between the two groups regarding changes in visual scores,appearance scores,CAS,protrusion degree,fissure width,and proportion of reduced eye movement before and after treatment.Notably though,the combined therapy group demon-strated a significantly higher improvement rate for pain relief and reduction of eyelid congestion during eye movement when compared to the monotherapy group(P<0.001).At the endpoint of treatment,there were no statistically significant differences in appearance score,protrusion degree,tear width,and reduction in eye movement between the two groups before and after treatment(P>0.05).The combination group exhibited higher visual scores and greater improvement in CAS compared to the monotherapy group(P<0.05),along with a higher rate of eyelid edema improvement(P<0.05).At 12 weeks,the monotherapy group had an effective rate of 65.0%,while the combination group had an effective rate of 66.7%.By week 24,the combined group achieved an effective rate of 80.0%.The over-all effectiveness at week 12 and treatment endpoints did not show any statistically significant differences between the two groups(P>0.05).No cases of leukopenia or severe infection occurred in the combination group.Conclusions The combination therapy of methylprednisolone and mycophenolate mofetil demonstrates efficacy,tolerability,and safety in the treatment of moderate to severe active GO.While the overall effectiveness of this combination may not surpass that of hormone therapy alone,it exhibits potential superiority in improving visual scores,eyelid congestion,eyelid edema,and eye movement pain when compared to hormone therapy alone.
2.Establishment of HPLC Fingerprint of Lonicera japonica and Study on Its Anti-inflammatory Spectrum-effect Relationship
Yanyan MIAO ; Banghui XU ; Jian XU ; Yongping ZHANG ; Jie LIU ; Yao LIU
China Pharmacy 2020;31(20):2497-2502
OBJECTIVE:To establish fingerprint of Lonicera japonica ,and to study its anti-inflammatory spectrum-effect relationship. METHODS :HPLC was adopted. The determination was performed on Diamonsil C 18 column with mobile phase consisted of 0.1% formic acid solution-acetonitrile (gradient elution )at the flow rate of 1.0 mL/min. The column temperature was 30 ℃,and detection wavelength was 238 nm. The sample size was 10 μL. Using chlorogenic acid as reference,HPLC fingerprint of 10 batches of L. japonica from different production areas was established according to TCM Chromatographic Fingerprint Similarity Evaluation System (2012 edition). By comparing with reference substance ,chemical constituents corresponding to common peaks were identified ,and the similarity analysis was conducted. Acute and chronic inflammatory models of mice induced by xylene ,carrageenan and cotton ball were used to evaluate inhibition rate of 10 batches of L. japonica to ear,foot and granuloma swelling; the average value was calculated as the comprehensive pharmacodynamic index. The spectrum-effect relationship with HPLC fingerprint of L. japonica and anti-inflammatory effect was analyzed by grey relational analysis (GRA)and partial least squares regressiosn (PLSR)based on common peak area and comprehensive pharmacodynamic index . Chromatographic peaks with correlation>0.7 and regression coefficient of PLSR model >0 were characteristic peaks. The percentage of peak areas of characteristic peaks to peak areas of common peak was calculated in 10 batches of L. japonica (e.g.“peak ratio ”). RESULTS : There were 25 common peaks in HPLC fingerprints of 10 batches of L. japonica ,with similarity of 0.775-0.994. Totally 9 peaks were confirmed ,i.e. rutin (peak 18),hyperoside(peak 20),isochlorogenc acid B (peak 22),galuteolin(peak 21),chlorogenc acid(peak 9),loganin(peak 10),neochlorogenic acid (peak 2),isochlorogenic acid C (peak 25),isochlorogenic acid A (peak 23). All 10 batches of L. japonica had inhibitory effects on ear swelling ,foot swelling and granuloma ,with average inhibitory rate of 47.95%-56.52%. The correlation by GRA was peak 8>12>18>16>3>11>20>22>19>21>1>9>10>13>24>14>2> 17>25>23>5>4>15,and all of correlations were greater than 0.7. The regression coefficient of PLSR for peaks 2,4,5,7,8, 10,12,13,14,15,16,17,18,20,21,22,24 were all greater than 0;those peaks were positively correlated with anti-inflammatory effect and were characteristic peaks except for peak 7; among them ,VIP values of peaks 5,8,10,16,18, 20,24 were greater than 1. The peak ratio of 10 batches of L. japonica was 58.61%-71.19%. CONCLUSIONS :HPLC fingerprint of 10 batches of L. Japonica is successfully established. 10 batches of samples have similar components ,and the content of anti-inflammatory components is relatively high. The proportion of characteristic peaks to common peaks should not be less than 51.8%.