Glucocorticoid tus neeg sawv cev > Kev khomob thiab kev tiv thaiv

Tus txheej txheem ntawm kev ua ntawm GCS cuam tshuam nrog lawv lub peev xwm los cuam tshuam nrog cov receptors hauv cytoplasm ntawm lub cell: cov tshuaj steroid - receptor complex nkag mus rau lub cell nucleus, khi rau DNA, cuam tshuam qhov hloov pauv ntawm ntau cov noob, uas ua rau muaj kev hloov pauv hauv cov synthesis ntawm cov protein, enzymes, nucleic acids. GCS cuam tshuam txhua yam ntawm cov metabolism, muaj cov lus tshaj tawm los tiv thaiv, tiv thaiv kev ua xua, tiv thaiv poob siab thiab tiv thaiv kab mob.

Tus txheej txheem ntawm cov nyhuv los tiv thaiv kev tiv thaiv ntawm corticosteroids yog txhawm rau txhawm rau txha txhua ntu ntawm o. Los ntawm kev ua kom lub zog ntawm lub qias thiab xaim qauv, incl. lysis, steroidal anti-inflammatory tshuaj tiv thaiv kev tso tawm ntawm cov tshuaj tiv thaiv proteolytic los ntawm cov cell, inhibit qhov kev tsim ntawm cov oxygen dawb radicals thiab lipid peroxides hauv daim nyias nyias. Hauv kev tsom xam ntawm o, corticosteroids txwv cov hlab ntsha me thiab txo cov haujlwm ntawm hyaluronidase, yog li inhibiting theem ntawm exudation, tiv thaiv kev txuas ntawm neutrophils thiab monocytes mus rau vascular endothelium, txwv lawv kev nkag mus rau hauv cov ntaub so ntswg, thiab txo cov haujlwm ntawm macrophages thiab fibroblasts.

Hauv kev siv ntawm cov txiaj ntsig los tiv thaiv kev tiv thaiv, ua lub luag haujlwm tseem ceeb yog ua si los ntawm kev muaj peev xwm ntawm GCS los tiv thaiv qhov sib txuas thiab tso tawm ntawm cov khoom kho mob (PG, histamine, serotonin, bradykinin, thiab lwm yam). Lawv ntxias cov synthesis ntawm lipocortins, inhibitors ntawm phospholipase A2 biosynthesis, thiab txo kev tsim ntawm COX-2 hauv kev tsom mus rau ntawm kis. Qhov no ua rau muaj kev txwv tsis pub tso arachidonic acid los ntawm phospholipids ntawm cov cell thiab ua rau kom cov ntshav ua rau nws txo qis (PG, leukotrienes thiab platelet activating factor).

GCS tuaj yeem thaiv txoj kev ua kom loj hlob theem, vim hais tias lawv txwv qhov kev nkag mus ntawm monocytes rau hauv cov nqaij mos, tiv thaiv lawv cov kev koom tes hauv theem no, tiv thaiv cov synthesis ntawm mucopolysaccharides, cov nqaijrog thiab inhibit cov txheej txheem ntawm lymphopoiesis. Nrog rau kev mob sib kis ntawm txoj kev mob caj dab ntawm corticosteroids, muab rau lub cev muaj cov tshuaj tiv thaiv kab mob, nws raug nquahu kom sib txuas nrog kev siv tshuaj tua kab mob.

Qhov ua rau lub cev tiv thaiv kab mob GCS yog vim los ntawm tus lej tsawg thiab cov haujlwm ntawm T-lymphocytes kis hauv cov ntshav, kev txo qis ntawm cov tshuaj tiv thaiv immunoglobulins thiab cov txiaj ntsig ntawm T-pab ntawm B-lymphocytes, kev txo qis ntawm cov ntsiab lus hauv cov ntshav, kev tsim kom muaj kev cuam tshuam ntawm cov tshuaj tiv thaiv tsis txaus thiab ib qho kev cuam tshuam ntawm kev cuam tshuam. Cov.

Cov nyhuv antiallergic ntawm corticosteroids yog vim qhov tsawg dua ntawm cov xovtooj ntawm lub cev, qhov kev ua txhaum ntawm kev cuam tshuam ntawm Fc receptors nyob rau saum npoo ntawm mast cells nrog rau thaj av Fc ntawm IgE thiab C3 cov khoom sib ntxiv, uas txwv tsis pub lub teeb liab nkag mus rau hauv lub cell thiab nrog los ntawm qhov txo qis hauv kev tso tawm ntawm histamine, heparin, thiab serotonin los ntawm cov hlwb. thiab lwm yam kev fab tshuaj kho kom haum xeeb ntawm hom tam sim ntawd thiab tiv thaiv lawv qhov cuam tshuam rau cov hlwb effector.

Qhov txiaj ntsig antishock yog vim muaj kev koom tes ntawm GCS hauv txoj cai tswj hwm lub suab vascular, tawm tsam lawv cov keeb kwm yav dhau los, qhov kev cuam tshuam ntawm cov hlab ntshav mus rau catecholamines nce, uas ua rau muaj kev nce siab hauv cov ntshav siab, dej-ntsev metabolism hauv kev hloov pauv, sodium thiab dej tau khaws cia, ntshav nce thiab hypovolemia poob qis.

Kam taus thiab phiv

Cov pab pawg ntawm cov tshuaj no feem ntau ua rau muaj kev phiv: kev tshem tawm ntawm lub cev lub cev, rov ua dua ntawm cov kab mob sib kis ntev thiab lub plab zom mov yog ua tau. Nrog rau kev siv ntev, kev nce ntxiv hauv cov ntshav siab, kev txhim kho steroid ntshav qab zib, edema, leeg tsis muaj zog, myocardial dystrophy, Itsenko-Cushing's syndrome, adrenal atrophy yog tau.

Qee lub sij hawm thaum noj tshuaj, muaj kev ntxhov siab, pw tsaug zog, mob siab intracranial, mob hlwb. Nrog lub caij nyoog ntev ntawm kev siv cov corticosteroids, kev sib txuas ntawm pob txha thiab calcium-phosphorus metabolism kuj yuav muaj qhov tsis taus, uas thaum kawg ua rau txha txha thiab pob txha lov.

Cov Yuav Tsum Tau Ua

Kev ua haujlwm tsis zoo.
Kev kis mob hnyav.
Kis thiab kab mob fungal.
Mob ntsws kom hnyav.
AIDS
Peptic rwj, mob plab los ntshav.
Cov hom mob ntshav siab.
Itsenko-Cushing's syndrome.
Jade
Syphilis
Mob ntshav qab zib mellitus.
Kab mob hauv
Cev xeeb tub
Kev pub niam mis.
Mob hlwb.
Cov menyuam yau zog.

Thaum ua ntawv thov saum toj no:

Muaj qhov txhab (cov kab mob, kis tau, ua pa) ntawm cov tawv nqaij thiab lub qog ua kua.
Cov qog ntawm daim tawv nqaij.
Ua txhaum ntawm kev ncaj ncees ntawm daim tawv nqaij thiab mucous daim nyias nyias.
Cov menyuam yau zog.

Kev sib txuam

GCS txhim kho cov nyhuv bronchodilating ntawm β-adrenostimulants thiab theophylline, txo cov nyhuv hypoglycemic ntawm insulin thiab cov tshuaj tiv thaiv kab mob hauv lub qhov ncauj, qhov hauj lwm anticoagulant ntawm coumarins (indirect anticoagulants).

Diphenin, ephedrine, phenobarbital, rifampicin thiab lwm yam tshuaj uas ua rau induction ntawm microsomal daim siab ua kom luv luv T1 / 2 GCS. Kev loj hlob hormone thiab antacids txo qhov nqus ntawm corticosteroids. Thaum ua ke nrog kev mob plawv glycosides thiab diuretics, qhov kev pheej hmoo ntawm arrhythmias thiab hypokalemia nce, thaum ua ke nrog NSAIDs, kev pheej hmoo ntawm kev mob plab hnyuv thiab ua kom tshwm sim ntawm lub plab zom mov nce.

Tus mechanism ntawm kev txiav txim thiab lub ntsiab pharmacodynamic teebmeem

Glucocorticoids diffuse hla cov cell mus rau hauv cytoplasm thiab khi rau cov glucocorticoid receptors. Lub txiaj ntsig txoj kev ua kom lub cev nkag mus rau hauv lub keeb thiab txhawb qhov tsim ntawm i-RNA, uas ua rau cov synthesis ntawm cov lej tswj hwm cov protein. Tus nab npawb ntawm cov tshuaj lom neeg lub cev (catecholamines, inflammatory mediators) muaj peev xwm ua kom lub zog ntawm glucocorticoid-receptor complexes, thiaj li txo cov kev ua ntawm glucocorticoids. Qhov cuam tshuam tseem ceeb ntawm glucocorticoids yog raws li hauv qab no.

• Cuam tshuam rau lub cev tiv thaiv kab mob.

- Cov nyhuv tiv thaiv kev tiv thaiv (feem ntau nrog kev ua xua thiab kev tiv thaiv kab mob ntawm lub cev tsis txaus) vim qhov ua haujlwm tsis zoo ntawm PG, RT thiab cytokines, txo qis capillary permeability, tsawg chemotaxis ntawm immunocompetent hlwb thiab inhibition ntawm fibroblast kev ua si.

- Kev tiv thaiv ntawm kev tiv thaiv cellular, tiv thaiv lub cev tiv thaiv kab mob thaum hloov khoom nruab nrog, txo qis kev ua haujlwm ntawm T-lymphocytes, macrophages, eosinophils.

• Ua rau cov metabolism hauv dej-electrolyte metabolism.

- Ncua kev ncua nyob rau hauv lub cev ntawm sodium thiab dej ions (nce rov muaj dua nyob rau hauv lub plab hlaus distal), nquag tshem tawm cov potassium ions (rau cov tshuaj muaj mineralocorticoid kev ua si), nce lub cev hnyav.

- Kev txo qis hauv kev nqus ntawm calcium ions nrog cov zaub mov, qhov txo qis hauv lawv cov ntsiab lus hauv cov pob txha pob txha (mob pob txha), thiab nce ntxiv hauv cov zis.

• Cuam tshuam rau cov txheej txheem metabolic.

- Rau cov lipid metabolism - rov ua dua ntawm cov nqaij adipose (nce ntawm cov rog hauv lub ntsej muag, caj dab, lub xub pwg girdle, plab), hypercholesterolemia.

- Rau cov khoom noj uas ua rau cov metabolism hauv plab - kev ua haujlwm ntawm gluconeogenesis nyob rau hauv daim siab, txo qis permeability ntawm cov cell ua rau qabzib (kev loj hlob ntawm cov ntshav qab zib steroid yog ua tau).

- Rau cov protein metabolism - kev txhawb nqa anabolism hauv lub siab thiab catabolic cov txheej txheem hauv lwm cov ntaub so ntswg, qhov txo qis hauv cov ntsiab lus ntawm globulins hauv ntshav ntshav.

• Cuam tshuam rau CVS - cov ntshav siab ntxiv (mob ntshav steroid) vim cov kua nyeem tau zoo hauv lub cev, qhov nce ntawm qhov ceev thiab qhov mob ntawm adrenoreceptors hauv lub plawv thiab cov hlab ntsha, thiab nce siab ntxiv ntawm cov nyhuv pressor ntawm angiotensin II.

• Cuam tshuam rau cov kab mob hypothalamus-pituitary-adrenal cov qog - cov kev txwv vim qhov kev cuam tshuam tsis zoo lub tswv yim.

• Ua rau cov ntshav - lymphocytopenia, monocytopenia thiab eosinopenia, tib lub sijhawm glucocorticoids txhawb kev loj hlob ntawm cov ntshav liab, ua rau kom tag nrho cov neutrophils thiab platelets (kev hloov pauv ntawm cov roj ntsha muaj pes tsawg leeg tuaj yeem tshwm hauv 6-12 teev tom qab kev tswj hwm thiab mob siab rau kev siv lub sijhawm ntev ntawm cov tshuaj no rau ob peb lub lis piam).

Glucocorticoids rau kev siv ua haujlwm tsis zoo rau hauv dej, zoo nyob rau hauv cov rog thiab lwm cov kuab tshuaj organic. Lawv mob hauv cov ntshav feem ntau hauv cov protein-khi (tsis ua haujlwm) lub xeev. Daim ntawv txhaj tshuaj ntawm glucocorticoids yog lawv cov dej-soluble esters lossis ntsev (succinates, hemisuccinates, phosphates), uas ua rau muaj qhov pib sai ntawm kev ua. Qhov tshwm sim ntawm kev tshem tawm me me-crystalline ntawm glucocorticoids tshwm sim qeeb, tab sis tuaj yeem ntev txog 0.5-1 hlis, lawv tau siv rau kev txhaj tshuaj rau intraarticular.

Glucocorticoids rau lub qhov ncauj tswj hwm tau zoo nqus los ntawm cov hnyuv, C_tah hauv cov ntshav, nws tau sau tseg tom qab 0.5-1.5 teev .Qhov zaub mov ua rau poob qis, tab sis tsis cuam tshuam rau qhov lom neeg ntawm cov tshuaj (tab. 27-15).

KAWM HOM KEV Glucocorticoids LOS NTAWM DAIM NTAWV THOV KEV PAB CUAM

1. Glucocorticoids rau siv tshuaj pleev:

A) rau thov rau ntawm daim tawv nqaij (hauv daim ntawv pleev tshuaj, tshuaj pleev, emulsion, hmoov):

- fluocinolone acetonide (sinaflan, flucinar)

- flumethasone pivalate (lorinden)

- betamethasone (celestoderm B, celeston)

B) rau instillation rau hauv lub qhov muag thiab / lossis pob ntseg, hauv daim ntawv ntawm qhov muag pleev:

- betamethasone n (betamethasone dipropionate, thiab lwm yam.) B) rau kev siv tshuaj txau:

- beclomethasone (beclometh, becotide)

- fluticasone propionate (flixotide)

D) rau kev tswj fwm intraarticular:

D) rau cov kev qhia rau cov ntaub so ntswg:

Kev cuam tshuam txog metabolic

Glucocorticoids muaj qhov ua los tiv thaiv kev ntxhov siab, los tiv thaiv kev poob siab. Lawv cov ntshav nce siab ntxiv nrog kev ntxhov siab, kev raug mob, ntshav poob, thiab qhov ua haujlwm poob siab. Kev nce hauv lawv qib hauv cov xwm txheej no yog ib qho ntawm cov txheej txheem ntawm lub cev kev yoog raws kev ntxhov siab, poob ntshav, sib ntaus tawm tsam kev poob siab thiab kev cuam tshuam ntawm kev mob. Glucocorticoids nce ntshav nce ntshav hauv lub cev, nce rhiab ntawm myocardium thiab vascular phab ntsa rau catecholamines, thiab tiv thaiv desensitization ntawm receptors rau catecholamines ntawm lawv theem. Tsis tas li ntawd, glucocorticoids kuj tseem txhawb cov erythropoiesis hauv cov leeg pob txha, uas pab txhawb kom muaj ntshav nce siab ntxiv.