Cov kev mob tseem ceeb ntawm glucocorticoids

Ntau xyoo dhau los ntawm kev paub txog cov tshuaj glucocorticoid hauv ntau cov kab mob hauv cov menyuam yaus tau pom tias tsis yog qhov zoo xwb, tab sis kuj pom qhov tsis zoo ntawm hom kev kho no. Nws tau pom tias hauv qee cov neeg mob, cov kev mob tshwm sim yog ib ntus thiab me ntsis hais tawm hauv qhov xwm thiab ploj mus yam tsis muaj qhov cim tseg.

Hauv lwm cov menyuam yaus, tom qab raug tshem tawm ntawm glucocorticoid tus neeg sawv cev, cov teeb meem uas tau tshwm sim, qee zaum ua haujlwm hnyav, mob siab rau ntau xyoo, thiab qee zaum thoob plaws lub neej. Qhov xwm txheej thiab mob hnyav ntawm qhov tshwm sim tsis zoo thiab cov teeb meem nyob ntawm qhov koob tshuaj txhua hnub thiab lub sijhawm rau kev kho mob nrog rau cov tshuaj glucocorticosteroid, hnub nyoog ntawm tus menyuam thiab tus yam ntxwv ntawm qhov tshwm sim ntawm nws lub cev.

Cov txheej txheem ntawm cov kev mob tshwm sim los ntawm glucocorticosteroids yog cov nyuaj, vim tias cov tshuaj no nkag mus rau txhua qhov ntawm cov haujlwm tseem ceeb ntawm tus menyuam lub cev. Txawm li cas los xij, ib qho tsis tuaj yeem tham txog cov tshuaj lom thiab ua rau muaj kev cuam tshuam los ntawm cov tshuaj no, hais txog lawv lub peev xwm los txhawm rau ua txhaum lub xeev ntawm kev tiv thaiv kab mob, ua rau cov ntaub so ntswg puas tsuaj thiab inhibit cov txheej txheem tsim dua tshiab hauv lawv, cuam tshuam loj heev cov metabolism. Kev phiv tshuaj thiab cov kev phom sij rau kev kho cov menyuam yaus uas muaj glucocorticosteroids tuaj yeem ua raws li hauv qab no.

1.Ib qho kev nquag tshwm sim ntawm cov tshuaj hypercorticism uas tsim los hauv tus menyuam lub cev yog Cushingoid syndrome: qhov hnyav nce nrog cov tsos mob ntawm kev rog peculiar (puag ncig lub ntsej muag, ntau dhau ntawm kev tso cov rog ntawm lub ntsej muag, caj dab, xub pwg, plab) hauv kev sib xyaw nrog hypertrichosis, tawm hws lossis daim tawv nqaij qhuav, nws cov pigmentation, nce vascular txawv txav ntawm daim tawv nqaij, cov tsos ntawm pob txuv thiab striae.

Cov rog rog zuj zus (txiv neej hom kev rog) yog txuam nrog cov txiaj ntsig catabolic ntawm cov tshuaj glucocorticosteroid, cov txheej txheem gluconeogenesis ntau ntxiv, thiab kev hloov pauv ntawm carbohydrates rau cov rog. Kev txwv tsis pub cov rog hloov txheej txheem tsim los ntawm kev loj hlob hormone tseem ceeb heev.

2. Cov kev mob tshwm sim tsis zoo rau kev tswj hwm ntawm glucocorticosteroids yog lub npe hu ua steroid gastritis, uas pom los ntawm kev tsis zoo hauv qab los noj mov, kub siab, xeev siab, qee zaum ntuav, acid belching, mob hauv thaj av epigastric.

Qhov kev tsis sib haum xeeb hauv daim ntawv ntawm kev ua kom viav vias thiab mob voos ntawm lub plab thiab duodenum kuj muaj peev xwm (lawv kuj tuaj yeem tshwm sim hauv cov hnyuv me thiab loj). Kev mob plab zom mov thiab mob hnyuv nrog qee zaum ua rau muaj ntshav tawm los thiab txos. Nws yuav tsum raug sau tseg tias kev mob plab thiab mob hnyuv ntawm cov theem pib ntawm lawv tsim yuav ua asymptomatic, thiab lub cim ntawm lawv lub neej yog qhov tshwm sim zoo rau cov ntshav tshwm sim hauv cov quav.

Ntau zaus, kev mob plab hnyuv tshwm tuaj tom qab noj cov tshuaj glucocorticosteroid sab hauv, txawm hais tias lawv txoj kev txhim kho tsis suav nrog kev tswj hwm kev coj ntawm cov tshuaj no. Qhov tshwm sim ntawm cov txheej txheem ulcerative feem ntau yuav tshwm sim thaum sau ntawv ntawm prednisone thiab prednisone, tshwj xeeb tshaj yog ua ke nrog lwm cov kab mob ulcerogenic (immunosuppressants, acetylsalicylic acid, tetracyclines, thiab lwm yam).

Lwm yam ua rau muaj qhov mob rwj:

Noj tshuaj glucocorticosteroids ua ntej noj mov,

Lub sijhawm ntev tswj hwm ntawm kev siv cov tshuaj ntau ntau yam tsis muaj kev cuam tshuam hauv kev kho,

Kev tsis ua raws li kev noj haus hauv lub sijhawm kawm glucocorticosteroid txoj kev kho (noj cov ntsim thiab ua zaub mov tawv, txuj lom, khoom noj txias lossis kub, thiab lwm yam).

Glucocorticosteroids ua rau kev tsim cov mob ntawm lub plab thiab txoj hnyuv vim yog vim li cas hauv qab no:

Lawv nce lub acidity thiab tso pa tawm ntawm cov kua txiv zom thiab ua rau lub sijhawm cuam tshuam ntawm kev tsim cov hnoos qeev, uas tiv thaiv cov leeg ntawm lub plab thiab cov hnyuv los ntawm kev puas tsuaj (cov synthesis ntawm polysaccharides uas ua rau cov qog ua ke ntawm lub plab thiab cov hnyuv yog inhibited),

· Glucocorticosteroids ua rau lub zog kho tsis zoo ntawm cov kab mob me me - thiab macro mob ntawm lub plab thiab cov hnyuv, uas yog, nyob rau hauv lawv txoj kev cuam tshuam loj hlob ntawm cov hlwb ntawm cov glandular thiab cov nqaij sib txuas ntawm cov phab ntsa ntawm cov plab hnyuv siab raum yog inhibited. Cov kev kawm asymptomatic (tsis mob) ntawm cov txheej txheem ulcerative tau piav qhia los ntawm qhov tseeb tias kev mob plab tshwm sim tiv thaiv keeb kwm yav dhau los tiv thaiv kev tiv thaiv ntawm glucocorticosteroid tshuaj.

3. Hauv kev coj ntawm cov tshuaj glucocorticosteroid, kev ua kom tsis zoo ntawm cov mob focal (tonsillitis, sinusitis, hniav lwj, cholecystitis thiab lwm tus), kev pom dav dav ntawm cov txheej txheem sib kis tuaj yeem pom. Cov neeg muaj mob ntsws thiab mob ntsws ntsws muaj mob muaj keeb kwm txaus, nthuav dav ntawm cov kab mob mus ntev (mob siab, cholecystitis, pancreatitis, mob ntsws thiab lwm yam) tau piav qhia.

Nws raug sau tseg tias kev teem sijhawm rau glucocorticosteroids ua rau muaj kev phom sij ntau dua ntawm cov menyuam yaus, ua rau muaj kev cuam tshuam ntau dua ntawm kev txhaj tshuaj. Cov kev mob tshwm sim saum toj no tau piav qhia los ntawm kev muaj peev xwm ntawm glucocorticosteroids mus rau kev tiv thaiv cov kab mob hauv nruab nrab thiab hauv zej zog.

4. Hauv kev kho mob nrog glucocorticosteroids, kev hloov pauv ntawm lub hlwb thiab lub siab ntsws muaj peev xwm: kev ua haujlwm hauv lub siab, logorrhea, psychomotor ntxhov siab, pw tsaug zog. Cov kev hloov pauv ntawm menyuam yaus no yog qhov thim rov qab.

5. Ib qho kev tshwm sim tsis zoo nrog kev kho glucocorticosteroid yog kev nce ntshav ntxiv. Tom qab tso tawm hauv tsev kho mob, mob ntshav tawm hauv cov neeg mob hla, txawm hais tias nyob rau qee tus menyuam yaus cov ntshav nce siab li 15 - 20 hli RT. Kos duab. mob tsuam ntev txog li 1 txog 3 xyoos yog tias muaj kev tsis txaus siab twg (A. V. Dolgopolova, N. N. Kuzmina, 1963).

Tus txheej txheem ntawm txoj hlab ntshav hauv txoj kev kho mob hypercorticism tseem tsis meej. Ntau zaus, xws li cov tshuaj tiv thaiv tau muab sau tseg ntawm prepubertal thiab puberty.

6. Qee qhov glucocorticosteroids (cortisone, hydrocortisone, prednisone, prednisone) muaj peev xwm tuav tau sodium thiab dej hauv tus neeg mob lub cev, uas ua rau pom kev ntawm edema thiab nce hauv lub cev qhov hnyav. Cov tshuaj glucocorticosteroid zoo li dexamethasone, triamcinolone, methylprednisolone tsis qeeb sodium thiab dej.

7.Nrog kev kho loj thiab ntev ntev glucocorticosteroid txoj kev kho hauv cov ntxhais hluas, cov kev tso cov ntshav endocrine feem ntau pom: kev ncua sijhawm zoo li ntawm thawj zaug kev coj khaub ncaws, lawv cov lus tsis meej, thaum lawv tau tsim tsa lawm. Nws yog ib qho tsim nyog yuav tsum xam nrog qhov no thiab tsis muaj qhov taw qhia nruj me ntsis tsis txhob sau cov tshuaj no rau cov ntxhais nyob rau lub sijhawm tiav nkauj tiav nraug, ncua tseg thaum thawj cov cim ntawm cov kev tsis zoo tshwm sim no

8. Cov ntawv sau ua pov thawj pom tias nyob rau hauv kev tswj hwm ntawm kev saib xyuas ntev ntawm cov tshuaj glucocorticosteroid, kev rov qab loj hlob ntawm tus menyuam lub cev tuaj yeem tshwm sim. Qhov tshwm sim no tau piav qhia los ntawm cov tshuaj tiv thaiv kab mob glucocorticosteroids rau kev tsim cov tshuaj loj hlob los ntawm lub caj pas pituitary thiab kev tsim cov somatomedin hauv lub siab, kev nce ntxiv hauv catabolic cov txheej txheem hauv cov nqaij, nrog rau pob txha.

9. Hauv cov menyuam yaus, ntshav qab zib mellitus tuaj yeem tsim los ntawm cawv ntawm glucocorticosteroids los ntawm ntshav qab zib.

Tus txheej txheem ntawm kev tsim cov tshuaj ntshav qab zib steroid yog txuam nrog cov yam ntxwv ntawm kev nqis tes ntawm cov tshuaj glucocorticosteroid ntawm metabolism metabolism: lawv inhibit qhov ua haujlwm ntawm cov ua haujlwm tsis tseem ceeb ntawm cov neeg txiav ntshav, txhawb kev tsim cov insulin-khi cov ntshav plasma protein, ua kom cov txheej txheem ntawm cov kua nplaum tsim los ntawm amino acids thiab tib lub sijhawm ua kom tsis muaj zog ntawm kev siv carbohydrates los ntawm cov ntaub so ntswg.

Thaum kawg, hyperglycemia thiab glucosuria tsim, thiab nyob rau hauv cov menyuam yaus nrog kev muaj mob muaj txiaj ntsig ntawm cov tsis muaj peev xwm ntawm cov cuab yeej tsis muaj peev xwm - ntshav qab zib. Hauv feem ntau ntawm cov neeg mob, tom qab tshem tawm ntawm glucocorticosteroids, carbohydrate metabolism yog li qub. Dexamethasone muaj peev xwm ua rau muaj kev cuam tshuam tshwj xeeb tshaj yog ua rau cov metabolism hauv kev ua kom yuag, muaj tsawg dua li triamcinolone, methylprednisolone, prednisolone, prednisone. Mob ntshav qab zib tsawg kawg yog yam ntxwv ntawm cortisone thiab hydrocortisone.

10. Ib qho kev tshwm sim tsis zoo ntawm tus me nyuam lub cev rau kev tswj hwm ntawm glucocorticosteroids yog nce lub cev muaj zog ntawm cov poov tshuaj hauv cov zis thiab kev txhim kho ntawm hypokalemic syndrome.

Cov cim ntawm lub tom kawg: kev hnov ​​mob tsis muaj zog, malaise, poob ntawm cov leeg nqaij thiab lub zog (qee zaum paresis ntawm nqua), ua kom tsis muaj zog ntawm myocardial kev ua haujlwm, mob plawv dhia tsis xwm yeem, xeev siab, ntuav, cem quav.

Lub sijhawm ntawm kev txhim kho hypokalemic mob nce ntxiv nrog kev tswj hwm ntawm glucocorticosteroids nrog kev sib txuas ntawm cov mob glycosides thiab diuretics, thaum tsis quav ntsej cov poov tshuaj noj thiab tsis them nyiaj txaus rau cov tshuaj pharmacogenic potassium poob vim kev tswj hwm ntxiv ntawm cov tshuaj tua kab mob potassium.

11. Ntau qhov kev soj ntsuam tau txiav txim siab pom tias muaj cov kev tsis zoo ntawm cov tshuaj glucocorticosteroid rau cov pob txha ntawm lub cev ntawm cov menyuam yaus lub cev loj hlob. Steroid osteopathy qhia nyob rau hauv cov tsos ntawm txha os feem ntau tubular cov pob txha ntev, pob tw thiab vertebral lub cev. Feem ntau, txoj kev loj hlob ntawm epiphyseal pob txha mos yog ntxhov, qee zaum cov tsos mob aseptic necrosis ntawm cov pob txha tshwm.

Ib qhov teeb meem loj heev yog brevispondylia: kev tsim ntses ntses pob txha caj qaum (vim yog kev rhuav tshem lub pob txha caj qaum lub cev thiab intervertebral disc), tom qab los ntawm kev ua txhaum kev ua txhaum ntawm cov leeg cag, ib qho kev puas tsuaj ntawm lub nraub qaum, thiab muaj zog ntawm pob txha caj qaum.

Steroid osteopathy yog qhov txiaj ntsig ntawm kev ua txhaum tag nrho hauv kev ua ke ntawm cov qauv protein ntawm cov pob txha nqaij (txo qis ntawm collagen, mucopolysaccharides, hexosamine), cov txheej txheem ntau ntxiv ntawm reabsorption ntawm calcium los ntawm cov pob txha nqaij thiab ntau dhau ntawm nws thiab phosphorus hauv cov zis. Cov txheej txheem rov ua hauv cov pob txha nqaij ntawm cov neeg mob mob steroid osteopathy yog tus yam ntxwv nkees thiab ntev.

12. Hauv qee tus neeg mob, myopathy muaj nyob rau hauv kev cuam tshuam ntawm cov tshuaj glucocorticosteroid.

Cov tsos mob ntawm nws: cov leeg tsis muaj zog (feem ntau yog nyob rau ntawm qhov tsis sib thooj qis qis kawg thiab cov leeg lub cev), hypotension, txo leeg leeg tsis nco qab. Ntawm kev tshuaj xyuas, koj tuaj yeem pom cov cim ntawm cov leeg nqaij (hypertrophy), tshwj xeeb tshaj yog cov qis qis (cov ntsiab lus glycogen hauv cov leeg mob nce). Qhov kev ua txhaum ntawm cov qauv ntawm neuromuscular synapses tau pom tseeb. Triamcinolone muaj tshuaj fluorine feem ntau ua rau myopathy. Steroid myopathy tom qab tshem tawm tshuaj maj ploj mus, thiab txoj haujlwm thiab cov qauv ntawm cov leeg yog rov qab los ntawm kab noj hniav.

13. Kev siv cov glucocorticosteroids (tshwj xeeb tshaj yog nyob rau hauv kev tswj hwm mus ntev ntawm kev siv tshuaj ntau) yog fraught nrog kev phom sij ntawm cov teeb meem tshwm sim los ntawm cov khoom hauv nruab nrog ntawm kev pom kev hauv daim ntawv ntawm clouding ntawm lub lens thiab glaucoma. Cov kev hloov pauv ntawm lub lens tuaj yeem hloov tsis tau vim qhov encapsulation ntawm aqueous kev lom zem, kev cog lus ntawm nraub qaum nws. Glaucoma thaum yau yog yam tsis tshua muaj.

14. Txawm hais tias cov tshuaj glucocorticosteroid yog qhov muaj txiaj ntsig zoo rau kev ua xua, nyob rau qee qhov lawv tus kheej tsim cov tshuaj tiv thaiv kev ua xua, nce mus rau qhov tsis txaus ntseeg anaphylactic. Cov kev cuam tshuam zoo li no feem ntau tshwm sim nrog cov kev kawm ntxiv ntawm glucocorticosteroid txoj kev kho thiab nthuav qhia lawv tus kheej hauv daim ntawv ntawm urticaria, Quincke's edema, erythema multiforme, khaus tawv nqaij thiab lwm yam cim.

15. Kev siv tshuaj ntev ntev ntawm glucocorticosteroid thiab cov txiaj ntsig ntawm lub xeev ntawm pharmacogenic hypercorticism yog fraught nrog kev phom sij ntawm kev cuam tshuam ntawm kev ua haujlwm ntawm cov cortical txheej ntawm cov qog adrenal thiab tsim kho kev rov kho dua ntawm cov kab mob hypothalamic-gynephysial-adrenal.

Tawm tsam cov keeb kwm yav dhau los no, nrog kev tshem tawm sai ntawm cov tshuaj, tshem tawm cov tsos mob tuaj yeem tshwm sim ua ib qho kev tawm tsam ntawm qhov tsis muaj zog, tsis muaj zog, mob taub hau, poob qis ntawm lub hlwb thiab lub cev, thiab qhov kub nce hauv lub cev.

Qhov kev tshem tawm tus mob yog qhov txaus ntshai tshwj xeeb tshaj yog thaum cov thawj coj loj ntawm glucocorticosteroids nres yam tsis muaj kev npaj ua ntej ntawm tus neeg mob lub cev, uas yog, tsis muaj qhov maj mam txo qis hauv cov tshuaj txhua hnub, kev qhia txog tshuaj tua kab mob uas ua rau lub luag haujlwm ntawm adrenal cortex.

Yog li, pab pawg ntawm cov tshuaj glucocorticosteroid yog tus cwj pwm tsis yog tsuas yog los ntawm nws muaj peev xwm kho tau zoo rau tus neeg mob lub cev, tab sis kuj los ntawm ntau qhov kev tshwm sim tsis zoo, qhov mob hnyav thiab qhov tseem ceeb ntawm uas nyob ntawm ob qho tshuaj yeeb nws tus kheej, cov qauv ntawm nws siv, lub hnub nyoog thiab kev sib deev ntawm tus menyuam, thiab lwm yam cuam tshuam, hmoov tsis. tseem tsis tau kawm.

Pharmacological txoj kev kho rau HA tuaj yeem siv zog (luv luv), txwv (ntau hnub lossis ntau hlis) thiab ntev-ntev (kev kho mob rau ntau lub hlis, xyoo, lossis tseem tas lub neej).

Tsis pom qhov koj tab tom nrhiav? Siv txoj kev tshawb:

Kev phiv los ntawm cov kab mob glucocorticoids

Cov txheej txheem

Sab sij huam
Hibition Kev txwv tsis zoo ntawm kev ua haujlwm thiab atrophy ntawm adrenal cortex, kev siv tshuaj steroid, "tshem tawm cov tsos mob" (exacerbation ntawm qhov mob qis, adrenal tsis txaus). Kev kho mus sij hawm ntev ntev nrog cov kab ke glucocorticoids, tshwj xeeb tshaj yog ua rau tsis suav mus rau hauv tus account lub cev circadian rhythms ntawm lawv qhov tso tawm, ua rau inhibition thiab atrophy ntawm adrenal cortex. Kev ua kom tiav kev cuam tshuam ntawm cov qog adrenal cortex hauv tus neeg mob laus, cov tshuaj txhua hnub ntawm exogenous glucocorticoid yuav tsum yog 10-20 mg nyob rau hauv cov nqe lus ntawm prednisone. Kev poob qis hauv qhov ua haujlwm ntawm adrenal cortex pib thaum 4 - 7 hnub ntawm kev siv txhua hnub ntawm cov tshuaj nruab nrab ntawm glucocorticoids thaum lawv tau kho thaum sawv ntxov thiab txij li hnub thib thaum lawv tau muab tshuaj rau yav tsaus ntuj. Qhov kev mob tshwm sim no yog feem ntau ntawm tus yam ntxwv ntawm lub qhov ncauj ntev ntev ntawm lub cev glucocorticoids thiab depot npaj. Txhawm rau rov qab ua haujlwm li qub tsis pub lwm tus ua ntawm adrenal cortex, tsawg kawg 6-9 lub hlis yuav tsum tau ua, thiab nws cov lus teb txaus rau kev ntxhov siab yog txog 1-2 xyoos.

■ thinning ntawm daim tawv nqaij, striae, do hau.
■ Kev mob pob txha, pob txha lov thiab mob aseptic necrosis ntawm cov pob txha, kev mob hlwb sai. Txha caj qaum mob hauv 30-50% ntawm cov neeg mob thiab yog qhov hnyav tshaj plaws ntawm kev kho mob glucocorticoid. Nws yog vim lawv qhov tsis zoo rau kev tsim cov pob txha nqaij thiab kev ua kom zoo ntawm nws resorption. Feem ntau muaj kev loj hlob hauv cov poj niam hauv lub sijhawm postmenopausal. Raws li txoj cai, osteoporosis cuam tshuam rau hauv nruab nrab ntawm lub cev pob txha (mob nraub qaum, pob txha pob txha, pob tw) thiab maj mam kis mus rau cov leeg pob txha (txhais tes, ko taw, thiab lwm yam). cov chaw haujlwm), tav, caj dab poj niam, tshwm sim los ntawm kev raug mob me lossis tshwm sim ntuag. Txhawm rau kho qhov kev tsis txaus siab no, kev npaj tshuaj calcium, vitamin D3, calcitonin, thiab bisphosphonates siv. Lub sijhawm ntawm kev kho mob yuav tsum yog ob peb xyoos.
• Myopathy, leeg nkim, myocardial dystrophy. Steroid myopathies tshwm sim los ntawm qhov tsis muaj zog thiab atrophy ntawm cov leeg pob txha, nrog rau cov leeg ua pa (intercostal leeg, diaphragm), uas ua rau muaj kev txhim kho kev ua pa tsis ua haujlwm. Feem ntau, qhov kev cuam tshuam no ua rau triamcinolone. Cov txheej txheem ntawm kev txhim kho ntawm myopathies cuam tshuam nrog qhov tsis zoo ntawm glucocorticoids ntawm cov protein thiab ntxhia metabolism. Cov tshuaj anabolic steroids thiab potassium npaj siv rau lawv kho.
Yp Kev mob siab tsis haum, sodium thiab dej cia, edema yog qhov kev tshwm sim ntawm mineralocorticoid cuam tshuam ntawm glucocorticoids.
Be Kev ntsuas ntshav nce siab tuaj yeem pom hauv cov neeg mob noj glucocorticoids ntev. Nws yog vim muaj kev cuam tshuam ntau ntxiv ntawm cov vascular phab ntsa mus rau catecholamines, sodium thiab dej cia.
■ Kev puas tsuaj rau phab ntsa vascular nrog kev txhim kho ntawm "steroid vasculitis" feem ntau tshwm sim los ntawm cov tshuaj fluorinated (dexamethasone thiab triamcinolone). Nws yog tsiag ntawv los ntawm nce vascular permeability. Nws yog pom tshwm los ntawm hemorrhages nyob rau hauv daim tawv nqaij ntawm forearms, mucous daim nyias nyias ntawm qhov ncauj kab noj hniav, pom ntawm lub qhov muag, epithelium ntawm lub plab zom mov. Rau kev kho mob, cov vitamins C thiab P, ntxiv rau tshuaj tiv thaiv kab mob vog leeg hauv leeg ntshav liab tau siv.
Kev nce ntxiv ntawm cov ntshav coagulability tuaj yeem ua rau cov ntshav txhaws nyob rau hauv cov hlab ntsha tob tob thiab mob heev.
Ua kom cov nqaij mos ua kom rov ua dua vim qhov kev tiv thaiv anabolic thiab catabolic rau cov metabolism hauv protein - txo cov protein synthesis ntawm cov amino acids, ua kom cov protein tsis zoo.
■ Steroid mob ntawm lub plab thiab hnyuv, mob plab zom mov. Kev kho mob hauv plab yog feem ntau asymptomatic lossis asymptomatic, ua kom pom kev los ntshav thiab perforation. Yog li, cov neeg mob uas tau txais qhov ncauj glucocorticoids rau lub sijhawm ntev yuav tsum tau kuaj xyuas tsis tu ncua (fibroesophagogastroduodenoscopy, fecal occult blood test). Lub tshuab ua haujlwm ntawm ulcerogenic ntawm glucocorticoids cuam tshuam nrog lawv cov nyhuv catabolic thiab kev txhawb zog ntawm prostaglandin synthesis thiab muaj nyob rau hauv kev ua kom muaj kev zais ntawm hydrochloric acid, txo cov kev tsim cov hnoos qeev thiab inhibiting cov kev tsim kho tshiab ntawm epithelium. Qhov kev mob hnyav no feem ntau tshwm sim los ntawm kev kwv yees.
■ Pancreatitis, nplooj siab rog, rog rog, hyperlipidemia, hypercholesterolemia, rog embolism yog qhov tshwm sim ntawm cov txiaj ntsig anabolic ntawm glucocorticoids rau cov roj metabolism - ua kom muaj zog ntau dua ntawm triglycerides, cov rog rog thiab cov roj cholesterol, faib cov rog rog.
CN Muaj kev tiv thaiv CNS ntau ntxiv, pw tsis tsaug zog, zoo siab, mob siab ntsws, mob hlwb, cov tsos mob ntawm cov leeg hlwb, qaug dab peg hauv cov neeg mob vwm.
■ Posterior subcapsular cataract, glaucoma, exophthalmos.
Ter Steroid mob ntshav qab zib, hyperglycemia. Glucocorticoids nce ntxiv rau kev nqus ntawm carbohydrates los ntawm kev mob plab, txhim kho gluconeogenesis, txo qis kev ua haujlwm ntawm insulin thiab hexokinase, thiab txo qhov rhiab ntawm cov ntaub so ntswg mus rau insulin thiab kev siv cov ntshav qabzib. Txog rau kev kho mob ntshav qab zib steroid, kev noj haus uas tsis pub rog (carbohydrate-txwv tsis pub noj), tshuaj noj qhov ncauj hypoglycemic, thiab tshuaj insulin yog siv.
Ol Kev ua txhaum ntawm lub cev ntas, kev ua haujlwm ntawm kev sib deev, ncua kev sib deev, hirsutism, kev loj hlob tsis zoo ntawm tus menyuam yog cuam tshuam nrog kev txo qis hauv kev tsim cov txiv neej kev sib deev.
■ Kev tiv thaiv ntawm kev tiv thaiv kab mob, kev ua kom tshem tawm cov kab mob sib kis thiab mob, nrog rau mob ntsws, kev kis mob thib ob, kev hais txog tus kab mob hauv zos. Raws li txoj cai, kev sib kis kis yog asymptomatic vim muaj cov tshuaj tiv thaiv ntawm glucocorticoids. Kev loj hlob ntawm candidiasis ntawm lub qhov ncauj kab noj hniav thiab pharynx yog yam ntxwv.
Ushing Cushing's syndrome (kev sib sau los ntawm cov rog los ntawm cov roj subcutaneous ntawm cov nqaj, txhawm dhau ntawm cov rog hauv lub ntsej muag, caj dab, lub xub pwg girdle thiab lub plab, hypertrichosis, striae, pob txuv, ua rau lub siab tsis ua hauj lwm zoo.)
■ Hematologic hloov.
Qhia txog ntshav siab neutrophilic tsis muaj qhov hloov ntawm leukocyte mis rau sab laug. Nws ntseeg tau hais tias lawv yog vim qhov kev txhawb ntawm cov tshuaj steroids ntawm granulopoiesis.

Kev Tiv Thaiv Cov Teeb Meem

Siv cov txheej txheem kho mob cuam tshuam ib ntus (sib hloov).
Kev siv cov ntshav qab zib hauv lub cev glucocorticoids tsawg kawg ntawm kev txhaj tshuaj. Rau qhov no, hauv kev mob ntsws asthma, lawv txoj kev tswj hwm yuav tsum tau ua ke nrog kev siv tshuaj tiv thaiv kab mob glucocorticoids nrog kev ua haujlwm ntev β2-adrenergic agonists, theophylline, lossis tshuaj antileukotriene.
Kev tswj hwm ntawm glucocorticoids nyob rau hauv raws li lub zog txhua hnub kev sib tw ntawm cortisol zais cia.
Kev siv cov zaub mov uas muaj protein ntau thiab calcium, nrog rau kev txwv ntawm kev zom cov zaub mov kom yooj yim, ntsev (txog 5 g ib hnub) thiab kua (txog 1.5 litres ib hnub).
Tablet Kev noj cov ntsiav tshuaj glucocorticoids tom qab noj mov kom txo lawv cov nyhuv ulcerogenic.
■ Kev tshem tawm kev haus luam yeeb thiab quav dej quav cawv.

Exercise Kev qoj ib ce tsis sib haum.

Lub tswvyim ntawm glucocorticoids, lawv qhov kev siv ua tshuaj, kev faib tawm los ntawm cov qauv thiab kev ua. Txoj kev ntawm kev coj ua ntawm kev coj ua thiab kev ua kom zais ntawm cov tshuaj hormones ntawm adrenal cortex Cov txheej txheem ntawm kev ua ntawm glucocorticoids, cov kev mob tshwm sim lub ntsiab los ntawm lawv siv.

Xa koj cov haujlwm zoo rau hauv kev paub kev paub yog yooj yim. Siv daim ntawv hauv qab no

Cov tub ntxhais kawm, cov tub ntxhais kawm kawm tiav, cov tub ntxhais hluas tshiab uas siv kev paub hauv lawv txoj kev kawm thiab kev ua haujlwm yuav zoo siab rau koj.

Muab lo rau http://www.allbest.ru/

Ministry of Health ntawm Ukraine

Zaporizhzhya State Medical University

Lub Tsev Haujlwm Saib Xyuas Tshuaj thiab Tshuaj Kho Mob

Los ntawm cov ntsiab lus: "Pharmacology"

Ntawm cov ncauj lus: "Phiv los ntawm glucocorticoids"

Ua tiav: tub ntxhais kawm xyoo 3

Saiko Roman Eduardovich

1. Kev faib tawm ntawm glucocorticoids

2. Cov txheej txheem ntawm kev ua ntawm glucocorticoids

3. Kev siv ntawm glucocorticoids

4. Qhov tseem ceeb tshwm sim los ntawm cov glucocorticoids

5. Kev tiv thaiv kev phiv los ntawm glucocorticoids

Daim ntawv teev npe

1.Kev faib hom Glucocorticoidhauv

Glucocorticoids yog cov tshuaj hormones steroid los ntawm cov adrenal cortex. Ntuj glucocorticoids thiab lawv cov tshuaj tiv thaiv hluavtaws tau siv rau hauv cov tshuaj rau adrenal tsis txaus. Tsis tas li ntawd, qee cov kab mob siv cov tshuaj tiv thaiv, tiv thaiv kev tsis haum, tiv thaiv kev ua xua, tiv thaiv poob siab thiab lwm yam khoom ntawm cov tshuaj no.

Thaum pib ntawm kev siv glucocorticoids ua tshuaj (PM) hnub rov qab rau 40s. XX caug xyoo. Rov qab rau hauv lub 30s lig. ntawm lub xyoo pua xeem, nws tau qhia tias cov tshuaj hormones keeb kwm ntawm cov tshuaj steroid yog tsim nyob rau hauv adrenal cortex. Xyoo 1937, mineralocorticoid deoxycorticosterone tau cais tawm ntawm adrenal cortex, hauv 40s. - glucocorticoids cortisone thiab hydrocortisone. Ntau qhov cuam tshuam ntawm kev siv tshuaj ntawm hydrocortisone thiab cortisone tau txiav txim siab qhov tseem ntawm lawv txoj kev siv tshuaj. Tsis ntev lawv cov tshuaj tiv thaiv tau nqa tawm.

Glucocorticoid lub ntsiab thiab tseem ceeb tshaj plaws tsim nyob hauv tib neeg lub cev yog hydrocortisone (cortisol), lwm cov tsis tshua muaj siab ntseeg tau sawv cev los ntawm cortisone, corticosterone, 11-deoxycortisol, 11-dehydrocorticosterone.

Kev tsim cov tshuaj hormones los ntawm cov qog adrenal yog nyob rau ntawm kev tswj hwm ntawm lub hauv nruab nrab ntawm cov hlab ntsha leeg thiab tau ze ze rau kev ua haujlwm ntawm lub qog pituitary (saib Daim Duab 2). Adrenocorticotropic pituitary hormone (ACTH, corticotropin) yog lub zog kev xav ntawm lub adrenal cortex. Corticotropin txhim kho kev tsim thiab kev zais ntawm glucocorticoids. Qhov kawg, nyeg, cuam tshuam rau lub caj pas pituitary, inhibiting zus tau tej cov corticotropin thiab yog li txo qis ntxiv kev cuam tshuam ntawm cov qog adrenal (los ntawm cov ntsiab lus tsis zoo). Kev siv lub sijhawm ntev ntawm glucocorticoids (cortisone thiab nws cov analogues) rau hauv lub cev tuaj yeem ua rau inhibition thiab atrophy ntawm adrenal cortex, ntxiv rau inhibition ntawm kev tsim ntawm tsis tsuas yog ACTH, tab sis kuj gonadotropic thiab cov thyroid-txhawb cov pituitary cov tshuaj hormones.

Daim duab.Kev faib tawm ntawm glucocorticoids thiab cov hau kev rau lawv siv

Daim duab.Txoj kev ntawm kev tswj ntawm kev coj ua thiab tso pa tawm ntawm cov tshuaj hormones ntawm adrenal cortex

Txij li thaum 50s ntawm lub xyoo pua xeem, glucocorticoids tau nyob hauv qhov chaw tseem ceeb hauv ntau qhov ntawm cov tshuaj thiab, saum toj no tag nrho, hauv kev kho kom zoo. Cov kev sib txuas ntawm cov ntaub ntawv ntawm glucocorticoids rau kev tswj hwm ntawm cov leeg thiab intramuscular nthuav dav tau muaj peev xwm ntawm kev kho glucocorticoid. Xyoo 15-20 xyoo dhau los, peb lub tswv yim hais txog cov txheej txheem ntawm kev ua ntawm glucocorticoids tau nthuav dav, thiab tseem muaj qhov hloov pauv ntawm kev siv cov glucocorticoids, suav nrog kev noj tshuaj, txoj kev khiav, kev siv sijhawm thiab kev sib txuas nrog lwm cov tshuaj.

Kev siv cov glucocorticoids hauv kev kho mob hauv tsev kho mob tau pib thaum xyoo 1949, thaum lub sijhawm luv luv zoo ntawm cortisone rau cov neeg mob uas muaj mob caj dab ua ntej tshaj tawm. Xyoo 1950, tib pawg tshawb fawb qhia txog cov txiaj ntsig zoo ntawm kev kho mob rheumatoid, mob rheumatism thiab lwm yam mob rheumatic nrog cortisone thiab adrenocorticotropic hormone (ACTH). Tsis ntev, cov ntawv sau qhia tau nthuav dav cov nyhuv ci ntsa iab ntawm glucocorticoid txoj kev kho rau cov kab mob lupus erythematosus (SLE), dermatomyositis, thiab vasicitis.

Niaj hnub no, glucocorticoids, txawm hais tias muaj kev pheej hmoo siab ntawm kev mob tshwm sim (suav nrog cov mob loj), nyob twj ywm rau hauv cov hauv paus kev kho mob ntawm ntau cov kab mob rheumatic. Tsis tas li ntawd, lawv tau siv dav hauv ntau cov kab mob hematological, thawj thiab theem nrab glomerulonephritis, nrog rau ntau lub plab zom mov thiab mob ua pa, muaj mob ua xua, poob siab ntawm ntau lub hauv paus thiab ntau dua. Kev sib txuas ntawm cov tshuaj glucocorticoids rau kev tso quav, intramuscular thiab intraarticular siv tau nthuav dav cov kev txwv thiab kev siv ntawm lawv siv.

Adrenal corticosteroids muab faib ua ob hom loj - glucocorticoids thiab mineralocorticoids. Lub qub muaj qhov cuam tshuam rau yuav luag txhua yam hauv nruab nrog cev thiab kab ke ntawm lub cev, los ntawm kev cuam tshuam cov txheej txheem nruab nrab ntawm lub cev, ua haujlwm lub cev tsis muaj zog thiab ua rau lub cev tsis haum. Kev ua haujlwm tseem ceeb ntawm mineralocorticoids yog tswj kev ua kom ntsev-ntsev cov metabolism.

Cov kev siv dav dav ntawm glucocorticoids yog qhov kev txhawb nqa los ntawm lawv lub zog los tiv thaiv kev txhim kho, tiv thaiv kab mob thiab tiv thaiv kev ua xua.

Nyob rau ntawm 1 European Symposium txog kev kho glucocorticoid, nws raug nquahu kom siv cov lus glucocorticoids lossis glucocorticosteroids. Lwm cov lus - "steroids", "corticosteroids", "corticoids" yog qhov dav heev lossis tsis txaus, thiab vim li no nws tsis pom zoo kom siv.

Hauv cov kev soj ntsuam niaj hnub no, tshwj xeeb hluavtaws glucocorticoids siv, uas muaj qhov tseem ceeb los tiv thaiv, tiv thaiv kab mob thiab kev ua xua nrog kev ua kom tsis muaj zog lossis txawm tias xoom mineralocorticoid cov teebmeem, thiab yog li ntawd lawv yog ntawm cov tshuaj siv feem ntau hauv ntau cov tshuaj.

Kev faib tawm ntawm glucocorticoids los ntawm cov qauv tshuaj

Glucocorticoids (Neeg endogenous):

* cortisol * hydrocortisone * hydrocortisone acetate

Khoom cua roj-muaj glucocorticoids:

* prednisolone * prednisone * methylprednisolone

Cov tshuaj fluorine muaj glucocorticoids hluavtaws:

* dexamethasone * triamcinolone * betamethasone

Kev faib tawm ntawm glucocorticoids los ntawm kev ua ntawm sijhawm

Cov tshuaj yeeb yam luv luv (8-12 teev):

Cov tshuaj kho nruab nrab ncua sijhawm (12-36 teev):

* prednisolone * methylprednisolone * triamcinolone

Cov tshuaj tiv thaiv ntev (36-72 teev):

* parameterazone * betamethasone * dexamethasone

Depot glucocorticoids yog cov yam ntxwv ntev dua (tshem tawm hauv ob peb lub lis piam).

2.Plaubglucocorticoid anism

Lub hypothalamic-pituitary-adrenal axis ua cov txheej txheem nyuaj uas tswj hwm kev tso tawm ntawm glucocorticoids hauv kev ua haujlwm hauv lub cev thiab hauv ntau yam pathological. Kev tsim cov cortisol los ntawm adrenal cortex yog tswj hwm ACTH, zais los ntawm anterior pituitary caj pas. ACTH tso tawm, nyeg, yog tswj hwm los ntawm corticotropin-tso cov tshuaj hormones, qhov tso pa tawm uas yog tswj los ntawm neurological, endocrine thiab cytokine theem ntawm qib ntawm periventricular nuclei ntawm hypothalamus. Corticotropin-tso cov tshuaj hormones yog thauj hauv cov me me mus rau lub zos portal ncig ntawm lub caj pas pituitary, thiab tom qab ntawd mus rau nws sab xub ntiag, qhov twg corticotropin-tso cov tshuaj hormones stimulates ACTH secretion. glucocorticoid tshuaj ib sab

Kev noj txhua hnub hauv lub cev cortisol hauv tib neeg yog kwv yees li 20 mg. Ntxiv mus, nws txoj kev zais cia yog qhov txawv txav los ntawm nruab hnub thaum sawv ntxov nrog lub siab tshaj plaws thaum sawv ntxov thiab cov txiaj ntsig nyob rau yav tsaus ntuj. Feem ntau zais cia cortisol (kwv yees li 90%) nthuav tawm nrog corticoid-binding ntshav globulins. Cortisol dawb yog ib hom kev ua xyem xyaws hauv lub cev.

Hyperreactivity ntawm hypothalamic-pituitary-adrenal txoj hauv kev tsis muaj mob (piv txwv, nrog Cushing's syndrome) ua rau muaj kev tiv thaiv kab mob thiab ua rau muaj mob rhiab heev. Kev ua haujlwm ntawm lub hypothalamic-pituitary-adrenal axis, ua rau nce cortisol ntau ntau thiab ua rau cov tshuaj tiv thaiv kab mob, tuaj yeem tshwm sim los ntawm ntau yam kev ntxhov siab, suav nrog kev mob, kev mob siab rau lub cev, mob khaub thuas, kev tawm dag zog lub cev, kis kab mob, kev phais mob, kev txwv kev noj zaub mov hauv lub cev thiab ntau dua. Endogenous glucocorticoids, nrog rau lub luag haujlwm hauv tsev, kuj tseem tuaj yeem hloov kho cov lus teb. Cov ntaub ntawv pov thawj tau nthuav tawm tias cov lus tsis hnov ​​lus ntawm endogenous glucocorticoids ua lub luag haujlwm tseem ceeb hauv pathogenesis ntawm ntau cov kab mob ntawm cov kab mob ntawm cov nqaij sib txuas lossis hauv kev tawm tsam. Hauv cov kab mob rheumatic xws li mob caj dab, SLE, dermatomyositis thiab lwm yam, kev hloov pauv tseem ceeb nyob rau hauv hypothalamic-pituitary-adrenal axis, ua rau tsis muaj qhov tsis txaus ntawm ACTH txheeb ze rau ncig cytokines, tsis txaus ntawm lub hauv paus qis thiab tsaws zais zais ntawm cortisol hauv kev teb rau mob, nrog rau kev txo qis tseem ceeb androgen.

Kev siv cov khoom cua glucocorticoids ua rau inhibition ntawm synthesis thiab tso tawm ntawm ob qho tib si corticotropin-tso cov tshuaj hormones thiab ACTH, thiab yog li, txo qis ntawm cortisol ntau lawm. Lub sij hawm ntev glucocorticoid txoj kev kho tau ua rau adrenal atrophy thiab kev txhawb zog ntawm lub qog hypothalamic-pituitary-adrenal, ua rau lub peev xwm ua kom muaj peev xwm tsim cov tshuaj glucocorticoids ntxiv rau cov lus teb rau ACTH thiab kev ntxhov siab.

Tam sim no, nws yog kev coj los cais qhov sib txawv ntawm ob cov txheej txheem ntawm kev txiav txim ntawm glucocorticoids - genomic thiab tsis-genomic.

Lub tswv yim genomic los ntawm kev khi ntawm cov cytoplasmic receptors yog soj ntsuam ntawm txhua qhov tshuaj thiab zoo li tsis pub dhau 30 feeb tom qab kev tsim cov tshuaj hormones-receptor complex.

Cov txheej txheem tseem ceeb ntawm cov kev txiav txim siab genomic ntawm glucocorticoids yog txoj cai ntawm kev hloov tsheb ntawm cov noob caj dab uas tswj cov synthesis ntawm cov protein thiab DNA. Cov txiaj ntsig ntawm glucocorticoids ntawm glucocorticoid receptors (uas yog cov tswv cuab ntawm cov membrane steroid receptor tsev neeg) ua rau kev txhim kho ntawm cov txheej xwm uas muaj feem cuam tshuam nrog tus neeg xa xov RNA, nuclear RNA, thiab lwm yam khoom txhawb. Qhov txiaj ntsig ntawm qhov no yog qhov kev txhawb nqa lossis kev txwv ntawm cov hloov tsheb. Glucocorticoids cuam tshuam rau ntau lub noob, suav nrog cov noob uas tswj cov kev tsim cov cytokines xws li IL-la, IL-4, IL-6, IL-9 thiab gamma interferon. Hauv qhov no, glucocorticoids tuaj yeem ob leeg txhim kho kev sib hloov ntawm cov caj ces thiab txwv nws.

Glucocorticoids kuj tswj hwm cellular protein synthesis. Nkag tau yooj yim thiab nrawm dhau los ntawm cov cell nyias nyias, lawv tsim cov khoom nrog cov tshuaj steroid hauv cov cytoplasm uas hloov mus rau ntawm lub hlwb, muaj cov hloov pauv ntawm cov caj ces

tshwj xeeb cov tub xa xov RNA rau kev sib txuas ntawm cov kev cai peptides thiab cov protein, feem ntau cuam tshuam nrog lub kaw lus ntawm cov enzymes, uas, nyeg, tswj cov haujlwm cellular.Cov enzymes no tuaj yeem ua tau ob qho kev ua kom lub zog thiab tiv thaiv tsis siv zog. Piv txwv li, lawv tuaj yeem txhawb kev tsim cov tshuaj tiv thaiv kab mob hauv qee cov hlwb, uas ua kom tiav qhov kev hloov pauv ntawm cov noob hauv lymphoid hlwb, yog li hloov kho cov tsis muaj zog thiab cov lus teb.

Glucocorticoids cuam tshuam rau lub cev thiab kev ua haujlwm ntawm lub cev muaj zog. Kev loj hlob ntawm lymphocytopenia nyob rau hauv lawv lub zog yog vim muaj kev txwv tsis pub tsim thiab tso cov qog ntshav ntawm cov hlwb pob txha, kev txwv tsis pub lawv tsiv teb tsaws thiab rov faib cov lymphocytes mus rau lwm cov tshooj lymphoid. Glucocorticoids cuam tshuam rau kev sib koom tes ntawm T thiab B hlwb hauv kev tiv thaiv kab mob. Lawv nyias ua nyias rau nyias subpopulations ntawm T-lymphocytes, ua rau muaj qhov txo qis ntawm T-hlwb cov kabmob receptors rau lub IgM Fc tawg, thiab tsis hloov qib T-lymphocytes bearing receptors rau lub IgG Fc fragment. Nyob rau hauv kev cuam tshuam ntawm glucocorticoids, qhov loj hlob muaj peev xwm ntawm T cell raug suppressed ob qho tib si hauv vivo thiab hauv vitro. Qhov cuam tshuam ntawm glucocorticoids ntawm B-cell cov lus teb tau pom tias muaj tsawg tshaj li ntawm T-hlwb. Yog li, hauv cov neeg mob tau txais cov tshuaj nruab nrab ntawm glucocorticoids, cov tshuaj tiv thaiv kab mob ib txwm muaj rau kev txhaj tshuaj tiv thaiv tau pom. Nyob rau tib lub sijhawm, kev tswj xyuas lub sijhawm luv luv ntawm kev siv tshuaj ntau ntawm glucocorticoids ua rau txo qis ntshav ntawm IgG thiab IgA qib qis thiab tsis cuam tshuam rau qib IgM. Cov nyhuv ntawm glucocorticoids ntawm B-cell ua haujlwm tuaj yeem kho kom haum vim lawv cov nyhuv ntawm macrophages.

Tsis zoo li cov noob caj noob ces, uas tsis yog-cov caj ces ntawm glucocorticoids yog qhov tshwm sim ntawm kev sib txuas ntawm physicochemical ncaj qha nrog cov roj ntsha ua kom muaj pa thiab / lossis steroid-xaiv cov membrane txais. Cov tsis muaj teebmeem ntawm cov tshuaj glucocorticoids tshwm sim los ntawm kev haus ntau dua thiab tshwm sim tom qab ob peb feeb lossis feeb.

Lub non-genomic los tiv thaiv cov kab mob ntawm glucocorticoids cuam tshuam nrog kev ruaj khov ntawm lysosomal daim nyias nyias, qhov txo qis ntawm qhov permeability ntawm cov qog cell, txo qis ntawm capillary permeability thiab cov ntshav hauv zos hauv thaj chaw ntawm o, txo qis o ntawm cov hlwb endothelial, txo qis lub peev xwm ntawm lub cev tiv thaiv kab mob rau hauv lub hauv paus puas, ua rau muaj kev loj hlob ntawm cov hlab ntsha. hlab ntsha hauv lub tsom xam ntawm o thiab txo qis hauv lawv cov permeability (ib feem vim yog

inhibition of syntaglandin synthesis), txo qis ntawm monocytes thiab cov hlwb mononuclear hauv kev tsom xam ntawm kev mob, nrog rau kev cuam tshuam rau polymorphonuclear leukocytes. Pom tseeb, lub luag haujlwm tseem ceeb hauv kev tiv thaiv kev tiv thaiv ntawm glucocorticoids belongs rau inhibition ntawm tsiv teb tsaws thiab tsub zuj zuj ntawm leukocytes hauv foci ntawm o. Nyob hauv kev cuam tshuam ntawm glucocorticoids, kev ua haujlwm ntawm bactericidal, Fc receptor khi thiab lwm cov haujlwm ntawm monocytes thiab macrophages tau cuam tshuam, thiab cov theem ntawm eosinophils, monocytes thiab lymphocytes hauv kev txo qis. Tsis tas li ntawd, cov lus teb ntawm tes rau kinins, histamine, prostaglandins, thiab chemotactic yam hloov, thiab kev tso tawm ntawm prostaglandins los ntawm cov tshuaj tiv thaiv hlwb tsawg zuj zus. Ib qho kev kawm zoo uas tsis yog-qhov tsis haum xeeb txuam nrog kev ua kom endothelial synthase ntawm nitric oxide.

Qhov kev txhaj tshuaj ntawm glucocorticoids txiav txim siab lawv cov hauj lwm zoo, nrog rau cov zaus thiab qhov mob ntawm cov kev mob tshwm sim. Cov teeb meem caj ceg ntawm glucocorticoids tsim tawm ntawm qhov tsawg kawg thiab kom ntau ntxiv raws li kwv yees li 100 mg ntawm prednisolone sib npaug ib hnub tau mus txog, thiab nyob ruaj khov yav tom ntej. Yog tias thaum siv glucocorticoids nyob rau hauv ib koob tshuaj txog 30 mg ntawm prednisolone sib npaug, cov txiaj ntsig kho tau yuav luag txiav txim siab los ntawm cov tshuaj tua kab mob genomic, tom qab ntawd hauv cov koob tshuaj ntau dua 30 mg ntawm prednisolone sib npaug uas tsis yog-tshuaj tua kab mob los ua qhov tseem ceeb, lub luag haujlwm uas nce nrawm nrog qhov nce ntxiv.

Glucocorticoids tau txais txiaj ntsig zoo rau txhua yam kev hloov ntawm lawv txoj kev siv, i.e., rau qhov ncauj, intramuscular, tso quav ntshav lossis leeg ntshav. Tom qab cov tshuaj qhov ncauj, kwv yees li 50-90% ntawm glucocorticoids yog nqus tau. Kev khi ntawm glucocorticoids rau cov ntshav protein yog kwv yees li 40-90%. Cov metabolism ntawm glucocorticoids yog nqa tawm hauv daim siab feem ntau, thiab kev nthuav tawm - feem ntau los ntawm lub raum hauv daim ntawv ntawm metabolites. Qhov siab tshaj plaws ntawm cov glucocorticoids hauv cov ntshav tom qab kev tswj hwm qhov ncauj tshwm sim tom qab 4-6 teev. Nrog kev tswj hwm cov ntshav qab zib ntawm glucocorticoids, lub siab ntawm lawv qhov kev ua tiav tau tiav nrawm dua. Yog li, nrog qhov qhia txog 1.0 g ntawm Solomedrol® (methylprednisolone sodium succinate), qhov siab tshaj plaws hauv nws lub plasma concentration tau pom tom qab 15 feeb. Nrog kev tswj hwm intramuscular ntawm glucocorticoids, lub siab tshaj plaws ntawm lawv cov kev mob siab hauv plasma tshwm sim muaj txiaj ntsig

tom qab. Piv txwv li, nrog kev txhaj tshuaj intramuscular ntawm Depo-medrol® (methylprednisolone acetate), nws cov ntsiab lus siab tshaj plaws hauv cov ntshav tau mus txog tom qab 7 teev.

3. Kev siv ntawm glucocorticoids

Cov lus piav qhia txog ntau cov txheej txheem ntawm kev ua ntawm glucocorticoids thiab ntau yam ntsiab lus ntawm lawv daim ntawv thov tau txais kev pabcuam ua lub hauv paus rau lawv cov kev siv dav hauv ntau yam kabmob ntawm cov kabmob hauv nruab nrog, nrog rau ntau yam kab mob pathological. Nrog rau mob rheumatic thiab mob vasculitis, qhov twg glucocorticoids feem ntau yog cov tshuaj yooj yim, glucocorticoid txoj kev kho kuj tseem siv rau hauv endocrinology, gastroenterology, resuscitation, cardiology, pulmonology, nephrology, traumatology thiab ntau dua.

Hauv qab no peb nthuav qhia kab mob thiab kab mob pathological uas glucocorticoids siv:

1.Kev mob caj dab - nyob rau qhov tsis muaj qhov tshwm sim hnyav ntxiv ntawm tus kab mob (kab mob vasculitis, serositis, myocarditis, fibrosing alveolitis, bronchiolitis obliterans), qis dua ntawm glucocorticoids yog siv los tiv thaiv keeb kwm ntawm kev hloov kho kab mob. Nrog rau kev txhim kho ntawm cov kab mob sab nrauv sab nrauv los ntawm kev mob caj dab, mob nruab nrab thiab, yog tias tsim nyog, siab kawg ntawm glucocorticoids siv.

2. Ankylosing spondylitis - hauv ntu nquag, nruab nrab lossis siab tshuaj ntawm glucocorticoids yog siv.

3. Systemic lupus erythematosus - nyob rau ntu tseem ceeb ntawm tus kabmob, nrog rau thaum tseem ceeb cov kabmob thiab cov kab ke koom nrog cov txheej txheem pathological (mob hnyav pericarditis thiab / lossis pleurisy nrog kev tso tawm ntau ntawm exudate, thiab / lossis myocarditis, thiab / lossis kev puas tsuaj rau lub hauv nruab nrab cov hlab ntsha, thiab / lossis mob ntsws). , thiab / lossis cov mob ntsws ntsig, thiab / lossis hemolytic anemia, thiab / lossis thrombocytopenic purpura, thiab / lossis cov lupus glomerulonephritis III, IV, V morphological chav kawm) qhia txog kev siv nruab nrab lossis siab siab ntawm glucocorticoids, thiab yog tias tsim nyog - siab heev FIR.

4. Mob caj dab rheumatic lossis exacerbation ntawm rheumatism - nruab nrab lossis siab kawg ntawm glucocorticoids (tshwj xeeb nrog kev txhim kho rheumatic carditis).

5. Rheumatic polymyalgia - glucocorticoids yog cov tshuaj ntawm kev xaiv. Hauv kev mob siab, theem nruab nrab lossis siab tshuaj ntawm glucocorticoids yog siv.

6. Polymyositis thiab dermatomyositis - glucocorticoids yog cov tshuaj ntawm kev xaiv. Hauv kev mob siab, theem siab ntawm glucocorticoids raug kho.

7. Systemic scleroderma - glucocorticoids raug kho nyob rau hauv cov tshuaj qis thiab nruab nrab nrog kev txhim kho ntawm myositis.

8. Tseem muaj tus kabmob - nyob rau theem mob, nrog rau thaum tseem ceeb cov kabmob thiab cov kabmob (myocarditis, pericarditis, epilepsy) koom nrog hauv cov txheej txheem pathological - nruab nrab lossis siab ntawm glucocorticoids.

1.Giant cell arteritis - nyob rau theem mob ceev, glucocorticoids yog kev kho mob ntawm kev xaiv thiab raug txiav txim siab hauv kev siv tshuaj ntau.

2. Kab mob Takayasu - nyob rau theem mob hnyav, nruab nrab lossis siab siab ntawm glucocorticoids siv.

3. Nodular polyarteritis thiab microscopic polyangiitis - nyob rau theem mob ceev, qib siab ntawm glucocorticoids yog siv.

4. Wegener tus kab mob - nyob rau theem mob - nce siab ntawm glucocorticoids.

5. Kev Them Nyiaj-Strauss Syndrome - mob theem ntawm txoj kev xaiv - kev txhaj tshuaj ntau ntawm glucocorticoids.

6. Behcet's syndrome - nyob rau theem mob ceev, nruab nrab lossis siab kawg ntawm glucocorticoids raug kho.

7. Kev txiav mob tawv nqaij txha caj dab ntau ntau - ntau qhov mob loj, glucocorticoids ntau npaum li cas tau siv.

8. Hemorrhagic vasculitis (Shenlein-Genoch purpura) - glucocorticoids raug kho nyob rau hauv nruab nrab lossis siab tshuaj nrog kev txhim kho ntawm glomerulonephritis nrog nephrotic syndrome thiab / lossis kev tsim ntawm 50-60% ntawm glomeruli thiab ntau tshaj ib nrab lub hli. Raws li tus naj npawb ntawm tus kws kho mob rheumatologist, nruab nrab koob tshuaj glucocorticoids tuaj yeem siv rau kev mob plab.

1.Glomerulonephritis nrog kev hloov tsawg heev (idiopathic nephrotic syndrome) - nyob rau theem pib ntawm tus kabmob lossis nrog nws cov exacerbations, glucocorticoids tshuaj hauv nruab nrab lossis siab tshuaj yog kev kho mob xaiv.

2. Focal-segmental glomerulosclerosis-hyalinosis - nyob rau theem pib ntawm tus kabmob lossis nrog exacerbations, nruab nrab lossis siab kawg ntawm glucocorticoids yog siv.

3. Mesangioproliferative glomerulonephritis nruab nrab lossis siab kawg ntawm glucocorticoids yog siv nyob rau hauv kev txhim kho cov nephrotic syndrome thiab / lossis ib nrab hli hauv 50-60% glomeruli.

4. Mesangiocapillary glomerulonephritis - siab kawg ntawm glucocorticoids yog siv rau kev txhim kho ntawm nephrotic syndrome thiab / lossis ib nrab lub hli nyob hauv 50-60% glomeruli.

5. Membranous glomerulonephritis - nyob rau hauv muaj cov tsos mob nephrotic, nruab nrab lossis siab kawg ntawm glucocorticoids siv.

6. Cov kab mob nrawm nrawm nrawm qis glomerulonephritis (subacute, hmoov zoo) - siab kawg ntawm glucocorticoids siv.

Secondary glomerulonephritis (i.e., glomerulonephritis uas tsim nrog SLE, mob rheumatoid, mob polymyositis, dermatomyositis, vasculitis) siv nruab nrab lossis siab kawg ntawm glucocorticoids.

1.ACTH tsis muaj peev xwm hauv ntau cov kab mob ntawm lub caj pas pituitary - hydrocortisone lossis hloov pauv qis kawg ntawm glucocorticoids yog siv los hloov kho.

2. Amiodarone-vim raug thyrotoxicosis - siab kawg ntawm glucocorticoids yog siv.

3. Kev qog tsis txaus ntawm adrenal - hydrocortisone lossis hloov pauv qis lossis nruab nrab ntawm cov tshuaj glucocorticoids raug siv ua kev hloov kho.

1.Crohn tus kab mob - hauv ntu mob nyhav, ntshav siab kawg ntawm glucocorticoids yog siv.

2. Cov mob tsis muaj paug uas tsis mob - nyob rau theem mob, qhov nruab nrab lossis siab kawg ntawm glucocorticoids siv.

3. Kab mob siab autoimmune - koob tshuaj nruab nrab lossis siab kawg ntawm glucocorticoids siv.

4. Cov theem thaum pib ntawm tus kab mob siab - thov nruab nrab qhov nruab nrab ntawm glucocorticoids.

5. Kev haus dej cawv ntau heev - nruab nrab lossis siab kawg ntawm glucocorticoids siv.

1.Post-viral thiab nonspecific lymphocytic myocarditis - nruab nrab lossis siab kawg ntawm glucocorticoids raug kho.

2. Mob tsis yog-purulent pericarditis nrog exudate - cov tshuaj nruab nrab lossis siab siab ntawm glucocorticoids siv.

1.Bronchial hawb pob - qhov ncauj glucocorticoids (tshuaj nruab nrab lossis siab) yog tshuaj rau tus mob ua pa nyuaj, mob hawb pob kom hnyav, qhov uas nqus tau glucocorticoids thiab bronchodilators tsis ua hauj lwm zoo.

2. Cryptogenic fibrosing alveolitis - qib siab ntawm glucocorticoids yog siv.

3. Cov kab mob ntsws (bronchiolitis) - ua rau cov ntshav ntau ntawm glucocorticoids siv.

4. Sarcoidosis ntawm lub ntsws - nruab nrab lossis siab kawg ntawm glucocorticoids siv.

5. Kev mob ntsws Eosinophilic - kev noj tshuaj nruab nrab lossis siab kawg ntawm glucocorticoids raug kho.

1.Hemoblastoses - koob tshuaj glucocorticoids ntau heev thiab siv tau.

2. Kev ua haujlwm tsis txaus (hemolytic, autoimmune, aplastic) - nruab nrab thiab siab ntawm glucocorticoids siv.

3. Thrombocytopenia - cov tshuaj nruab nrab thiab siab ntawm glucocorticoids raug kho.

1. Poob siab ntawm ntau lub hauv paus - siv ntau thiab feem ntau koob ntawm glucocorticoids. Kev kho tus mem tes yog qhov zoo dua.

2. Kev tsis haum cov tshuaj tiv thaiv - cov koob tshuaj glucocorticoids ntau dua yog qhov tsim nyog, yog tias tsim nyog, "kev kho cov mem tes".

3. Mob ntsws ua pa nyuaj siab - Muaj ntau cov glucocorticoids ntau heev siv.

1.Nyob ntawm qhov xwm txheej mob hauv chaw kho mob, glucocorticoids los ntawm qis rau qhov hnyav rau kev siv tshuaj ntau, thiab, yog tias tsim nyog, "kho ntsws".

4.Yooj Yim rauphiv ntawm glucocorticoids

Nrog cov kev qhia luv luv ntawm kev kho mob nrog glucocorticoids, kev phiv loj heev feem ntau tsis tshwm sim. Qee tus neeg mob tau tshaj tawm txog kev nce ntxiv hauv lub siab, qhov hnyav nce ntxiv, kev txob txob siab, thiab kev pw tsaug zog.

Nrog rau kev tswj hwm ntev ntev ntawm corticosteroids, lub npe hu ua Itsenko-Cushing's syndrome muaj kev rog loj heev, "lub ntsej muag lub hli" lub ntsej muag, kev loj hlob ntawm plaub hau ntau ntawm lub cev thiab nce ntshav siab. Nrog rau qhov txo qis hauv cov koob tshuaj hormones, cov tshwm sim no yuav thim rov qab. Qhov phom sij tshaj plaws ntawm glucocorticoids rau ntawm lub plab zom mov ntawm txoj hnyuv: lawv tuaj yeem ua rau mob ntawm lub plab thiab duodenum. Yog li, muaj cov neeg mob nrog mob rwj yog ib qho tseem ceeb contraindications rau siv corticoids. Thaum tus neeg mob tau noj cov tshuaj steroid, yog tias muaj kev tsis txaus siab ntawm qhov hnyav lossis mob hauv plab sab sauv, kub siab, nws yog qhov yuav tsum tau sau cov tshuaj uas txo qis cov kua qaub ntawm lub plab ua kua. Kev kho mob nrog rau txhua yam glucocorticoids yog nrog los ntawm ib qho kev ploj ntawm potassium, yog li noj prednisone yuav tsum tau ua ke nrog kev noj cov tshuaj potassium (panangin, asparkum). Corticosteroids ua rau kom sodium thiab kua dej kom zoo rau hauv lub cev, yog li thaum edema tshwm, tsuas yog cov tshuaj potassium-sparing diuretics siv tau (piv txwv li triampur, trireside K). Nrog rau kev tswj hwm ntev ntev ntawm corticosteroids rau menyuam yaus, cuam tshuam kev loj hlob thiab ncua kev sib deev yog tau.

Txhua yam tshuaj glucocorticoids muaj cov kev mob tshwm sim zoo ib yam, uas nyob ntawm qhov koob tshuaj thiab lub sijhawm kho.

1. Kev txwv ntawm txoj haujlwm ntawm adrenal cortex. Glucocorticoids ua rau lub luag haujlwm ntawm cov kab mob hypothalamus-pituitary-adrenal cortex. Cov nyhuv no yuav nyob ntev mus txog ntau lub hlis tom qab tsis kho thiab kho nyob ntawm seb siv ntau npaum li cas, kev siv ntau npaum li cas thiab kev kho mob ntev npaum li cas. Cov nyhuv ntawm adrenal cortex tuaj yeem ua kom tsis muaj zog yog tias, hloov ntawm cov tshuaj yeeb ntev (dex-metazone), cov tshuaj yeeb yam luv luv xws li prednisone lossis methylprednisolone hauv cov tshuaj me me tau siv. Nws raug nquahu kom noj tag nrho cov tshuaj txhua hnub thaum sawv ntxov ntxov, uas yog feem ntau zoo sib xws nrog lub zog ntawm lub plawv ntawm qhov cortisol zais cia. Thaum noj txhua lwm hnub, kev siv tshuaj glucocorticoids luv luv yog siv thiab ib koob nkaus xwb tseem tau noj thaum ntxov thaum sawv ntxov. Nyob hauv kev cuam tshuam ntawm kev ntxhov siab (kev ua haujlwm hauv plab, mob hnyav rau cov kab mob concomitant, thiab lwm yam), kev ua haujlwm ntawm lub adrenal cortex feem ntau tshwm sim, tshwm sim los ntawm kev tsis qab los noj mov, poob phaus, poob tsaug zog, kub cev thiab mob ntshav orthostatic hypotension. Lub mineralocorticoid kev ua haujlwm ntawm adrenal cortex yog tshwj tseg, yog li ntawd, hyperkalemia thiab hyponatremia, yam ntxwv ntawm thawj adrenal cortical tsis txaus, feem ntau tsis tuaj. Cov neeg mob yuav tsum hnav ib txoj hlua tes tshwj xeeb lossis muaj daim npav kho mob nrog lawv kom thaum muaj xwm txheej ceev tus kws kho mob paub txog qhov xav tau kev tswj hwm sai ntawm glucocorticoids. Hauv cov neeg mob noj ntau lub lis piam ntau tshaj 10 mg ntawm prednisone ib hnub (lossis ib qho sib npaug ntawm lwm cov tshuaj), ib lossis lwm qib kev tiv thaiv ntawm adrenal cortex tuaj yeem mob mus txog 1 xyoo tom qab txiav kho.

2. Kev tiv thaiv ntawm kev tiv thaiv kab mob.Glucocorticoids txo qis tsis kam rau kis, tshwj xeeb tshaj yog cov kab mob, qhov kev pheej hmoo ntawm kev kis tau ncaj qha nyob ntawm koob tshuaj glucocorticoids thiab tseem yog qhov tseem ceeb ua rau muaj kev nyuaj siab thiab tuag ntawm cov neeg mob nrog SLE. Raws li qhov kev kho mob steroid, ib tus kab mob hauv zos tuaj yeem hloov mus ua kab ke, tus kab mob latent tuaj yeem ua mob tau, thiab cov kab mob tsis yog kab mob kuj tuaj yeem ua rau nws. Tawm tsam keeb kwm ntawm glucocorticoid txoj kev kho, kab mob tuaj yeem tshwm sim npog, tab sis lub cev kub feem ntau nce. Raws li kev tiv thaiv kab mob, kev txhaj tshuaj tiv thaiv nrog kev txhaj tshuaj tiv thaiv kev mob ua npaws thiab mob ntsws, uas tsis ua rau muaj kev cuam tshuam loj ntawm SLE, raug pom zoo. Ua ntej pib kho nrog glucocorticoids, nws raug nquahu kom ua daim tawv nqaij tuberculin mus kuaj.

3. Cov kev hloov pauv ntawm lub ntsej muag suav nrog: kev sib tw ntawm lub ntsej muag, lub cev qhov hnyav, kev faib tawm ntawm lub cev muaj roj, hirsutism, pob txuv, ntshav tawm, ua rau nqaij doog nrog kev raug mob me me. Cov kev hloov no poob qis lossis ploj tom qab txo koob tshuaj.

4. Lub paj hlwb muaj ntau yam los ntawm kev txob taus me me, muaj kev zoo siab thiab pw tsaug zog txog kev nyuaj siab lossis mob hlwb (qhov tom kawg yuav raug txiav txim siab tias yog lupus lesion ntawm lub hauv nruab nrab lub paj hlwb).

5. hyperglycemia tuaj yeem tshwm sim lossis nce ntxiv thaum kho nrog glucocorticoids, tab sis, raws li txoj cai, tsis ua haujlwm rau kev sib kis rau lawv lub sijhawm. Kev siv tshuaj insulin tej zaum yuav xav tau, ketoacidosis tsis tshua muaj kev loj hlob.

6. Cov kev ua txhaum ntawm cov dej-electrolyte tshuav suav nrog sodium tuav thiab hypokalemia. Qhov tshwj xeeb nyuaj hauv kev kho mob tshwm sim nrog congestive plawv nres thiab edema.

7. Glucocorticoids tuaj yeem ua lossis nce ntshav siab ntawm txoj hlab ntshav. I / O cov mem tes kho nrog cov tshuaj steroids feem ntau ua rau kev phom sij preexisting leeg ntshav txhaws yog qhov nyuaj kho.

8. Osteopenia nrog compression pob txha loj ntawm lub cev txha caj qaum feem ntau loj hlob nrog kev kho ntev glucocorticoid. Yog li, cov neeg mob yuav tsum tau txais calcium ions (1-1.5 g / hnub los ntawm qhov ncauj). Vitamin D thiab thiazide diuretics yuav pab tau. Hauv cov poj niam postmenopausal, ntawm kev pheej hmoo ntawm txha, estrogens feem ntau yog qhia, tab sis cov txiaj ntsig ntawm lawv siv hauv SLE yog qhov sib txawv. Calcitonites thiab diphosphonates kuj tseem siv tau. Kev tawm dag zog tawm dag zog osteogenesis yog kev pom zoo.

9. Steroid myopathy yog tsiag ntawv los ntawm cov leeg mob feem ntau yog lub xub pwg thiab lub plab mog. Kev ua kom tsis muaj zog yog sau tseg, tab sis tsis muaj mob, qhov kev ua haujlwm ntawm cov ntshav enzymes ntawm cov leeg nqaij thiab electromyographic tsis zoo, tsis zoo li cov leeg nqaij tsis muaj zog, tsis hloov. Kev tshuaj xyuas nqaij mus kuaj yog ua rau qee tus neeg tsawg thaum nws yuav tsum tshem tawm lawv qhov mob. Tseem ntawm steroid myopathy poob qis dua li qhov koob tshuaj glucocorticoids raug txo qis thiab ib qho kev sib txuam ntawm cov kev tawm dag zog lub cev yog qhov tseem ceeb, txawm li cas los xij, kev kho mob tag nrho tuaj yeem siv sijhawm ntau lub hlis.

10. Cov kev mob Ophthalmic cuam tshuam nrog kev muaj zog ntawm lub siab (uas qee zaum vim yog muaj teeb meem ntawm lub ntsej muag) thiab posterior subcapsular cataract.

11. Ischemic pob txha necrosis (aseptic, avascular necrosis, osteonecrosis) kuj tuaj yeem tshwm sim thaum kho steroid. Cov kev cuam tshuam no feem ntau muaj ntau yam, nrog kev puas tsuaj rau ntawm tus poj niam lub taub hau thiab lub ntsej muag humerus, nrog rau tib lub hauv siab tib lub siab. Cov kab mob thaum ntxov pom tau muaj isotopic scintigraphy thiab MRI. Cov tsos ntawm cov yam ntxwv hloov kho hluav taws xob qhia pom kev ua tiav. Kev phais mob pob txha decompression tej zaum yuav ua tau zoo thaum ntxov ntawm ischemic necrosis, tab sis kev kwv yees ntawm txoj kev kho no muaj kev sib cav.

12. Lwm cov kev mob tshwm sim ntawm glucocorticoids suav nrog hyperlipidemia, kev coj khaub ncaws tsis xwm yeem, tawm hws ntau, tshwj xeeb tshaj yog thaum tsaus ntuj, thiab benign intracranial hypertension (pseudotumor cerebri). Kev ua ntawm glucocorticoids qee zaum cuam tshuam nrog cov tsos ntawm thrombophlebitis, necrotizing arteritis, kab mob pancreatitis thiab mob plab peptic, tab sis cov pov thawj ntawm kev sib txuas tsis txaus.

5.Yuav tsum ceeb toomglucocorticoids

1. Qhov pom meej meej rau kev siv glucocorticoids.

2. Kev txiav txim siab xaiv cov tshuaj glucocorticoid, uas yog los ntawm kev ua haujlwm siab thiab muaj qhov cuam tshuam tsawg kawg ntawm cov kev mob tshwm sim. Methylprednisolone (Medrol, Solu-medrol thiab Depo-medrol) ua tau raws li cov kev xav tau no, kev sib cav rau cov uas tau muab rau saum toj no.

3. Cov kev xaiv ntawm thawj qhov kev txiav txim siab ntawm cov tshuaj glucocorticoid uas muab cov kev pabcuam tsim nyog thaum nws qhov tsawg kawg yuav tsum ua raws li kev tshuaj ntsuam ntawm tus neeg mob, suav nrog nosology ntawm tus kabmob, nws cov haujlwm, muaj kev puas tsuaj rau cov kabmob tseem ceeb thiab cov kab ke, zoo li feem ntau lees txais cov lus pom zoo hauv kev siv tshuaj tua kabmob glucocorticoid rau ntau qhov chaw kuaj mob. xwm txheej. Niaj hnub no, kev kho glucocorticoid yog qhov pom tau tias kev kho mob rau kev xaiv rau ntau yam mob rheumatic, suav nrog SLE, dermatomyositis thiab polymyositis, vasculitis, glomerulonephritis thiab ntau dua. Tib lub sijhawm, kev pib tshuaj ntau ntau txawv nyob ntawm cov yam ntxwv ntawm cov duab hauv chaw kuaj mob thiab kuaj pom. Yog li, piv txwv, nrog kev ua haujlwm siab ntawm SLE, dermatomyositis, polymyositis, systemic vasculitis thiab / lossis kev koom tes ntawm cov kabmob tseem ceeb thiab cov kab ke hauv cov kabmob no, kev siv tshuaj lossis siab kawg ntawm glucocorticoids yog qhia. Nyob rau tib lub sijhawm, nrog kev ua haujlwm tsawg ntawm SLE, vasculitis, cov txiaj ntsig zoo hauv chaw kho mob tuaj yeem ua tiav los ntawm qis kawg ntawm glucocorticoids, thiab thaum tsis muaj kev puas tsuaj rau cov kabmob hauv nruab nrog thiab cov hlab ntsha nruab nrab, nws tsis tsim nyog los sau tshuaj glucocorticoid txoj kev kho mob kom tau txais kev kho mob, vim tias qhov kev soj ntsuam muaj txiaj ntsig tuaj yeem ua tiav siv NSAIDs , feem ntau yog ua ke nrog aminoquinoline npaj. Nyob rau tib lub sijhawm, tus naj npawb ntawm cov neeg mob xav tau siv ntxiv ntawm qis kawg ntawm glucocorticoids (Medrol 4-6 mg rau ib hnub lossis prednisolone 5-7.5 mg ib hnub).

Kev siv ntau ntawm kev hloov kho cov kab mob uas twb muaj nyob rau thaum ntxov ntawm kev mob rheumatoid, qhov tsis muaj cov ntaub ntawv qhia txog cov txiaj ntsig zoo ntawm nruab nrab thiab siab kawg ntawm glucocorticoids ntawm kev txheeb xyuas tus kab mob mus ntev hauv cov neeg mob uas muaj mob rheumatoid, thiab qhov kev pheej hmoo ntawm kev phiv loj heev thaum siv lawv, hloov pauv mus kom ze rau kev siv glucocorticoids. Niaj hnub no hauv qhov tsis muaj

Cov kev mob hnyav ntxiv-txhawm rau muaj pob txha caj qaum (piv txwv, vasculitis, mob ntsws) tsis pom zoo rau kev siv cov glucocorticoids hauv kev noj tshuaj ntau dua 7.5 mg ib hnub twg ntawm prednisone lossis 6 mg ntawm methylprednisolone. Ntxiv mus, nyob rau ntau tus neeg mob rheumatoid kev mob caj dab, qhov ntxiv ntawm 2-4 mg ib hnub twg ntawm Medrol mus rau kev kho mob-hloov kho tus cwj pwm yog pom los ntawm cov nyhuv tshuaj tau zoo.

1. Tsim tus txheej txheem rau kev noj cov tshuaj glucocorticoids: kev xaiv (niaj hnub) lossis sib quas ntus (xaiv thiab sib quas ntus).

2. Hauv feem ntau cov kab mob rheumatic, vasculitis, glomerulonephritis, glucocorticoids feem ntau tsis txaus ua tiav lossis ib nrab ntawm cov chaw kho mob thiab chaw kuaj mob, uas yuav tsum tau ua ke nrog ntau cov tshuaj cytotoxic (azathioprine, cyclophosphamide, methotrexate thiab lwm tus). Tsis tas li ntawd, kev siv cytostatics tuaj yeem txo qhov ntau npaum li cas ntawm glucocorticoids (lossis txawm tias tso tseg lawv) thaum tswj hwm cov kev tshawb fawb tau txais, uas cuam tshuam txo qhov zaus thiab qhov mob ntawm kev phiv los ntawm kev kho glucocorticoid.

3. Ntau tus kws kho mob pom zoo tias ntev mus tsawg kawg ntawm cov tshuaj glucocorticoids (2-4 mg / hnub ntawm Medrol® lossis 2.5-5.0 mg / hnub ntawm prednisolone) yuav txuas ntxiv hauv ntau cov neeg mob uas muaj mob rheumatic tom qab ua tiav kev kho mob thiab kuaj ntshav.

Nrogcov npe ntawm cov ntawv siv

1 qhuab ntuas MD, prof. Lobanova E.G., Ph.D. Chekalina N.D.