Zotsatira zoyipa za glucocorticoids

Zaka zambiri zokumana ndi mankhwala a glucocorticoid m'matenda osiyanasiyana mu ana awululira zabwino zokha, komanso zoipa za njirayi. Zinapezeka kuti mwa odwala ena, kusintha kodetsa nkhawa kumakhala kwakanthawi ndipo kumangotchulidwa pang'ono mwanjira ndipo kumatha popanda kuwatsata.

Mu ana ena, atatha kuthetsedwa kwa glucocorticoid wothandizila, zovuta zomwe zimachitika, nthawi zina kwambiri, zimakhalapo kwa zaka zambiri, ndipo nthawi zina m'moyo wonse. Mawonekedwe ndi kuuma kwa zovuta komanso zosokonezeka zimadalira tsiku ndi tsiku komanso nthawi yanthawi ya mankhwalawa ndi glucocorticosteroid mankhwala, msinkhu wa mwana komanso machitidwe a thupi lake.

Njira zopanga zovuta zomwe zimayambitsidwa ndi glucocorticosteroids ndizovuta, chifukwa mankhwalawa amalowerera pazinthu zonse zofunika m'thupi la mwana. Komabe, mosakayikira munthu akhoza kuyankhula za zovuta komanso zovuta za mankhwalawa, za kuthekera kwawo kuphwanya mkhalidwe wopanda chitetezo, kuyambitsa kuwonongeka kwa minofu ndikulepheretsa kusintha kwazomwe zimachitika mwa iwo, kusokoneza kwambiri kagayidwe. Zotsatira zoyipa ndi zovuta pa mankhwala a ana omwe ali ndi glucocorticosteroids atha kukhala motere.

1.Chimodzi mwazinthu zomwe zimapangidwa kawirikawiri mthupi la mwana ndi matenda a Cushingoid: kunenepa kwambiri ndi zizindikiro za kunenepa kwambiri kwazinthu zina (kuzungulira nkhope, kunenepa kwambiri kwamafuta kumaso, khosi, mapewa, m'mimba) kuphatikiza ndi hypertrichosis, thukuta kapena khungu lowuma, kutulutsa kwake pakhungu, kukulira kwamachitidwe amtundu wa khungu, mawonekedwe a ziphuphu ndi kunenepa.

Kuchulukitsidwa kwamafuta (mtundu wamafuta onenepa) kumalumikizidwa ndi mphamvu ya kagayidwe kazigwiritsa ntchito mankhwala a glucocorticosteroid, njira zowonjezera shuga, komanso kusintha kwa chakudya chamafuta kukhala mafuta. Kulepheretsa njira zolimbikitsira mafuta zomwe zimapangitsidwa ndi kukula kwa mahomoni ndikofunikira.

2. Nthawi zambiri zoyipa makonzedwe a glucocorticosteroids ndiomwe amadziwika kuti ndi steroid gastritis, yomwe imawonetsedwa ndi kulakalaka, kutentha kwa mtima, nseru, nthawi zina kusanza, kupweteka kwa asidi, kupweteka kwa dera la epigastric.

Vuto lakusintha kwa kukokoloka ndi zilonda zam'mimba ndi duodenum ndizothekanso (zimatha kuonekanso m'matumbo ang'ono ndi akulu). Zilonda zam'mimba ndi zam'mimba nthawi zina zimakhala zovuta chifukwa cha kutuluka kwa magazi ndi kufukiza. Dziwani kuti zilonda zam'mimba komanso zam'matumbo kumayambiriro kwa mapangidwe ake zimatha kukhala zosasinthika, ndipo chizindikiro cha kukhalapo kwawo ndichotheka ndi magazi amatsenga mu ndowe.

Nthawi zambiri, zovuta m'matumbo zimachitika nditatha kumwa mankhwala a glucocorticosteroid mkati, ngakhale chitukuko sichiphatikizidwa ndi kholo la mankhwalawa. Kupezeka kwa ulcerative kumachitika makamaka mukamapereka mankhwala a prednisone ndi prednisone, makamaka osakanikirana ndi ma ulcerogenic agents (immunosuppressants, acetylsalicylic acid, tetracyclines, etc.).

Zina zomwe zimathandizira kukulitsa zilonda:

Kumwa glucocorticosteroids musanadye,

Kutalika kwa nthawi yayitali kwa mankhwalawa osasokoneza mankhwalawa.

· Kusagwirizana ndi zakudya munthawi ya glucocorticosteroid mankhwala (kudya zakudya zonunkhira komanso zokwiyitsa, zonunkhira, zakudya zozizira kapena zotentha, ndi zina).

Glucocorticosteroids amachititsa mapangidwe azilonda zam'mimba ndi matumbo chifukwa cha zifukwa zotsatirazi:

· Amachulukitsa acidity ndi kubisala kwa madzi am'mimba ndipo nthawi yomweyo amasokoneza mapangidwe a ntchofu, omwe amateteza mucous membrane wam'mimba ndi matumbo kuti asawonongeke (kapangidwe ka ma polysaccharides omwe amapanga mucous membranes am'mimba ndi matumbo oletsedwa),

· Glucocorticosteroids imafooketsa machiritso a micro ndi micro yam'mimba komanso m'matumbo, kutanthauza kuti, mwa kuchuluka kwawo maselo a glandular komanso minofu yolumikizana ya khoma la ziwalozi imalepheretseka. Njira ya asymptomatic (yopweteka) ya ulcerative imafotokozedwa chifukwa chakuti zilonda zam'mimba zimachitika motsutsana ndi maziko a anti-yotupa ya mankhwala a glucocorticosteroid.

3. Mukamamwa mankhwala a glucocorticosteroid, kuchuluka kwa matenda oyamba ndi matendawa (tonsillitis, sinusitis, kuwola kwa mano, cholecystitis ndi ena), kufalikira kwa matenda opatsirana kumatha kuonedwa. Milandu ya chibayo ndi kufalikira kwa m'mapapo a autoinfidal chiyambi, kuchulukitsa kwa matenda osachiritsika (hepatitis, cholecystitis, kapamba, chifuwa chachikulu ndi ena).

Amadziwika kuti kuikidwa kwa glucocorticosteroids kumayambitsa kwambiri matenda opatsirana mwa ana kwa ana, zomwe zimapangitsa kwambiri katemera wa katemera. Zotsatira zoyipa zomwe zatchulidwa pamwambazi zikufotokozedwa ndi kuthekera kwa glucocorticosteroids kupondereza zochita ndi chitetezo chamderalo.

4. Mankhwalawa ndi glucocorticosteroids, kusintha kwamalingaliro ndi m'maganizo ndikotheka: kulumikizidwa kwazinthu, kuchepa kwa mitsempha, kusinthasintha kwa psychomotor, kusokonezeka kwa kugona. Kusintha kwa ana kumasinthika.

5. Nthawi zambiri zoyipa zomwe zimachitika ndi glucocorticosteroid mankhwala ndiwowonjezera magazi. Pambuyo pakuchoka ku chipatala, matenda oopsa oopsa mwa odwala amadutsa, ngakhale mwa ana ena kuchuluka kwa magazi ndi 15 - 20 mm RT. Art. amalimbikira kwa zaka 1 mpaka 3 popanda kudandaula kulikonse (A. V. Dolgopolova, N. N. Kuzmina, 1963).

Njira yopanga matenda oopsa kwambiri pa mankhwala oopsa oopsa. Nthawi zambiri, izi zimachitika pakalembeka komanso kutha msinkhu.

6. Ma glucocorticosteroids (cortisone, hydrocortisone, prednisone, prednisone) amatha kukhalabe ndi sodium ndi madzi m'thupi la wodwalayo, zomwe zimathandiza kuti mawonekedwe a edema awonjezeke. Mankhwala ngati glucocorticosteroid monga dexamethasone, triamcinolone, methylprednisolone samazengereza ndi sodium ndi madzi.

7.Ndi chithandizo chachikulu komanso chotalika cha glucocorticosteroid mu atsikana aubwana, vuto la endocrine limawonedwa nthawi zambiri: kuchedwa kwa maonekedwe a kusamba, kusakhazikika kwawo, mukakhazikika kale. Ndikofunikira kuwerengera izi ndipo popanda zisonyezo zovuta musamapereke mankhwala kwa atsikana omwe akutha msambo, muwathetse pomwe zizindikirika zoyamba za zovuta zoyipa izi.

8. Zolemba zimapereka umboni kuti mothandizidwa ndi kuphatikiza kwa nthawi yayitali mankhwala a glucocorticosteroid, kukula kwa thupi la mwana kumatha kuchitika. Vutoli limafotokozedwa ndikuwonetsa mphamvu ya glucocorticosteroids pakupanga mahomoni amakula ndi ma pituitary gland komanso mapangidwe a somatomedin mu chiwindi, kuwonjezeka kwa njira za katemera m'matumbo, kuphatikiza mafupa.

9. Muubwana, matenda a shuga amayamba mu mphamvu ya glucocorticosteroids kuchokera ku prediabetes.

Kapangidwe kameneka ka mankhwala a shuga a shuga amaphatikizidwa ndi mbali zina za zochita za mankhwala a glucocorticosteroid pa metabolism ya carbohydrate: zimalepheretsa kugwira ntchito kwa ziwiya za kapamba, zimathandizira kupanga mapuloteni otsekemera a plasma, zimapangitsa kuti mapangidwe a shuga apangidwe kuchokera ku amino acids ndipo nthawi yomweyo imafooketsa kugwiritsidwa ntchito kwa chakudya chamafuta ndi minofu.

Pomaliza, hyperglycemia ndi glucosuria zimayamba, ndipo mu ana omwe ali pachiwopsezo chobadwa nacho cha ziwiya zobisika - shuga. Odwala ambiri, atatha kuthetsedwa kwa glucocorticosteroids, metabolism ya carbohydrate imakhala yofanana. Dexamethasone imatha kuyambitsa chisokonezo makamaka mu chakudya cha carbohydrate, ochepera kuposa triamcinolone, methylprednisolone, prednisolone, prednisone. Diabetogenicity yocheperako imadziwika ndi cortisone ndi hydrocortisone.

10. Pafupipafupi zochita za thupi la mwana kukhazikitsidwa kwa glucocorticosteroids ukuwonjezeka excretion wa potaziyamu mu mkodzo ndi kukula kwa hypokalemic syndrome.

Zizindikiro zomaliza: kumverera kufooka, kuchepa mphamvu, kuchepera kwa minofu kamvekedwe ndi mphamvu (nthawi zina maresi a miyendo), kufooka kwa ntchito yam'mimba, mtima arrhasmia, nseru, kusanza, kudzimbidwa.

Kuthekera kwa kukhala ndi hypokalemic syndrome kumawonjezeka ndi makonzedwe a glucocorticosteroids osakanikirana ndi mtima glycosides ndi okodzetsa, pomwe kunyalanyaza zakudya za potaziyamu ndi kubwezeredwa kosakwanira kwa mankhwala a potaziyamu a potaziyamu chifukwa cha kuwonjezereka kwa mankhwala a potaziyamu okhala ndi chemotherapy.

11. Zowonera zambiri zamankhwala zakhala zikuwonetsedwa zomwe zikuwonetsa zovuta za mankhwala a glucocorticosteroid pamafupa amthupi la mwana womakula. Steroid osteopathy imasonyezedwa pakuwoneka ngati mafupa am'mimba ambiri, mafupa ndi ma vertebral. Nthawi zambiri chitukuko cha epiphyseal cartilage chimasokonezeka, nthawi zina zizindikiro za aseptic necrosis m'mafupa zimawonekera.

Vuto lalikulu kwambiri ndi brevispondylia: mapangidwe nsomba vertebrae (chifukwa kuwonongedwa kwa vertebral matupi ndi ma intervertebral disc), kutsatiridwa ndi kuphwanya kwa mizu ya mitsempha, kuwonongeka kwa msana, kukakamira kwa chingwe cha msana.

Steroid osteopathy ndi chifukwa cha kuphwanya kwakukulu mu kapangidwe ka mapuloteni a mafupa minofu (kuchepa kwa kuchuluka kwa collagen, mucopolysaccharides, hexosamine), njira zowonjezereka zama calcium ndi minofu ya mafupa ndikudziwonetsa kwambiri kwa phosphorous mkodzo. Njira zosinthira mafupa minofu ya odwala omwe ali ndi mafupa am'madzi amadziwika ndi kupanikizika ndi kutalika.

12. Mwa odwala ena, myopathy imayamba chifukwa cha mankhwala a glucocorticosteroid.

Zizindikiro zake: kufooka kwa minofu (makamaka m'makutu am'munsi komanso minyewa yayikulu), hypotension, kuchepa kwa tendon Reflex. Pakufufuzidwa, mutha kuwona zizindikiro za hypertrophy ya minofu, makamaka malekezero apansi (zomwe glycogen zili m'misempha zimawonjezeka). Kuphwanya kapangidwe ka mitsempha ya ma neuromuscular kutsimikiziridwa. Triamcinolone yokhala ndi fluorine nthawi zambiri imayambitsa myopathy. Steroid myopathy atasiya mankhwala amapezeka pang'onopang'ono, ndipo ntchito ndi kapangidwe ka minofu zimabwezeretsedwa ndi patsekeke.

13. Kugwiritsa ntchito glucocorticosteroids (makamaka pa nthawi yayitali yogwiritsira ntchito mankhwalawa) kumakhala kodzaza ndi chiopsezo cha zovuta kuchokera ku gawo la masomphenyawo mwanjira ya ma mandala ndi glaucoma. Zosintha pamagalasi zimatha kusinthika chifukwa cha nthabwala zamadzi, kuphatikizika kwa kumbuyo kwake. Glaucoma ali mwana nthawi zambiri.

14. Ngakhale mankhwala a glucocorticosteroid ndi othandizira amphamvu pazomwe zimayambitsa matenda ena, nthawi zina iwo amatulutsa thupi lawo siligwirizana. Kusintha koteroko kumachitika kawirikawiri ndi njira zingapo za glucocorticosteroid mankhwala ndipo amadzionetsa ngati urticaria, edema ya Quincke, erythema multiforme, khungu loyenda ndi zizindikiro zina.

15. Kugwiritsa ntchito kwa nthawi yayitali mankhwala a glucocorticosteroid ndi chifukwa cha mankhwala a pharmacogenic hypercorticism kumakhala kodzala ndi chiopsezo cholepheretsa kugwira ntchito kwa cortical wosanjikiza kwaminyewa ya adrenal komanso kubwezeretsanso dongosolo la hypothalamic-gynephysial-adrenal system.

Poyerekeza ndi izi, kusiyanasiyana kwa mankhwalawa, matenda olekanitsidwa ndi mankhwalawa atha kukhala ngati vuto lofooka, kufooka, kupweteka mutu, kuchepa kwamphamvu m'maganizo ndi m'thupi, komanso kutentha kwamphamvu pamthupi.

Matenda achire ndi owopsa makamaka ngati makonzedwe akulu a glucocorticosteroids atayimitsidwa popanda kukonzekereratu kwa thupi la wodwalayo, mwachitsanzo, popanda kuchepa kwapang'onopang'ono mu mlingo wa tsiku ndi tsiku wa mankhwalawa, kuyambitsa kwa othandizira a chemotherapeutic omwe amathandizira ntchito ya adrenal cortex.

Chifukwa chake, gulu la mankhwala a glucocorticosteroid limadziwika osati machitidwe ake othandizira olimbitsa thupi la wodwalayo, komanso ndi zovuta zambiri, kuopsa kwake komanso tanthauzo lake lomwe limatengera mankhwala omwewo, njira yogwiritsira ntchito, msinkhu ndi kugonana kwa mwana, ndi zina, mwatsoka sanaphunzire.

Pharmacological mankhwala a HA amatha kukhala ochulukirapo (osakhalitsa), ochepa (kwa masiku angapo kapena miyezi yambiri) komanso osakhalitsa (chithandizo kwa miyezi ingapo, zaka, kapenanso kutalika kwa moyo).

Sanapeze zomwe mukuyang'ana? Gwiritsani ntchito kusaka:

Zotsatira zoyipa za zokhudza glucocorticoids

Zamkatimu

Zotsatira zoyipa
Kuletsa ntchito ndi kuwunika kwa adrenal cortex, kudalirika kwa steroid, "achire matenda" (kuchulukitsa kwa zomwe zimayambitsa matenda, kuperewera kwa adrenal). Kutalika kwa nthawi yayitali pogwiritsa ntchito michere ya glucocorticoids, makamaka yochitika osaganizira za kuzungulira kwazizolowezi zawo zobisika, kumabweretsa zoletsa komanso kuwonongeka kwa adrenal cortex. Pofuna kuletsa kwathunthu kwa adrenal cortex wodwala wamkulu, tsiku lililonse mlingo wa glucocorticoid wa tsiku lililonse uyenera kukhala 10-20 mg malinga ndi prednisone. Kuchepa kwa ntchito ya adrenal cortex kumayambira pa 4 - tsiku la 7 la kugwiritsa ntchito tsiku ndi tsiku mankhwala a glucocorticoids akapatsidwa mankhwala m'mawa komanso kuyambira tsiku lachiwiri pomwe amapatsidwa mankhwalawa. Mbali iyi ndi yodziwika kwambiri kwa glucocorticoids omwe amakhala nthawi yayitali komanso kukonzekera kwa malo ogulitsa. Kuti abwezeretse zabwinobwino ntchito ya adrenal cortex, miyezi isanu ndi umodzi ndi itatu ndiyofunikira, ndipo kuyankha kwake kokwanira pamavuto mpaka zaka 1-2.

Kuchepetsa khungu, khungu, khola.
■ Minyewa ya m'magazi, mafinya ndi aseptic necrosis ya mafupa, kubwezeretsa kukula. Osteoporosis imayamba mu 30-50% ya odwala ndipo vuto lalikulu kwambiri la glucocorticoid mankhwala. Ndi chifukwa chakuipa kwawo pakupanga minofu ya mafupa ndi kutsegulira kwa kugwiranso ntchito kwake. Nthawi zambiri amayamba azimayi atatha nyengo ya postmenopausal. Monga lamulo, mafupa am'mimba amakhudza zigawo zikuluzikulu za mafupa (msana, mafupa a m'chifuwa, nthiti) ndipo zimafalikira pang'onopang'ono mpaka mafupa otumphukira (manja, mapazi, ndi zina). Kuwonekera kwake kwamankhwala ndikumva kupweteka kwa msana komanso mafupa a m'chiuno, kuchepa kwa kukula ndi kugwirana kwa msana (kutsika kwa thoracic ndi lumbar madipatimenti), nthiti, khosi lachikazi, kuchokera ku kuvulala kwakung'ono kapena mosadziletsa. Pothana ndi zovuta izi, kukonzekera calcium, vitamini D3, calcitonin, ndi bisphosphonates amagwiritsidwa ntchito. Kutalika kwa chithandizo chotere kuyenera kukhala zaka zingapo.
• Myopathy, kuwononga minofu, myocardial dystrophy. Steroid myopathies amawonetsedwa ndi kufooka komanso kuwongolera kwa minofu yam'magazi, kuphatikiza minofu ya kupuma (minofu yam'mimba, diaphragm), yomwe imathandizira kukulitsa kupuma. Nthawi zambiri, kuphatikiza kumeneku kumayambitsa triamcinolone. Limagwirira kukula kwa myopathies limalumikizidwa ndi zotsatira zoyipa za glucocorticoids pama protein ndi mineral metabolism. Anabolic steroids ndi potaziyamu amakonzekera amagwiritsidwa ntchito pochiza.
■ Hypokalemia, posachedwa ndi sodium ndi madzi, edema ndizowonetsera za mineralocorticoid zotsatira za glucocorticoids.
Kuwonjezeka kwa kuthamanga kwa magazi kumatha kuonekanso kwa odwala omwe amatenga glucocorticoids kwa nthawi yayitali. Zimachitika chifukwa cha chidwi champhamvu cha khoma lamitsempha kuti ma catecholamines, sodium ndi madzi azisungika.
■ Kuwonongeka kwa khoma la mtima ndi chitukuko cha "steroid vasculitis" nthawi zambiri kumayambitsidwa ndi mankhwala osinthika (dexamethasone ndi triamcinolone). Amadziwika ndi kuchuluka kwamphamvu mtima. Amawonetsedwa ndi zotupa pakhungu la manja, mucous membrane wamkamwa, conjunctiva wamaso, epithelium yam'mimba thirakiti. Mankhwala, mavitamini C ndi P, komanso anti-bradykinin vascular agents amagwiritsidwa ntchito.
Kuwonjezereka kwa magazi m'magazi kumatha kupangitsa kuti magazi azigundika m'mitsempha yambiri ndi thromboembolism.
Kuchepetsa kubwezeretsanso kwa minofu chifukwa cha anti-anabolic ndi zotsatira za catabolic pa kagayidwe kazakudya zamapuloteni - kuchepetsa mapangidwe a mapuloteni kuchokera ku amino acid, kukulitsa kuwonongeka kwa mapuloteni.
■ Zilonda zam'mimba za m'mimba ndi matumbo, magazi am'mimba. Zilonda za Steroid nthawi zambiri zimakhala asymptomatic kapena asymptomatic, kuwonetsera kutuluka kwa magazi ndi kupangika. Chifukwa chake, odwala omwe amalandila glucocorticoids pakamwa kwa nthawi yayitali ayenera kumawunikira nthawi ndi nthawi (fibroesophagogastroduodenoscopy, fecal zamatsenga zamatsenga). Kupanga kwa ulcerogenic zochita za glucocorticoids kumalumikizidwa ndi mphamvu yawo yokhudzana ndi kuphatikizika kwa kaphatikizidwe ka prostaglandin ndipo kumawonjezera kubisika kwa hydrochloric acid, kuchepetsa mapangidwe a ntchofu ndi kulepheretsa kukonzanso kwa epithelium. Vutoli nthawi zambiri limayamba chifukwa cha prednisone.
■ Pancreatitis, mafuta a chiwindi, kunenepa kwambiri, hyperlipidemia, hypercholesterolemia, embolism yamafuta ndi zotsatira za anabolic zotsatira za glucocorticoids pa metabolism yamafuta - kuchuluka kwa triglycerides, mafuta acids ndi cholesterol, kugawa mafuta.
Kuwonjezereka kwa CNS chisangalalo, kusowa tulo, kusokonezeka, kukhumudwa, matenda amisala, zizindikiro za kutha, kugwidwa kwa odwala omwe ali ndi khunyu.
■ Posterior subcapsular cataract, glaucoma, exophthalmos.
■ Matenda a shuga a steroid, hyperglycemia. Glucocorticoids imachulukitsa kuyamwa kwa chakudya cham'mimba kuchokera m'mimba, imapangitsanso gluconeogeneis, kuchepetsa ntchito ya insulin ndi hexokinase, ndikuchepetsa chidwi cha zimakhala kuti insulini ndi kugwiritsa ntchito shuga. Pochiza matenda a shuga a steroid, zakudya zopatsa mphamvu zopatsa mphamvu, mankhwala a pakamwa a hypoglycemic, ndi insulin amagwiritsidwa ntchito.
Kuchepetsa kusamba, ntchito zogonana, kuchedwa kupititsa patsogolo kugonana, hirsutism, kusokonezeka kwa fetal kumalumikizidwa ndi kuchepa kwa kupanga kwa mahomoni ogonana.
■ Kuponderezedwa kwa chitetezo chokwanira, kuchulukitsa kwa matenda opatsirana ndi kutupa, kuphatikizira chifuwa chachikulu, matenda apakati, kufalitsa matenda wamba. Monga lamulo, zovuta zosagwirizana ndi asymptomatic chifukwa cha anti-yotupa ya glucocorticoids. Kukula kwa candidiasis pamlomo wamkamwa ndi pharynx ndichikhalidwe.
■ Cushing's syndrome (kulimbikitsa mafuta kuchokera ku mafuta opondaponda a miyendo, kuchuluka kwa mafuta kumaso, khosi, lamba lakhosi ndi m'mimba, hypertrichosis, striae, ziphuphu, kulolera shuga.
■ Kusintha kwa ma hemel.
Amawonetsedwa ndi neutrophilic leukocytosis popanda kusintha kosangalatsa kwa leukocyte kumanzere. Amakhulupirira kuti chifukwa cha kukondoweza kwa ma steroid pa granulopoiesis.

Kupewa kwa Mavuto

Kugwiritsa ntchito njira yanthawi zonse (yosinthira).
Kugwiritsa ntchito glucocorticoids wothandizila pa mlingo wofunikira. Chifukwa cha izi, mphumu ya bronchial, makonzedwe awo amayenera kuphatikizidwa ndikugwiritsa ntchito mpweya wambiri wa glucocorticoids kuphatikiza ndi β2-adrenergic agonists, mankhwala a theophylline, kapena antileukotriene.
■ Kupanga kwa glucocorticoids molingana ndi mtundu wa tsiku ndi tsiku wa cortisol secretion.
■ Kugwiritsa ntchito zakudya zomwe zili ndi mapuloteni komanso calcium, zoletsedwa zopatsa mphamvu zamagetsi, mchere (mpaka 5 g patsiku) ndi madzi (mpaka malita 1.5 patsiku).
Kumwa mapiritsi glucocorticoids mukatha kudya kuti achepetse ulcerogenic wawo.
Kuthetsa kusuta fodya komanso kuledzera.

Kuchita masewera olimbitsa thupi mosapweteka.

Lingaliro la glucocorticoids, kugwiritsa ntchito kwawo ngati mankhwala, kuphatikizidwa ndi kapangidwe ndi kachitidwe. Njira za kakonzedwe ka kaphatikizidwe ndi katulutsidwe ka mahomoni a adrenal kotekisi Njira ya zochita za glucocorticoids, zotsatira zoyipa kuchokera kugwiritsidwa ntchito kwawo.

Kutumiza ntchito yanu yabwino pamaziko azidziwitso ndikosavuta. Gwiritsani ntchito mawonekedwe pansipa

Ophunzira, ophunzira omaliza, asayansi achichepere omwe amagwiritsa ntchito chidziwitso m'maphunziro awo ndi ntchito adzayamika kwambiri.

Wolemba http://www.allbest.ru/

Ministry of Health of Ukraine

Zaporizhzhya State Medical University

Dipatimenti ya Pharmacology ndi Medical Dokotala

Pofotokoza: "Pharmacology"

Pamutu: "Zotsatira za glucocorticoids"

Kumaliza: Wophunzira wazaka 3

Saiko Roman Eduardovich

1. Gulu la glucocorticoids

2. limagwirira a glucocorticoids

3. Kugwiritsa ntchito glucocorticoids

4. Zotsatira zoyipa za glucocorticoids

5. Kupewa mavuto a glucocorticoids

Mndandanda wazidziwitso

1.Gulu la Glucocorticoidmu

Glucocorticoids ndi mahomoni a steroid omwe amapangidwa ndi adrenal cortex. Ma glucocorticoids achilengedwe ndi mawonekedwe awo opangira amagwiritsidwa ntchito ngati mankhwala a adrenal insufficiency. Kuphatikiza apo, matenda ena amagwiritsa ntchito anti-yotupa, immunosuppression, anti-allergic, anti-shock ndi zina mwa mankhwalawa.

Chiyambi chogwiritsa ntchito glucocorticoids ngati mankhwala (PM) chibwerera ku 40s. XX century. Kubwerera kumapeto 30s. wazaka zomalizira, adawonetsedwa kuti mitundu yamahomoni ya chikhalidwe cha steroid imapangidwa mu adrenal cortex. Mu 1937, mineralocorticoid deoxycorticosterone adadzipatula ku adrenal cortex, mu 40s. - glucocorticoids cortisone ndi hydrocortisone. Mitundu yambiri yamatenda a hydrocortisone ndi cortisone inakonzeratu mwayi wogwiritsira ntchito ngati mankhwala. Posakhalitsa kuphatikizika kwawo kunachitika.

Glucocorticoid wamkulu komanso wogwira ntchito kwambiri wopangidwa m'thupi la munthu ndi hydrocortisone (cortisol), enanso osagwira ntchito amaimiridwa ndi cortisone, corticosterone, 11-deoxycortisol, 11-dehydrocorticosterone.

Kupanga mahomoni ndi adrenal gland kumayang'aniridwa ndi dongosolo lamkati lamanjenje ndipo kumayenderana kwambiri ndi kugwira ntchito kwa pituitary gland (onani mkuyu. 2). Adrenocorticotropic pituitary hormone (ACTH, corticotropin) ndi othandizira mwakuthupi a adrenal cortex. Corticotropin imathandizira mapangidwe ndi kubisala kwa glucocorticoids. Zotsirizirazi, zimakhudza kutulutsa kwa pituitary, kulepheretsa kupanga kwa corticotropin ndipo potero kumachepetsa kukondoweza kwa grenic gland (mwa lingaliro labwinolo). Kukhazikika kwa nthawi yayitali kwa glucocorticoids (cortisone ndi analogies) mthupi kumatha kubweretsa zoletsa komanso chindoko cha adrenal cortex, komanso kuletsa mapangidwe a ACTH okha, komanso gonadotropic ndi chithokomiro cha chithokomiro cha chithokomiro.

Mkuyu.Gulu la glucocorticoids ndi njira zogwiritsira ntchito

Mkuyu.Njira za kukhazikitsidwa kwa kaphatikizidwe ndi katulutsidwe ka mahomoni a adrenal cortex

Kuyambira 50s ya zaka zapitazi, glucocorticoids akhala pamalo ofunikira mu mitundu yosiyanasiyana yamankhwala ndipo, koposa zonse, muzochita zochiritsira. Kuphatikizika kwa mitundu ya glucocorticoids kwa mtsempha wa magazi ndi mtsempha wamitsempha kumakulitsa kwambiri mwayi wa glucocorticoid mankhwala. Zaka 15 zapitazi, malingaliro athu okhudzana ndi njira ya glucocorticoids adakulirakulira, ndipo pakhala kusintha kwakukulu pamalingaliro ogwiritsa ntchito ma glucocorticoids, kuphatikizapo mlingo, njira zoyendetsera, nthawi yogwiritsira ntchito ndikuphatikiza ndi mankhwala ena.

Kugwiritsa ntchito kwa glucocorticoids muzochita zamankhwala kumayambika mu 1949, pomwe zotsatira zabwino za yochepa za cortisone mwa odwala omwe ali ndi nyamakazi inayamba kunenedwa. Mu 1950, gulu lomweli lofufuza linanenanso za zotsatira zabwino za mankhwalawa a nyamakazi, rheumatism ndi matenda ena amtundu wa cortisone ndi adrenocorticotropic hormone (ACTH). Posakhalitsa, malipoti angapo adawonetsa zotsatira zabwino za glucocorticoid mankhwala a systemic lupus erythematosus (SLE), dermatomyositis, ndi systemic vasculitis.

Masiku ano, glucocorticoids, ngakhale ali pachiwopsezo chachikulu cha zovuta (kuphatikizapo zazikulu), amakhalabe chimwala mu chithandizo cha pathogenetic cha matenda ambiri amitsempha. Kuphatikiza apo, amagwiritsidwa ntchito kwambiri m'matenda ambiri a hematological, glomerulonephritis yoyamba komanso yachiwiri, komanso matenda angapo am'mimba komanso kupuma, zovuta zamthupi, kugwedezeka kwamavuto osiyanasiyana ndi zina zambiri. Kuphatikizika kwa glucocorticoids pakugwiritsira ntchito kwamkati, kutsitsa komanso kugwiritsa ntchito intraarticular kwakulitsa kukula ndi njira zamagwiritsidwe ntchito awo.

Adrenal corticosteroids agawidwa m'magulu awiri akuluakulu - glucocorticoids ndi mineralocorticoids. Zoyambazo zimakhudza pafupifupi ziwalo zonse ndi machitidwe amthupi, pokopa njira zapakatikati za kagayidwe kazinthu, chitetezo cha mthupi ndi zotupa. Ntchito yayikulu ya mineralocorticoids ndikuwongolera madzi amchere amchere.

Kugwiritsa ntchito kufalikira kwa glucocorticoids kumalimbikitsidwa ndi mphamvu yawo yotsutsa-yotupa, immunosuppression ndi anti-allergic.

Pa 1 European Symposium pa glucocorticoid mankhwala, tikulimbikitsidwa kugwiritsa ntchito mawu akuti glucocorticoids kapena glucocorticosteroids. Mawu ena - "steroids", "corticosteroids", "corticoids" ndiwofalikira kapena osakwanira, motero sikulimbikitsidwa kuwagwiritsa ntchito.

Muzochita zamankhwala masiku ano, ma glucocorticoids opangidwa ndi othandizira amagwiritsidwa ntchito, omwe ali ndi vuto lothandizira anti-yotupa, immunosuppressive ndi anti-allergen ndi ofooka kapena ngakhale zero mineralocorticoid zotsatira, chifukwa chake ali m'gulu la mankhwala omwe amagwiritsidwa ntchito kwambiri pamagawo osiyanasiyana amankhwala.

Gulu la glucocorticoids ndi mankhwala

Masoka achilengedwe (amkati):

* cortisol * hydrocortisone * hydrocortisone acetate

Zopangira mafuta okhala ndi ma glucocorticoids:

* prednisolone * prednisone * methylprednisolone

Zopanga fluorine wokhala ndi glucocorticoids:

* dexamethasone * triamcinolone * betamethasone

Gulu la glucocorticoids mwa nthawi ya zochita

Mankhwala ocheperako (maora 8-12):

Mankhwala a nthawi yayitali pochita (maola 12-36):

* prednisolone * methylprednisolone * triamcinolone

Mankhwala omwe akhala akuchita kwa nthawi yayitali (maola 36-72):

* parlueazone * betamethasone * dexamethasone

Depot glucocorticoids amadziwika ndi kukhudzika kwakutali (kuchotsedwa mkati mwa masabata ochepa).

2.Furglucocorticoid anism

Hypothalamic-pituitary-adrenal axis imapanga dongosolo lovuta lomwe limayang'anira kutulutsidwa kwa glucocorticoids m'zochitika zathupi komanso munjira zosiyanasiyana za pathological. Kupanga kwa cortisol ndi adrenal cortex kumayendetsedwa ndi ACTH, yomwe imasungidwa ndi gustine pituitary gland. Kutulutsidwa kwa ACTH, kumayendetsedwanso ndi mahormoni otulutsa corticotropin, komwe khungu lawo limayendetsedwa ndi mitsempha, endocrine ndi cytokine pamlingo wa periventricular nuclei ya hypothalamus. Corticotropin yotulutsidwa ndi mahomoni imatengedwera yaying'ono kukafalitsa gawo lakwawo, kenako kupita ku malo ake akunja, komwe mahomoni otulutsa corticotropin amalimbikitsa kutulutsa kwa ACTH. glucocorticoid mankhwala mbali

Secaltion ya basal tsiku ndi tsiku ya cortisol mwa anthu pafupifupi 20 mg. Kuphatikiza apo, kubisala kwake kumadziwika ndi kusinthasintha kwa masana ndi magulu apamwamba kwambiri m'mawa kwambiri komanso zamtengo wapatali madzulo. Cortisol yobisika kwambiri (pafupifupi 90%) imazungulira ndi ma corticoid omanga magazi a magazi. Cortisol yaulere ndi mtundu wa mahomoni omwe amagwira nawo ntchito.

Hyperreacaction ya hypothalamic-pituitary-adrenal axis pakalibe kutupa (mwachitsanzo, ndi Cushing's syndrome) imayambitsa immunosuppression ndikuwonjezera chidwi cha matenda. Kutsegula kwa hypothalamic-pituitary-adrenal axis, ndikuwonjezera kuchuluka kwa cortisol ndikuwatsogolera ku immunosuppression, kumatha kuyambitsidwa ndi zinthu zingapo zopsinjika, kuphatikizapo kupweteka, kuvutika mumtima, kuzizira, kulimbitsa thupi, matenda, kuchitapo kanthu kwa opaleshoni, kuchepetsa kuchepa kwa calorie, ndi zina zambiri. Endo native glucocorticoids, komanso gawo la homeostatic, amasinthanso mayankho odana ndi kutupa. Umboni ukuperekedwa kuti kusokonezeka kwa glucocorticoids wa amkati amathandiza kwambiri pathogenesis yamatenda angapo azachilengedwe a minyewa yodziwika kapena pakulimbikira kotupa. Mu matenda amisempha monga nyamakazi, SLE, dermatomyositis ndi ena, kusintha kwakukulu kumachitika mu hypothalamic-pituitary-adrenal axis, yodziwika ndi chitetezo chokwanira cha ACTH chokhudzana ndi ma cytokines ozungulira, osakwanira oyambira komanso olimbikitsidwa ndi cortisol poyesa kuchepa, komanso kutsekeka kwachilengedwe androgen.

Kugwiritsa ntchito ma glucocorticoids opanga kumabweretsa kuyambitsa kuphatikizika ndi kutulutsidwa kwa mitundu yonse ya corticotropin-kumasula mahomoni ndi ACTH, ndipo chifukwa chake, kutsika kwa kupanga kwa cortisol. Kuchulukitsa kwa glucocorticoid wa nthawi yayitali kumapangitsa kuti adrenal atrophy ndi kukakamiza kwa hypothalamic-pituitary-adrenal axis, zomwe zimapangitsa kuchepa kwa kuthekera kotulutsa ma glucocorticoids owonjezera poyankha ACTH ndi zina.

Pakadali pano, ndichizolowezi kusiyanitsa pakati pa njira ziwiri za glucocorticoids - genomic ndi sanali genomic.

Ma genomic limagwirira ntchito pomanga mwachindunji ma cytoplasmic receptors amawonedwa pa mulingo uliwonse ndipo samawonekera kupitirira mphindi 30 atapangidwa ndi kupangika kwa hormone-receptor.

Makina ofunikira a genomic zochita za glucocorticoids ndikuwongolera kwa kusintha kwa majini omwe amayang'anira kapangidwe ka mapuloteni ndi DNA. Zotsatira za glucocorticoids pa glucocorticoid receptors (omwe ndi mamembala a membrane steroid receptor) zimabweretsa chitukuko cha zochitika zambiri zomwe zimaphatikizapo mthenga RNA, RNA ya nyukiliya, ndi zinthu zina zotsatsira. Zotsatira za ngoziyi ndi kukondoweza kapena kuletsa kwa zolembedwa za jini. Glucocorticoids imakhudza mitundu yambiri, kuphatikizapo majini omwe amawongolera mapangidwe a ma cytokine monga IL-la, IL-4, IL-6, IL-9 ndi gamma interferon. Potere, glucocorticoids imatha kupangitsa kuti majini azisindikizidwa ndikuwapanikiza.

Glucocorticoids imathandizanso kuphatikiza mapuloteni a ma cell. Zilowera mosavuta komanso mwachangu kudzera mu ziwalo za ma cell, zimapanga ma cell ndi ma protein omwe amapezeka mu cell ya ma cell, zomwe zimapangitsa kuti ziwonekere kuzinthu zama genetic

enieni mthenga RNA wa kapangidwe ka peptides yoyendetsera ndi mapuloteni, makamaka omwe amagwirizana ndi dongosolo la ma enzyme, omwe, amawongolera ma cell.Ma enzyme amenewa amatha kugwira ntchito zolimbikitsa komanso zopatsa mphamvu. Mwachitsanzo, amathandizira kupanga mapuloteni ovomerezeka m'maselo ena, omwe amaletsa kwathunthu kusintha kwa majini omwe amapezeka m'maselo a lymphoid, potero amasintha mayankho a chitetezo ndi kutupa.

Glucocorticoids imakhudza ma cell ndi ma humidity immune. Kukula kwa lymphocytopenia pansi pa kukopa kwawo kumachitika chifukwa cha kuletsa kwa kupanga ndi kumasulidwa kwa maselo a lymphoid kuchokera m'mmafupa, kulepheretsa kusamuka kwawo ndikugawidwanso kwa ma lymphocyte kupita kumagawo ena a lymphoid. Glucocorticoids imathandizira mogwirizana kwa maselo a T ndi B mu chitetezo cha mthupi. Amachita mosiyanasiyana pamatchulidwe osiyanasiyana a T-lymphocyte, zomwe zimapangitsa kuchepa kwa gawo la T-maselo okhala ndi ma receptors a gawo la IgM Fc, komanso osasintha mulingo wa T-lymphocyte okhala ndi ma receptors a gawo la IgG Fc. Mothandizidwa ndi glucocorticoids, luso lochulukitsa la maselo T limapanikizika mu vivo ndi vitro. Zotsatira za glucocorticoids pamavuto a B-cell amawonetsedwa pang'ono kuposa ma T-cell. Chifukwa chake, mwa odwala omwe amalandira Mlingo wambiri wa glucocorticoids, mayankho abwinobwino a munthu akamayikidwa Katemera amawonekera. Nthawi yomweyo, kuyang'anira kwakanthawi kwamadontho akulu a glucocorticoids amachititsa kuchepa kwa serum IgG ndi IgA magawo ndipo sikukhudza magawo a IgM. Zotsatira za glucocorticoids pa B-cell ntchito zitha kuphatikizidwa chifukwa cha momwe amawonera macrophages.

Mosiyana ndi genomic, zotsatira zosakhala za genomic zama glucocorticoids zimachitika chifukwa cholumikizana mwachindunji ndi ma membrane achilengedwe komanso / kapena ma cell membrane othandizira. Zotsatira zopanda genomic za glucocorticoids zimayamba mchikakamizo cha milingo yapamwamba ndipo zimawonekera masekondi kapena mphindi zochepa.

Mphamvu ya non-genomic anti-yotupa ya glucocorticoids imalumikizidwa ndi kukhazikika kwa ma membala a lysosomal, kuchepa kwamphamvu kwamitsempha yama cell, kuchepa kwa kuchuluka kwa magazi komanso kuthamanga kwa magazi kumadera akumatupa, kuchepa kwa kufalikira kwa maselo a endothelial, kuchepa kwa mphamvu ya kufooka kwa maselo osakanikirana ndi kuphatikizika kwa kuponderezedwa, kuphatikizira kwa gawo ziwiya zamagetsi poyang'ana kutukusira ndi kuchepa kwa kuchuluka kwawo (pang'ono chifukwa cha

kuletsa kwa syntaglandin synthesis), kuchepa kwa chiwerengero cha ma monocytes ndi ma cell a mononuclear poyang'ana kutupa, komanso momwe zimakhudzira leukocytes ya polymorphonuclear. Mwachidziwikire, gawo lotsogola polimbana ndi kutulutsa mphamvu ya glucocorticoids ndi gawo la zoletsa kusamuka komanso kudzikundikira kwa leukocytes pamaziko oyipa. Mothandizidwa ndi glucocorticoids, zochita za bactericidal, Fc receptor binding ndi ntchito zina za monocytes ndi macrophages zimasokonekera, ndipo milingo ya eosinophils, monocytes ndi lymphocyte pakufalikira. Kuphatikiza apo, mayankho pama cell kwa kinins, histamine, ma prostaglandins, ndi chemotactic zinthu zimasinthika, ndipo kumasulidwa kwa ma prostaglandins m'maselo omwe amalimbikitsidwa amachepa. Njira yophunziridwa bwino yopanda genomic imaphatikizanso kutsegula kwa endothelial synthase ya nitric oxide.

Mlingo wa glucocorticoids amatsimikiza kugwira ntchito kwawo, komanso pafupipafupi komanso kuopsa kwa mavuto. Zotsatira za genomic za glucocorticoids zimakhazikika pamlingo wocheperako ndipo zimawonjezeka ngati pafupifupi 100 mg ya prednisolone ofanana patsiku imafika, ndikukhalabe khola mtsogolo. Ngati mukugwiritsa ntchito glucocorticoids mu mlingo wa mpaka 30 mg wa prednisolone wofanana, zotsatirapo zochizira zimatsimikiziridwa kwathunthu ndi ma genomic methanems, ndiye kuti muyezo wa 30 mg wa prednisolone ofanana, osakhala genomic zotsatira zimakhala zazikulu, gawo lomwe limakulirakulira msanga.

Glucocorticoids amadziwikanso bwino pazinthu zosiyanasiyana zomwe amagwiritsa ntchito, i.e., pakamwa, intramuscular, intravenous kapena intraarticular. Pambuyo pakukonzekera pakamwa, pafupifupi 50-90% ya glucocorticoids amavuta. Kumangiriza kwa glucocorticoids kumapuloteni amwazi pafupifupi 40-90%. Kagayidwe ka glucocorticoids amachitika makamaka mu chiwindi, ndi chimbudzi - makamaka ndi impso mu mawonekedwe a metabolites. Kuchuluka kwa kuchuluka kwa glucocorticoids m'magazi pambuyo pakukonzekera kwamlomo kumachitika pambuyo pa maola 4-6. Ndi mtsempha wa magazi a glucocorticoids, nsonga ya ndende yawo imatheka mofulumira. Chifukwa chake, pakukhazikitsidwa kwa 1.0 g ya Solomedrol ® (methylprednisolone sodium succinate), nsonga ya plasma ndende yake imawonedwa pambuyo pa mphindi 15. Mothandizidwa ndi michere ya glucocorticoids, kuchuluka kwake kwa ndende ya plasma kumachitika kwambiri

pambuyo pake. Mwachitsanzo, ndi jekeseni wamitsempha wa Depo-medrol® (methylprednisolone acetate), kuchuluka kwake kwakukulu m'magazi kumatha kufikira pambuyo pafupifupi maola 7.

3. Kugwiritsa ntchito glucocorticoids

Zofotokozedwa multifaceted njira za glucocorticoids ndi magawo osiyanasiyana a ntchito zawo ndiwo maziko a ntchito yawo yambiri matenda ambiri a ziwalo zamkati, komanso njira zingapo zamomwe zimachitikira. Pamodzi ndi matenda amitsempha ndi systemic vasculitis, pomwe glucocorticoids nthawi zambiri amakhala mankhwala oyambira, glucocorticoid mankhwala amagwiritsidwanso ntchito mu endocrinology, gastroenterology, revuscitation, cardiology, pulmonology, nephrology, traumatology ndi zina zambiri.

Pansipa timapereka matenda ndi malo omwe ma glucocorticoids amagwiritsidwa ntchito:

1.Rheumatoid nyamakazi - pakalibe chiwonetsero chachikulu cha matendawa (systemic vasculitis, serositis, myocarditis, fibrosing alveolitis, bronchiolitis obliterans), Mlingo wochepa wa glucocorticoids amagwiritsidwa ntchito motsutsana ndi maziko a chithandizo. Ndi chitukuko cha ziwonetsero zomwe zimanenedwa pamwambapa za nyamakazi, yapakati ndipo ngati kuli koyenera, milingo yayikulu ya glucocorticoids imagwiritsidwa ntchito.

2. Ankylosing spondylitis - mu gawo yogwira ntchito, mulingo wapakati kapena wapamwamba wa glucocorticoids amagwiritsidwa ntchito.

. , ndi / kapena hemmonha hemorrhages, ndi / kapena hemolytic anemia, ndi / kapena thrombocytopenic purpura, ndi / kapena yogwira lupus glomerulonephritis III, IV, makalasi a V morphological) amawonetsa kugwiritsa ntchito milingo yapakati kapena yayikulu ya glucocorticoids, ndipo ngati pakufunika - okwera kwambiri Oil.

4. Acute rheumatic fever kapena kuchulukitsa kwa mseru - pakati kapena kwambiri Mlingo wa glucocorticoids (makamaka ndi kukula kwa rheumatic Carditis).

5. Rheumatic polymyalgia - glucocorticoids ndi mankhwala osankhidwa. Mu gawo la pachimake, mulingo wapakatikati kapena wapamwamba wa glucocorticoids amagwiritsidwa ntchito.

6. Polymyositis ndi dermatomyositis - glucocorticoids ndi mankhwala osankha. Mu gawo la pachimake, mlingo waukulu wa glucocorticoids ndi mankhwala.

7. Systemic scleroderma - glucocorticoids zotchulidwa mankhwala otsika ndi sing'anga ndi kukula kwa myositis.

8. Matenda omwe adakalipo - mu gawo la pachimake, komanso pamene ma membala ofunikira ndi machitidwe (myocarditis, pericarditis, khunyu) akukhudzidwa ndi matenda a pathological - Mlingo wapakati kapena waukulu wa glucocorticoids.

1.Giant cell arteritis - mu gawo lovuta, glucocorticoids ndi chithandizo cha kusankha ndipo amalembedwa pamtunda waukulu.

2. Matenda a Takayasu - mu siteji ya pachimake, mulingo wambiri kapena wapamwamba wa glucocorticoids amagwiritsidwa ntchito.

3. Nodular polyarteritis ndi ma microscopic polyangiitis - mu gawo lovuta, magwiritsidwe a glucocorticoids amagwiritsidwa ntchito.

4. Matenda a Wegener - mu gawo la pachimake - Mlingo waukulu wa glucocorticoids.

5. Charge-Strauss Syndrome - pachimake gawo la mankhwala kusankha - Mlingo waukulu wa glucocorticoids.

6. Behcet's syndrome - mu pachimake siteji, pakati kapena kwambiri Mlingo wa glucocorticoids ndi mankhwala.

7. Cutaneous leukocytoclastic vasculitis - woopsa, Mlingo wa glucocorticoids umagwiritsidwa ntchito.

8. hemorrhagic vasculitis (Shenlein-Genoch purpura) - glucocorticoids amalembedwa pakatikati kapena pamiyeso yayikulu komanso kukula kwa glomerulonephritis ndi nephrotic syndrome komanso / kapena kupangika kwa 50-60% ya glomeruli ndi theka la mwezi. Malinga ndi ma rheumatologists angapo, mulingo wambiri wa glucocorticoids ungagwiritsidwe ntchito pamimba.

1.Glomerulonephritis ndi kusintha kocheperako (idiopathic nephrotic syndrome) - koyambirira kwamatendawa kapena kutulutsa kwake, glucocorticoids wokhazikitsidwa pamlingo wapakati kapena wapamwamba ndiye chithandizo cha kusankha.

2. Focal-segmental glomerulosulinosis-hyalinosis - koyambirira kwa matendawa kapena kutulutsa mphamvu, Mlingo wapakati kapena wapamwamba wa glucocorticoids amagwiritsidwa ntchito.

3. Mesangioproliferative glomerulonephritis sing'anga kapena Mlingo wambiri wa glucocorticoids amagwiritsidwa ntchito popanga nephrotic syndrome komanso / kapena theka la mwezi mu glomeruli ya 50-60%.

4. Mesangiocapillary glomerulonephritis - Mlingo wambiri wa glucocorticoids amagwiritsidwa ntchito popanga nephrotic syndrome ndi / kapena theka la mwezi mu glomeruli ya 50-60%.

5. Membranous glomerulonephritis - pamaso pa nephrotic syndrome, Mlingo wapakatikati kapena wapamwamba wa glucocorticoids amagwiritsidwa ntchito.

6. glomerulonephritis yomwe ikupita patsogolo msanga (subacute, lunate) - Mlingo wambiri wa glucocorticoids umagwiritsidwa ntchito.

Second glomerulonephritis (i.e., glomerulonephritis yomwe imapangidwa ndi SLE, nyamakazi yam'mimba, polymyositis, dermatomyositis, vasculitis) amagwiritsa ntchito Mlingo wapakati kapena wapamwamba wa glucocorticoids.

1.Kuperewera kwa ACTH m'matenda osiyanasiyana a pituitary gland - hydrocortisone kapena njira zochepa za glucocorticoids amagwiritsidwa ntchito ngati mankhwala othandizira.

2. Amiodarone-inened myrotoxicosis - milingo yayikulu ya glucocorticoids imagwiritsidwa ntchito.

3. Kuperewera kwa adrenal - hydrocortisone kapena njira zochepa kapena zochepa pakati pa glucocorticoids amagwiritsidwa ntchito ngati mankhwala othandizira.

1.Matenda a Crohn - mu gawo lovuta kwambiri, milingo yambiri ya glucocorticoids imagwiritsidwa ntchito.

2. Nonspecific ulcerative colitis - mu pachimake gawo, Mlingo wambiri kapena wapamwamba wa glucocorticoids amagwiritsidwa ntchito.

3. Autoimmune hepatitis - Mlingo wapakatikati kapena wapamwamba wa glucocorticoids amagwiritsidwa ntchito.

4. Magawo oyamba a matenda enaake a shuga - gwiritsani ntchito pafupifupi glucocorticoids.

5. Mankhwala oopsa a hepatitis - amagwiritsa ntchito mphamvu zapakati kapena zazikulu za glucocorticoids.

1.Post-viral and nonspecific lymphocytic myocarditis - Mlingo wapakatikati kapena wapamwamba wa glucocorticoids ndi mankhwala.

2. Acute osavomerezeka a pericarditis omwe amakhala ndi kuchuluka kwa exudate - Mlingo wapakati kapena wapamwamba wa glucocorticoids amagwiritsidwa ntchito.

1.Mphumu ya bronchial - glucocorticoids (pakatikati kapena pamtunda waukulu) amalembedwa chifukwa cha mphumu, kuphipha kwambiri kwa mphumu, komwe kupuma kwa glucocorticoids ndi bronchodilators sikugwira ntchito.

2. Cryptogenic fibrosing alveolitis - Mlingo waukulu wa glucocorticoids umagwiritsidwa ntchito.

3. Kuletsa bronchiolitis - Mlingo waukulu wa glucocorticoids umagwiritsidwa ntchito.

4. Sarcoidosis yamapapu - Mlingo wapakatikati kapena wapamwamba wa glucocorticoids amagwiritsidwa ntchito.

5. Chibayo cha Eosinophilic - Mlingo wapakatikati kapena wapamwamba wa glucocorticoids ndi mankhwala.

1.Hemoblastoses - Mlingo wambiri komanso wapamwamba kwambiri wa glucocorticoids amagwiritsidwa ntchito.

2. Anemia (hemolytic, autoimmune, aplastic) - Mlingo wapakati komanso wapamwamba wa glucocorticoids amagwiritsidwa ntchito.

3. Supombocytopenia - Mlingo wapakatikati ndi wapamwamba wa glucocorticoids ndi mankhwala.

1. Manjenjemera osiyanasiyana omwe amagwiritsa ntchito - gwiritsani ntchito kwambiri Mlingo wambiri wa glucocorticoids. Chithandizo cha mafinya ndimakonda.

2. Thupi lawo siligwirizana - Mlingo wambiri komanso wambiri wa glucocorticoids ndi mankhwala, ngati pangafunike, "chithandizo cha mapapo".

3. Acute kupuma nkhawa syndrome - Mlingo waukulu kwambiri wa glucocorticoids amagwiritsidwa ntchito.

1.Kutengera ndi zomwe zimachitika kuchipatala, glucocorticoids kuyambira otsika mpaka kwambiri Mlingo amagwiritsidwa ntchito, ndipo ngati kuli kotheka, "pulse chithandizo".

4.Zoyambiramavuto a glucocorticoids

Ndi chithandizo chochepa cha mankhwala a glucocorticoids, zotsatira zoyipa zambiri sizimachitika. Odwala ena akuti kuchuluka kwa kudya, kunenepa, kusokonezeka kwamanjenje, komanso kugona.

Mothandizidwa ndi corticosteroids kwanthawi yayitali, dzina lotchedwa Itsenko-Cushing's limayamba kunenepa kwambiri, "nkhope yooneka ngati mwezi", tsitsi limakula kwambiri thupi ndikuwonjezera magazi. Ndi kuchepa kwa mphamvu ya mahomoni, izi zimachitikanso. Zowopsa zowopsa za glucocorticoids pa mucous membrane wa m'mimba: amatha kuyambitsa zilonda zam'mimba ndi m'mimba. Chifukwa chake, kukhalapo kwa wodwala wokhala ndi zilonda zam'mimba ndi imodzi mwazinthu zofunikira kwambiri pakugwiritsira ntchito corticoids. Wodwala akamamwa mahomoni a steroid, ngati pali zodandaula za kupweteka kapena kupweteka pamimba, kutentha kwa mtima, ndikofunikira kupereka mankhwala omwe amachepetsa acidity ya madzi a m'mimba. Kuchiza ndi glucocorticoids aliwonse amathandizana ndi kutaya kwa potaziyamu, kotero kutenga prednisone kuyenera kuphatikizidwa ndi kukonzekera kwa potaziyamu (panangin, asparkum). Corticosteroids imayambitsa kusungika kwa sodium ndi madzimadzi m'thupi, kotero edema ikawoneka, mankhwala ochepa okha a potaziyamu amatha kugwiritsidwa ntchito (mwachitsanzo, triampur, trireside K). Ndi nthawi yayitali makonzedwe a corticosteroids kwa ana, kusokonezeka kwa msambo ndi kuchedwa kutha kumatha.

Ma glucocorticoids onse ali ndi zovuta zina, zomwe zimatengera mlingo ndi nthawi ya chithandizo.

1. Kuponderezedwa kwa ntchito ya adrenal cortex. Glucocorticoids imaletsa kugwira ntchito kwa hypothalamus-pituitary-adrenal cortex system. Izi zimatha kupitilira miyezi yambiri atasiya kulandira chithandizo cha mankhwala ndipo zimatengera mlingo womwe umagwiritsidwa ntchito, pafupipafupi makonzedwe ndi nthawi yayitali ya mankhwala. Zotsatira za adrenal cortex zitha kufooka ngati, m'malo mwa mankhwala omwe akhala akuchita kwa nthawi yayitali (dex-metazone), mankhwala ogwirira ntchito mwachidule monga prednisone kapena methylprednisolone mu Mlingo wocheperako amagwiritsidwa ntchito. Ndikofunika kumwa tsiku lililonse m'mawa kwambiri, zomwe zimagwirizana kwambiri ndi kutulutsa kwina kwa chimbudzi cha cortisol. Mukamamwa tsiku lililonse, ma glucocorticoids omwe amagwiritsidwa ntchito mwachidule amagwiritsidwa ntchito ndipo kumwa kamodzi kumawonjezeranso m'mawa. Mothandizidwa ndi kupsinjika (m'mimba, matenda oopsa a pachimake, ndi zina), kuwonetseredwa kwa adrenal cortex nthawi zambiri kumadziwonetsera, komwe kumawonetsedwa ndi kusadya, kuchepa thupi, kugona, kutentha thupi komanso orthostatic hypotension. Ntchito ya mineralocorticoid ya adrenal cortex imasungidwa, motero, hyperkalemia ndi hyponatremia, yodziwika ndi kuperewera kwa adrenal cortical, nthawi zambiri kulibe. Odwala ayenera kuvala chibangili chapadera kapena kukhala ndi khadi la kuchipatala kuti mwadzidzidzi adokotala adziwenso zofunikira pakuwongolera mwachangu ma glucocorticoids. Odwala omwe amatenga kwa milungu ingapo kupitilira 10 mg ya prednisone patsiku (kapena mlingo wofanana wa mankhwala wina), gawo limodzi kapena lina la kuponderezana kwa adrenal cortex limatha kupitirira mpaka chaka 1 atasiya kulandira chithandizo.

2. Kuponderezedwa kwa chitetezo chathupi.Glucocorticoids amachepetsa kukhudzana ndi matenda, makamaka mabakiteriya, chiwopsezo cha matenda mwachindunji chimatengera mlingo wa glucocorticoids ndipo umakhalabe chifukwa chachikulu cha zovuta ndi kufa kwa odwala omwe ali ndi SLE. Zotsatira zamankhwala a steroid, nthenda yakumaloko imatha kukhala yachilengedwe, matenda opatsirana amatha kugwira ntchito, ndipo tizilombo toyambitsa matenda tizilombo toyambitsa matenda titha kuyambitsa. Poyerekeza ndi maziko a glucocorticoid mankhwala, matenda amatha kubisika mwachangu, koma kutentha kwa thupi kumadzuka. Monga njira yodzitetezera, Katemera wa fuluwenza ndi katemera wa pneumococcal, amene sayambitsa kukokomeza kwa SLE, akulimbikitsidwa. Musanayambe chithandizo ndi glucocorticoids, ndikofunika kuchita mayeso a chifuwa cha khungu.

3. Kusintha maonekedwe kumaphatikizapo: kuzungulira nkhope, kunenepa kwambiri, kugawa mafuta, thupi, ziphuphu, kunenepa, kuphwanya ndi kuvulala kochepa. Kusintha kumeneku kumacheperachepera kapena kutha pambuyo pakuchepetsa mlingo.

4. Mavuto a m'maganizo amachokera ku kusakwiya pang'ono, kusokonezeka ndi kugona tulo kwambiri pakukhumudwa kapena psychosis (yotsirizirayi imatha kuganiziridwa molakwika ngati lupus lesion of the central mantha system).

5. Hyperglycemia ikhoza kuchitika kapena kuwonjezeka panthawi ya chithandizo ndi glucocorticoids, koma, monga lamulo, sichingagwiritsidwe ntchito ngati kuphwanya kwawo nthawi yawo. Kugwiritsa ntchito insulini kungafunike, ketoacidosis sichimakula.

6. Kuphwanya mulingo wamagetsi wamagetsi kumaphatikizapo kusungidwa ndi sodium ndi hypokalemia. Mavuto apadera a mankhwalawa amayamba ndi kulephera kwa mtima ndi edema.

7. Glucocorticoids imatha kuyambitsa kapena kuonjezera matenda oopsa. I / O zimachitika ndi ma steroid nthawi zambiri zimachulukitsa matenda oopsa a magazi ngati kuli kovuta kuchitira.

8. Osteopenia ndi psinjika frattures wa vertebral matupi nthawi zambiri amakula ndi glucocorticoid wa nthawi yayitali. Chifukwa chake, odwala ayenera kulandira ioni a calcium (1-1,5 g / tsiku ndi pakamwa). Vitamini D ndi thiazide okodzetsa atha kukhala othandiza. Mwa azimayi a postmenopausal, pangozi yowonjezereka ya osteopenia, estrogens nthawi zambiri amawonetsedwa, koma zotsatira za kugwiritsidwa ntchito kwawo SLE ndizotsutsana. Ma calcitonites ndi diphosphonates angagwiritsidwenso ntchito. Kuchita masewera olimbitsa thupi olimbikitsa mtima kumalimbikitsa.

9. Steroid myopathy imadziwika ndi kuwonongeka kwa minofu makamaka kwa lamba ndi m'chiuno cha pelvic. Kufooka kwa minofu kumadziwika, koma palibe ululu, ntchito yama enzymes am'magazi minofu yoyambira ndi magawo a electromyographic, mosiyana ndi kuwonongeka kwa minofu yotupa, sasintha. Kuchita minofu kumachitika pokhapokha ngati sizofunikira kutulutsa kutupa. Kuthekera kwa steroid myopathy kumachepa ngati mlingo wa glucocorticoids umachepetsedwa ndikuwonetsa zochita zolimbitsa thupi kwambiri, komabe, kuchira kwathunthu kumatha kutenga miyezi ingapo.

10. Matenda a mphumu amaphatikizira kukakamira kwazomwe zimachitika (zomwe nthawi zina zimachitika chifukwa cha kupitiriza kwa glaucoma) ndi chikhodzodzo chapambuyo pake.

11. Ischemic bone necrosis (aseptic, avascular necrosis, osteonecrosis) ikhoza kukhalanso nthawi ya mankhwala a steroid. Mavutowa nthawi zambiri amakhala ochulukirapo, amawonongeka pamutu wachikazi ndi humerus, komanso nthaka ya tibia. Zoyipa zoyambirira zimapezeka ndi isotopic scintigraphy ndi MRI. Maonekedwe a kusintha kwa ma radiology kumaonetsa njira yomwe ikupita patali. Opaleshoni ya mafupa ingagwire bwino ntchito magawo oyambirira a ischemic necrosis, koma kuyerekezera kwa njira yothandizirayi ndikutsutsana.

12. Zotsatira zina za glucocorticoids zimaphatikizapo hyperlipidemia, kusamba kwa msambo, kuchuluka thukuta, makamaka usiku, ndi chosaopsa intracranial matenda oopsa (pseudotumor cerebri). Kuchita kwa glucocorticoids nthawi zina kumalumikizidwa ndi kuwonekera kwa thrombophlebitis, necrotizing arteritis, kapamba ndi zilonda zam'mimba, koma umboni wa kulumikizanaku ndiwosakwanira.

5.Chenjezoglucocorticoids

1. Mwambo wowonekeratu wogwiritsa ntchito glucocorticoids.

2. Kusankha koyenera kwa mankhwala a glucocorticoid, omwe amadziwika kwambiri ndi mphamvu komanso zotsatira zochepa zamavuto. Methylprednisolone (Medrol, Solu-medrol ndi Depo-medrol) amakwaniritsa izi, malingaliro omwe amaperekedwa pamwambapa.

3. Kusankhidwa kwa koyamba kwa mankhwala a glucocorticoid omwe amapereka chithandizo chofunikira pazoyenera zochepa kuyenera kuyikidwa pa kuwunika kozama kwa wodwalayo, kuphatikizapo nosology ya matendawa, ntchito yake, kupezeka kwa kuwonongeka kwa ziwalo ndi machitidwe ofunikira, komanso kuvomerezedwa ponseponse mu malingaliro a glucocorticoid mankhwala osiyanasiyana azachipatala zochitika. Masiku ano, mankhwala a glucocorticoid amadziwika popanda chidziwitso ngati chithandizo cha matenda amisempha yambiri, kuphatikizapo SLE, dermatomyositis ndi polymyositis, vasculitis, glomerulonephritis ndi zina zambiri. Nthawi yomweyo, milingo yoyambirira imasiyana mosiyanasiyana kutengera mawonekedwe azachipatala ndi magawo a ma labotale. Chifukwa chake, mwachitsanzo, ndi ntchito yayikulu ya SLE, dermatomyositis, polymyositis, vasculitis wothandizirana komanso / kapena kuyika kwazinthu zofunikira ndi machitidwe mu matenda awa, kugwiritsa ntchito milingo yayikulu kapena yayikulu kwambiri ya glucocorticoids imasonyezedwa. Nthawi yomweyo, ndi ntchito yotsika ya SLE, vasculitis, njira yabwino yachipatala imatha kupezeka ndi milingo yochepa ya glucocorticoids, ndipo pakalibe kuwonongeka kwa ziwalo zamkati ndi dongosolo lamanjenje lamkati, sikofunikira kupatsa mankhwala a glucocorticoid kuti mukwaniritse kuchiritsidwa kwachithandizo, chifukwa chokwanira chachipatala chimatha kugwiritsidwa ntchito pogwiritsa ntchito NSAIDs , nthawi zambiri kuphatikiza ndi aminoquinoline kukonzekera. Nthawi yomweyo, odwala ambiri amafunika kugwiritsa ntchito njira zochepa za glucocorticoids (Medrol 4-6 mg patsiku kapena prednisolone 5-7,5 mg patsiku).

Kugwiritsa ntchito kwa mankhwala osintha matenda komwe kumayambiriro kwa nyamakazi, kusowa kwa chidziwitso pazotsatira zabwino zamatenda a glucocorticoids pakapita nthawi yayitali kwa odwala omwe ali ndi nyamakazi, komanso chiwopsezo chazovuta zazikulu pakugwiritsa ntchito ma glucocorticoids. Lero posowa

Mawonekedwe owopsa owonjezera a rheumatoid nyamakazi (mwachitsanzo, vasculitis, chibayo) samalimbikitsidwa kuti azigwiritsidwa ntchito ndi glucocorticoids mu Mlingo woposa 7.5 mg patsiku la prednisone kapena 6 mg ya methylprednisolone. Komanso, mwa odwala ambiri omwe ali ndi nyamakazi, kuwonjezereka kwa 2-4 mg patsiku la Medrol ku chithandizo chosinthira matendawa kumadziwika ndi zotsatira zabwino zamankhwala.

1. Khazikitsani njira yomwe ingatengepo ma glucocorticoids: zosankha (zosinthika ndi zina) zina.

2. M'matenda ambiri amisala, vasculitis, glomerulonephritis, glucocorticoids nthawi zambiri samakwanira kuti chikwaniritso chonse kapena chachipatala chofunikira, chomwe chimafuna kuphatikizidwa ndi mitundu yosiyanasiyana ya mankhwala a cytotoxic (azathioprine, cyclophosphamide, methotrexate ndi ena). Kuphatikiza apo, kugwiritsa ntchito ma cytostatics kungachepetse kuchuluka kwa glucocorticoids (kapena ngakhale kuwaimitsa) pakukhalabe ndi zotsatira zamankhwala, zomwe zimachepetsa pafupipafupi komanso zovuta za zovuta za glucocorticoid mankhwala.

3. Madokotala ambiri amalimbikitsa kuti mankhwala ochepetsa mphamvu ya glucocorticoids a nthawi yayitali kwambiri (2-4 mg / tsiku la Medrol® kapena 2,5-5.0 mg / tsiku la prednisolone) apitilizidwa mwa odwala ambiri omwe ali ndi matenda amitsempha atakwaniritsa kukhululukidwa kwachipatala.

Ndimndandanda wazogwiritsidwa ntchito

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