Isi mmetụta dị na glucocorticoids

Ọtụtụ afọ nke ahụmịhe na ọgwụ glucocorticoid n'ọrịa dị iche iche na ụmụaka ekpughere ọ bụghị naanị dị mma, kamakwa akụkụ ndị na-adịghị mma nke usoro ọgwụgwọ a. Achọpụtara ya na ụfọdụ ndị ọrịa, mmeghachi omume ọjọọ na-adịru nwa oge, na-ekwukwa ntakịrị na okike ma pụọ ​​na-enweghị ọnaghị.

N’aka umuaka ndi ozo, mgbe ekpochapuchara ihe ndi mmanu n’aru glucocorticoid, nsogbu ndi bilitere, oge ufodu juputara, ghagidegide n’aho otutu, na oge ufodu na ndu ha. Ọdịdị na ịdị njọ nke mmeghachi omume na nsogbu dị iche iche na-adabere kwa ụbọchị na oge oge ọ na-eji ọgwụ glucocorticosteroid, afọ nwatakịrị ahụ na njiri mara nke arụmọrụ nke ahụ ya.

Usoro nke nsonaazụ na-akpata glucocorticosteroids dị mgbagwoju anya, n'ihi na ọgwụ ndị a na-abanye n'akụkụ niile nke ọrụ dị mkpa nke ahụ nwata ahụ. Agbanyeghị, mmadụ nwere ike ikwuwa okwu banyere ọgwụ ọjọọ ndị a na - egbu egbu na ihe nfụkasị ahụ, maka ike ha na - emebi oke nchekwa, na - akpata mbibi anụ ahụ ma gbochie usoro ịmụgharị n'ime ha, kpasuo oke metabolism ahụ. Mmeghachi omume na nsogbu na ọgwụgwọ ụmụaka nwere glucocorticosteroids nwere ike ịdị ka ndị a.

1.Otu n'ime ngosipụta a na-ahụkarị ọgwụ hypercorticism na-akpachapụ anya na ahụ nwata ahụ bụ ọrịa Cushingoid: Ibu ibu ya na ihe ngosiputa nke oke ibu (izo ihu, imeju oke abuba na ihu, olu, ubu, afọ) na aru, akpukpo ahu ma obu akpukpo ahiri, okpomoku ya, puru oria aru aru.

A na - ejikọta nkwakọba ụba abụba (ụdị oke oke nwoke) na mmetụta catabolic nke ọgwụ glucocorticosteroid, usoro gluconeogenesis mụbara, na ntụgharị nke carbohydrates na abụba. Inhibido usoro nchikota abụba nke mkpalite site na uto uto bukwa ihe di nkpa.

2. Mmeghachi omume na-esokarị na nchịkwa nke glucocorticosteroids bụ ihe a na-akpọ steroid gastritis, nke na-egosipụta site na ndakpọ agụụ, agụụ, ọgbụgbọ, mgbe ụfọdụ vomiting, acid belching, mgbu na mpaghara epigastric.

Nsogbu di n ’udiri mbuze na afọ nke afọ na duodenum ga - ekwekwa (ha nwekwara ike ime na obere eriri afọ). Ọbara afọ na ọnya afọ mgbe ụfọdụ na-agbagwojuta anya site na ọbara ọgbụgba na perforation. Okwesiri iburu n’obi na ọnya afọ na eriri afọ n’oge mbido nke ha hibere nwere ike ịbụ asymptomatic, ihe ịrịba ama nke ịdị adị ha bụ mmeghachi omume dị mma maka ọbara anwansi na feces.

Ọtụtụ mgbe, ọgbụgba na-apụta mgbe ị drugsụchara ọgwụ glucocorticosteroid n'ime, ọ bụ ezie na ewezugaghị mmepe ha na nchịkwa parenteral nke ọgwụ ndị a. Ihe omume nke usoro akwara bụ mgbe a na-edepụta prednisone na prednisone, ọkachasị yana njikọta ọnya ọnya ndị ọzọ (immunosuppressants, acetylsalicylic acid, tetracyclines, wdg).

Ihe ndị ọzọ na-eso akpata mmepe nke ọnya:

T Iwere glucocorticosteroids tupu nri,

Ogologo oge nchịkwa nke nnukwu ọgwụ ọgwụ ndị a n'enweghị nsogbu ọ bụla na ọgwụgwọ,

Non Na-edobe isi na nri n'oge ọgwụgwọ glucocorticosteroid (oriri nke nri na-egbu egbu na nke iwe, ngwa nri, oyi ma ọ bụ ihe oriri na-ekpo ọkụ, wdg).

Glucocorticosteroids na - akpata ọnya afọ na eriri afọ n'ihi ihe ndị a:

They Ha na - abawanye acid na mmiri nke ihe ọricụricụ gastric ma n'otu oge ahụ na - akpaghasị oghere nke imi, nke na - echebe mucous akpụkpọ nke afọ na eriri afọ pụọ na mmetụta ndị na - emebi (njikọ nke polysaccharides nke mejupụtara oke nke afọ na eriri afọ).

· Glucocorticosteroids na-akụda usoro ọgwụgwọ nke nje na-egbu egbu nke afọ na eriri afọ, ya bụ, n'okpuru nduzi ha na-abawanye mkpụrụ ndụ nke glandular na njikọ ahụ nke akụkụ ahụ ndị a. A kọwara usoro asymptomatic (enweghi mgbu) nke usoro ọnya ahụ site n'eziokwu ahụ na ọnya na-emegide nzụlite nke mgbochi mgbochi nke ọgwụ glucocorticosteroid.

3. N'ime usoro ị gluụ glucocorticosteroid ọgwụ, a na-ahụ njikarị nke ibute ọrịa (tonsillitis, sinusitis, ezé ezé, cholecystitis na ndị ọzọ), enwere ike ịhụpụta usoro nke ibute ọrịa. A kọwara ọrịa nke oyi baa na nkụchi nke mmalite ọrịa, ọrịa nke ọrịa na-adịghị ala ala (ịba ọcha n'anya, cholecystitis, pancreatitis, ụkwara nta na ndị ọzọ).

Achọpụtara ya na nhọpụta nke glucocorticosteroids na-ebute ụzọ dị njọ nke ọrịa nje na-efe efe na ụmụaka, na-akawanye irè nke ịgba ọgwụ mgbochi. A na-akọwapụta nsonaazụ ndị a edepụtara site n'ike nke glucocorticosteroids iji gbochie mmeghachi omume na mmeghachi omume mpaghara.

4. N'ime usoro ọgwụgwọ glucocorticosteroids, mgbanwe na ọnọdụ uche na nke mmetụta uche ga - ekwe omume: ịkpa ike akwara, logorrhea, nsogbu uche, ụjọ nsogbu ụra. Mgbanwe ndị a na ụmụaka ga-agbanwe.

5. Mmeghachi omume oge na-adịghị mma na ọgwụgwọ glucocorticosteroid bụ mmụba nke ọbara mgbali. Mgbe mwachara ụlọ ọgwụ, ọbara ọgbụgba na-arịa ndị ọrịa na-agafe, n'agbanyeghị na ụmụaka ụfọdụ, mmụba ọbara mgbali elu site na 15 - 20 mm RT. Art. dịgidere ruo afọ 1 ruo atọ na enweghị mkpesa ọ bụla (A. V. Dolgopolova, N. N. Kuzmina, 1963).

Usoro nke ọbara mgbali elu na hypercorticism ọgwụ edoghị anya. Ọtụtụ mgbe, a na-ede ụdị mmeghachi omume a na prepubertal na ntozu.

6. Glufọdụ glucocorticosteroids (cortisone, hydrocortisone, prednisone, prednisone) nwere ikike ijigide sodium na mmiri n’ime ahụ onye ọrịa, nke na-enye aka na ọdịdị nke edema ma na-abawanye n’arụ ahụ. Ọgwụ glucocorticosteroid dị ka dexamethasone, triamcinolone, methylprednisolone anaghị egbu oge sodium na mmiri.

7.Site na ọgwụgwọ glucocorticosteroid dị ukwuu na ogologo oge na ụmụ agbọghọ, a na-ahụkarị nsogbu endocrine: oge igbu oge n’iru nke izizi mbu, nmebi ha, mgbe emebisiri ha. Ọ dị mkpa ịtụle nke a ma na - enweghị ihe ngosi siri ike edepụtaghị ọgwụ ndị a ka ụmụ agbọghọ na - eto eto, gbaghara ha mgbe ihe ịrịba ama mbụ nke ihe ịtụnanya ndị a pụtara.

8. Akwụkwọ ndị ahụ na-enye ihe akaebe na n’okpuru nchịkwa nke ogologo oge nke glucocorticosteroid ọgwụ, nlọghachi azụ nke ahụ nwatakịrị nwere ike ime. A kọwara ihe ịtụnanya a site na nsonaazụ mgbochi nke glucocorticosteroids na mmepụta homonụ nke uto site na pituitary gland na nguzobe somatomedin na imeju, mmụba nke usoro catabolic na anụ ahụ, gụnyere ọkpụkpụ.

9. N'oge nwata, ọrịa shuga mellitus nwere ike ịmalite site na mmetụta nke glucocorticosteroids site na ọrịa shuga.

Usoro nke iguzogide oria steroid na njiri mara nke ihe glucocorticosteroid ọgwụ na carbohydrate metabolism: ha na - egbochi ọrụ nke ikpuchi ume nke pancreas, na - akpali mmepụta nke protein protein na - egbochi insulin, na - eme ka usoro glucose site na amino acid ma n'otu oge na - emebi ike nke carbohydrates site na anụ ahụ.

Na ngwụcha, hyperglycemia na glucosuria na-etolite, na n'ime ụmụaka nwere oke mmerụ ahụ nke ngwa mkpuchi - ọrịa shuga. N'ọtụtụ ndị ọrịa, mgbe ikpochasị glucocorticosteroids, a na-ahụkarị metabolism metabolism. Dexamethasone nwere ike ibute ọgba aghara kachasị na metabolism metabolism, erughị triamcinolone, methylprednisolone, prednisolone, prednisone. Diabetogenicity dị ntakịrị bụ ihe ejiri mara cortisone na hydrocortisone.

10. Mmeghachi omume mmerụ ahụ nwa na-ahụkarị na nlekọta nke glucocorticosteroids bụ excretion nke potassium na mmamịrị na mmepe nke ọrịa hypokalemic.

Ihe ịrịba ama nke ikpeazu: mmetụta nke adịghị ike, ịba, olu olu na ike (mgbe ụfọdụ paresis nke aka), na-ebelata ọrụ myocardial, cardiac arrhythmia, ọgbụgbọ, vomiting, afọ ntachi.

Ohere ịmalite hypokalemic syndrome na-abawanye na nchịkwa nke glucocorticosteroids na njikọta cardiac glycosides na diuretics, ebe na-eleghara nri potassium na ụgwọ ezughi ezu maka ọnwụ potassium na-eme n'ihi ọgwụ ndị ọzọ nke ọgwụ kemịkal.

11. Achịkọtala ọtụtụ nyocha ụlọ ọgwụ na-egosi mmetụta ọjọọ nke ọgwụ glucocorticosteroid na sistemụ ọkpụkpụ nke ahụ nwatakịrị na-eto eto. A na-egosipụta osteopathy steroid n'ọrịa osteoporosis nke ọkpụkpụ tubular ogologo oge, akụkụ ahụ ya na akụkụ ahụ ya. Ọtụtụ mgbe, mmepe nke azụ apịrị nke epiphyseal na-agbagha, mgbe ụfọdụ ihe ịrịba ama nke aseptic necrosis nke ọkpụkpụ na-apụta.

Nsogbu di oke njo bu brevispondylia: etolite azu nke azu (n'ihi mbibi nke akwara vertebral na intervertebral discs), ihe sochiri mmebi nke nkpuru akwara, okpukpo nke okpukpo, mkpakọ nke ọgirigi azụ.

Steroid osteopathy bụ nsonaazụ nke ngabiga oke na njikọta nke protein protein nke anụ ahụ (mbelata nke ego nke collagen, mucopolysaccharides, hexosamine), ụba usoro nke reabsorption nke kalisiki site na anụ ahụ na mpụga nke ukwuu na phosphorus na mmamịrị. A na-eji usoro mgbapụta na ọkpụkpụ anụ ahụ nke ndị ọrịa nwere osteopathy steroid na-egosipụta ike ọgwụgwụ na oge.

12. N'ime ụfọdụ ndị ọrịa, myopathy na-etolite n'okpuru ọgwụ glucocorticosteroid ọgwụ.

Mgbaàmà nke ya: ike ahu (tumadi na ogo ikpere ya na akwara nke ogwe aka), hypotension, reflexes tendon. Na nyocha, ị ga-ahụ ihe ịrịba ama nke oke ume akwara, karịsịa nke akụkụ ala (glycogen ọdịnaya n'ime akwara na-abawanye). E gosipụtara na imebi ihe neuromuscular synapses. Triamcinolone nwere fluorine na-ebutekarị myopathy. Steroid myopathy mgbe mwepụ ọgwụ na-apụ n'anya nke nta, a na-eweghachi ọrụ na nhazi nke uru ahụ site na oghere.

13. Ojiji nke glucocorticosteroids (ọkachasị n'ihe banyere njikwa ogologo oge nke ọgwụ oke) juputara n'ihe egwu nke nsogbu site na akụkụ nke ọhụụ n'ụdị igwe ojii na oghere ihu igwe. Mgbanwe nke oghere nwere ike bụrụ nke a na-atụgharị echegharị site na nkwalite ọchị nke ihe ọchị, nchịkọta nke azụ ya. Glaucoma n'oge ọ bụ nwata dị ụkọ.

14. Ọ bụ ezie na ọgwụ glucocorticosteroid bụ ihe dị egwu na-agwọ ọrịa na-emetụta ahụ, n'ọnọdụ ụfọdụ, ha onwe ha na-ewepụta mmeghachi omume nfụkasị, ruo ụjọ anaphylactic. Mmeghachi omume ndị dị otú a na-abụkarị na usoro ọmụmụ glucocorticosteroid ugboro ugboro ma gosipụta onwe ha n'ụdị urticaria, ede ede Quincke, erythema multiforme, akpụkpọ ahụ itchy na ihe ịrịba ama ndị ọzọ.

15. Ogologo oge iji ọgwụ glucocorticosteroid na steeti pharmacogenic hypercorticism na-apụta na ihe egwu nke mgbochi nke ọrụ cortical nke gland adrenal na mmeghachi nke ụgwọ hypothalamic-gynophysial-adrenal system.

Megide usoro a, na ịhapụ ọgwụ ngwa ngwa, mwepu ọrịa nwere ike ịmalite n'ụdị ọgụ nke adịghị ike, adịghị ike, isi ọwụwa, mbelata uche na anụ ahụ, yana mmụba dị elu na ahụ ọkụ.

Ọrịa nkwụghachi ahụ dị oke egwu n'ọnọdụ ndị ahụ mgbe a kwụsịrị nchịkwa nke oke nke glucocorticosteroids na-enweghị nkwadebe mbido nke ahụ onye ọrịa, ya bụ, na-enweghị mbelata nke ọgwụ kwa ụbọchị, iwebata ndị ọrụ chemotherapeutic na-akpali ọrụ nke adrenal cortex.

Ya mere, a na-amata ìgwè nke glucocorticosteroid ọgwụ ọ bụghị naanị site na ọgwụgwọ ahụ dị ike na ahụ onye ọrịa, kamakwa site na ọtụtụ ihe na-adịghị mma, ogo na njiri mara nke dabere na ọgwụ ahụ n'onwe ya, ụzọ iji ya, afọ na mmekọahụ nke nwatakịrị ahụ, na ihe ndị ọzọ, ọ dị mwute ikwu. agụbeghị akwụkwọ.

Usoro ọgwụgwọ ọgwụ maka HA nwere ike ịdị oke ike (oge dị mkpirikpi), nwere oke (maka ọtụtụ ụbọchị ma ọ bụ ọnwa) na ogologo oge (ọgwụgwọ ruo ọtụtụ ọnwa, afọ, ma ọ bụ ọbụna ogologo ndụ).

O dighi ahu ihe ichoro? Jiri ọchụchọ:

Nsonaazụ nke usoro glucocorticoids

Isiokwu dị n’ime

Nsonaazụ
Hib Mmachibido ọrụ na inrophy nke adrenal cortex, ịdabere steroid, “nzipu ọrịa” (iwepu ọrịa na-apụ apụ, enweghị ume adrenal). Ogologo oge ọgwụgwọ na glucocorticoids systemic, ọkachasị rụrụ na-enweghị iburu n'uche usoro akwara ji emetụta ihe nzuzo ha, na-eduga na mgbochi na atrophy nke cortex adrenal. Maka mgbochi zuru oke nke eriri afọ nke adrenal n'ime onye okenye, ọgwụ kwa ụbọchị nke glucocorticoid na-aba ụba kwesịrị ịbụ 10-20 mg n'ihe banyere prednisone. Mbelata nke ọrụ nke adrenal cortex na-amalite n’ụbọchị nke anọ ruo ụbọchị asaa nke iji ọgwụ glucocorticoids dị kwa ụbọchị mgbe edepụtara ha n'ụtụtụ na site n’ụbọchị nke abụọ mgbe edepụtara ha na mgbede. Mmetụta dị n'akụkụ a bụ njimara kachasị nke glucocorticoids na-eme ogologo oge na nkwadebe ebusa. Iji weghachite ọrụ nzuzo dị ka mmiri nke adrenal cortex, ọ dịkarịa ala ọnwa 6 ruo 9 ka achọrọ, azịza ya zuru oke maka nrụgide dị afọ 1-2.

■ Eji akpụkpọ, ajị anụ na isi nkwọcha.
■ Osteoporosis, ọkpọ na okpukpo ọkpụkpụ nke na - egbu egbu. Osteoporosis na-etolite na 30-50% nke ndị ọrịa ma bụrụ nsogbu kachasị njọ nke ọgwụgwọ glucocorticoid. Ọ bụ n'ihi mmetụta na-adịghị mma ha na-eme ka akwara ọkpụkpụ na-arụ ọrụ na ntinye nke resorption. Ọ na - etolite n'ime ụmụ nwanyị mgbe ha nwụsịrị. Dị ka a na-achị, osteoporosis na-emetụta akụkụ dị n'etiti akwara ụkwụ (spain, ọkpụkpụ pelvic, ọgịrịga) wee jiri nwayọ gbasaa n’ọkpụkpụ ụkwụ (aka, ụkwụ, wdg.) Ngosipụta nke ụlọ nyocha ya bụ ihe mgbu na ọkpụkpụ azụ na nkwonkwo úkwù ya, belatara uto na mmebi nke spain (obere thoracic na lumbar) ngalaba), ọgịrịga, olu nke anụ ahụ, nke na - esite na obere mmerụ ahụ ma ọ bụ n'otu oge. Iji gwọọ nsogbu a, a na-eji nkwadebe calcium, vitamin D3, calcitonin, na bisphosphonates. Ogologo oge ọgwụgwọ dị otú ahụ kwesịrị ọtụtụ afọ.
• Myopathy, mfu ahụ, myocardial dystrophy. A na-egosipụta stere myopathies site na adịghị ike na atrophy nke akwara nke ọkpụkpụ, gụnyere akwara umeji (intercostal muscle, diaphragm), nke na-enyere aka na mmepe nke ọdịda iku ume. Ọtụtụ mgbe, nsogbu a na - akpata triamcinolone. Usoro nke mmepe myopathies nwere njikọ na mmetụta ọjọọ nke glucocorticoids na protein na metabolism metabolism. A na-eji ọgwụ anabolic steroid na potassium eme ihe maka ọgwụgwọ ha.
Po Hypokalemia, sodium na njigide mmiri, edema bụ ngosipụta nke mmetụta mineralocorticoid nke glucocorticoids.
Can A ga-achọpụta mmụba nke ọbara mgbali na ndị ọrịa na-ewere glucocorticoids ogologo oge. Ọ bụ n'ihi mmụba nke mgbidi vaskụla na catecholamines, sodium na njigide mmiri.
■ na-emebi mgbidi vaskụla na mmepe nke "steroid vasculitis" bụ ọgwụ ndị nwere fluorinated (dexamethasone na triamcinolone). Ejiri ya na ụba vaskụla permeability. A na-egosipụta ya n'ọbara nke anụ ahụ nke aka na ntị, akpụkpọ ahụ mucous nke oghere ọnụ, njikọ nke anya, epithelium nke eriri afọ. Maka ọgwụgwọ, a na-eji vitamin C na P, yana ọgwụ ndị na-egbochi bradykinin vaskụla.
Ag agbawanyewanye ụba na-eme ka ọbara nwee ike ibute ọgbụgba ọbara n'ọbara na thromboembolism.
■ Na-emebi usoro anụ ahụ n'ihi mgbochi nke anabolic na catabolic na metabolism protein - na -ebelata njikọ protein site na amino acid, na-eme ka mmebi protein dị.
Steroid na-egbu egbu nke afọ na eriri afọ, ọbara ọgbụgba. Ọrịa Steroid na-abụkarị asymptomatic ma ọ bụ asymptomatic, na-egosipụta ọbara ọgbụgba na perforation. Ya mere, ndị ọrịa na-anata nkọ glucocorticoids nke ogologo oge ka a ga-enyocha ya kwa oge (fibroesophagogastroduodenoscopy, analysis of feces for ọbara anwansi). Usoro ọrụ ulcerogenic nke glucocorticoids na-emetụta mmetụta catabolic ha na mwepu nke prostaglandin njikọ ma mejupụta mmụba nke hydrochloric acid, na-ebelata nguzo nke imi na igbochi ịmaliteghachi nke epithelium. Ọkpụkpụ a na-ebutekarị site na prednisone.
■ Ọrịa pancreatitis, imeju na-egbu egbu, oke ibu, hyperlipidemia, hypercholesterolemia, embolism abụba bụ nsonaazụ nke anabolic nke glucocorticoids na metabolism abụba - ịba ụba nke triglycerides, abụba na abụba na cholesterol, ịgbanye abụba.
Irrit irritba ụba usoro akwara nke mgbakasị ahụ, ehighị ụra, obi ọgbụgba, ịda mba, ụbụrụ, njiri mara nke meningism, ihe ọdịdọ n’ime ndị ọrịa nwere ọrịa akwụkwụ.
Cat aralọ cataract nke na-ahụ n'ihu, glaucoma, exophthalmos.
Ọ na-arịa ọrịa shuga steroid, ịba ọcha n'anya. Glucocorticoids na-abawanye nnabata nke carbohydrates site na eriri afọ, welie gluconeogenesis, belata ọrụ insulin na hexokinase, ma belata mmetụta nke anụ ahụ na insulin na ojiji ha nwere glucose. Maka ọgwụgwọ nke ọrịa shuga steroid, a na-egbochi nri carbohydrate, ọgwụ hypoglycemic ọgwụ, na insulin.
Imebi usoro nsọ nwoke, ọrụ mmekọahụ, inwe mmekọahụ na-egbu oge, hirsutism, mmepe nke nwa ebu n’afọ nwere mmebi na mmepụta nke homonụ mmekọahụ.
Ression Mwepu nke mgbochi, ka njọ nke ọrịa na-efe efe na mkpali, gụnyere ụkwara nta, ọrịa nke abụọ, mgbasa nke ọrịa mpaghara. Dịka iwu, nsogbu na-efe efe bụ asymptomatic n'ihi mmetụta mgbochi mkpali nke glucocorticoids. Mmepe nke candidiasis nke oghere olu na pharynx bụ njirimara.
■ Cushing's syndrome (mkpokọta abụba sitere na abụba dị n'okpuru aka nke aka, oke abụba n'ihu, olu, ubu olu na afọ, ọbara mgbali elu, ọnya afọ, ọnya, nnabata glucose ọrịa, wdg).
Changes Mgbanwe hematologic.
E gosipụtara site na mkpịsị akị na-aga n'ihu na-enweghị mkparịta ụka nke leukocyte n'aka ekpe. A kwenyere na ha sitere na mmetụta na-akpali akpali nke steroid na granulopoiesis.

Mgbochi Ọkọlọtọ

Iji usoro ọgwụgwọ (ịgbatị) ọzọ.
Iji glucocorticoids systemic na nke pere mpe. Maka nke a, na ụkwara ume ọkụ, ha kwesịrị ijikọ ọrụ ya na iji glucocorticoids inhaled yana yana on2-adrenergic agonists na-arụ ọrụ ogologo oge, theophylline, ma ọ bụ ọgwụ antileukotriene.
■ Nchịkwa nke glucocorticoids dabere na usoro ọmụmụ kwa ụbọchị nke usoro cortisol.
Iji nri nwere protein na calcium n'ụba, na-egbochi ya, carbohydrate dị nnu (ihe ruru 5 g kwa ụbọchị) na mmiri mmiri (ihe ruru 1.5 lita kwa ụbọchị).
■ Iwere glucocorticoids mbadamba mgbe nri gachara iji belata utorogenic ha.
Mwepụ ise siga na ị abuseụbiga mmanya ókè.

Exercise Na mmega ahụ na - emekpa ahụ ọfụma.

Echiche nke glucocorticoids, ojiji ha dị ka ọgwụ, nhazi ọkwa site na nhazi na usoro. Ofzọ nke nhazi nke njikọta na nzuzo nke homonụ nke eriri afọ nke adrenal cortex Usoro nke glucocorticoids, nsonaazụ ndị bụ isi site na ojiji ha.

Idobe ezigbo ọrụ gị na ntọala ihe ọmụma dị mfe. Jiri mpempe akwụkwọ dị n'okpuru

Studentsmụ akwụkwọ, ụmụ akwụkwọ gụsịrị akwụkwọ, ndị sayensị na-eto eto na-eji ihe ọmụma ihe ọmụmụ ha na ọrụ ha ga-ekele gị nke ukwuu.

Ihe edebere http://www.allbest.ru/

Ministri Ahụike nke Ukraine

Mahadum Ahụike Zaporizhzhya

Ngalaba Ọgwụ na Ọgwụ

Site na isi okwu: "Ọgwụ"

Na isi okwu: “Nsonaazụ nke glucocorticoids”

Emezuru: Nwa akwụkwọ afọ 3

Saiko Roman Eduardovich

1. Nhazi nke glucocorticoids

2. Usoro nke ihe glucocorticoids

3. Ihe eji glucocorticoids

4. Nsonaazụ ndị bụ isi nke glucocorticoids

5. Mgbochi nke nsonaazụ ndị ọzọ nke glucocorticoids

Ndepụta aha

1.Nhazi nke Glucocorticoidn'ime

Glucocorticoids bụ homonụ steroid na-emepụta site na cortex adrenal. A na-eji glucocorticoids eke na analogues na sịntetik ha na nkà mmụta ọgwụ maka ezughị oke adrenal. Na mgbakwunye, ụfọdụ ọrịa na-eji mgbochi mkpali, immunosuppressive, mgbochi nfụkasị, mgbochi ụjọ na Njirimara ndị ọzọ nke ọgwụ ndị a.

Mmalite nke iji glucocorticoids dị ka ọgwụ (PM) malitere na 40s. XX narị afọ. Ko ke mbubreyo 30s. na narị afọ gara aga, e gosipụtara na homonụ nke homonụ nke steroid ọdịdị na etolite na adrenal cortex. N'afọ 1937, a nọpụrụ iche dị na peralocorticoid deoxycorticosterone site na eriri afọ adrenal, na 40s. - glucocorticoids cortisone na hydrocortisone. Mmetụta ọgwụ dị iche iche nke hydrocortisone na cortisone kpebiri tupu ha eji ọgwụ eme ihe. N'oge na-adịghị anya, ha rụrụ arụ ọrụ ha.

Ihe bụ isi na arụ ọrụ glucocorticoid guzobere n'ahụ mmadụ bụ hydrocortisone (cortisol), ndị ọzọ dị obere na-anọchite anya cortisone, corticosterone, 11-deoxycortisol, 11-dehydrocorticosterone.

Mmepụta homonụ site na gland adrenal dị n'okpuru nchịkwa nke usoro ụjọ ahụ ma nwee njikọ chiri anya na ọrụ nke gland pituitary (lee fig 2). Adrenocorticotropic pituitary homonụ (ACTH, corticotropin) bụ anụ ahụ na - akpali akpali nke adrenal cortex. Corticotropin na-eme ka njikọ nke glucocorticoids guzosie ike na izo ya ezo. Nke ikpeazụ a, n'aka nke ya, na-emetụta ọnya nke pituitary gland, na-egbochi mmepụta nke corticotropin ma si otú a na-ebelata mkpali ndị ọzọ nke gland adrenal (site na ụkpụrụ nke nzaghachi na-adịghị mma). Nlekọta ogologo oge nke glucocorticoids (cortisone na analogues) n'ime ahụ nwere ike ibute mgbochi na atrophy nke adrenal cortex, yana igbochi nguzobe nke ọ bụghị naanị ACTH, kamakwa gonadotropic na homonụ na-akpali pituitary homonụ.

Fig.Nhazi nke glucocorticoids na usoro maka ojiji ha

Fig.Ofzọ nke usoro njikọta na njikọta nke homonụ nke eriri afọ

Kemgbe 50s nke narị afọ gara aga, glucocorticoids ejiriwo ọnọdụ dị mkpa n'ọtụtụ ọgwụ na, karịa, na usoro ọgwụgwọ. Ngwakọta nke ụdị glucocorticoids maka nchịkwa intrauscular na intramuscular gbasawanụ ohere nke ọgwụgwọ glucocorticoid. N'ime afọ 15-20 gara aga, echiche anyị banyere usoro nke glucocorticoids amụbawo nke ukwuu, enwewokwa mgbanwe dị ukwuu na ụzọ nke iji glucocorticoids, gụnyere usoro onodu ogwu, ụzọ nchịkwa, oge ojiji na ijikọta ya na ọgwụ ndị ọzọ.

Ojiji nke glucocorticoids na usoro ọgwụgwọ malitere na 1949, mgbe izizi mmetụta dị mkpirikpi oge nke cortisone n'ahụ ndị ọrịa nwere ọrịa ogbu na nkwonkwo. Na 1950, otu otu nyocha ahụ rụpụtara maka nsonaazụ ọma nke ọgwụgwọ nke ọrịa ogbu na nkwonkwo, rheumatism na ọrịa ndị ọzọ na rheumatic na cortisone na adrenocorticotropic hormone (ACTH). N'oge na-adịghị anya, ọtụtụ akụkọ gosipụtara mmetụta dị mma nke ọgwụgwọ glucocorticoid maka sistemu lupus erythematosus (SLE), dermatomyositis, na vasculitis systemic.

Taa, glucocorticoids, n'agbanyeghị ihe egwu dị ukwuu nke nsonaazụ ndị ọzọ (gụnyere ndị siri ike), ka bụ isi nkuku ahụ na usoro pathogenetic nke ọtụtụ ọrịa rheumatic. Na mgbakwunye, a na-eji ha n'ọtụtụ ọrịa na hematological, isi na nke abụọ nke glomerulonephritis, yana n'ọtụtụ eriri afọ na akụkụ iku ume, ọnọdụ nfụkasị, nsogbu nke mmalite dị iche iche na ndị ọzọ. Ngwakọta nke glucocorticoids maka intravenous, intramuscular na intraarticular were emeela ka obosara na ụzọ eji ha eme ihe.

E kewara Adrenal corticosteroids ụzọ abụọ - glucocorticoids na mineralocorticoids. Ndị nke mbu nwere mmetụta na ihe niile akụkụ ahụ na sistemụ nke ahụ, site na ime ka usoro metabolic dị n'etiti, ọrụ mgbochi yana mmeghachi omume mbufụt. Isi ọrụ nke mineralocorticoids bụ ịhazi metabolism mmiri-nnu.

Ojiji nke glucocorticoids na-akpali mmetụta mgbochi ha dị ike, immunosuppressive na mmetụta nfụkasị.

Na 1st European Symposium na ọgwụgwọ glucocorticoid, a na-atụ aro iji okwu glucocorticoids ma ọ bụ glucocorticosteroids. Okwu ndị ọzọ - “steroid”, “corticosteroids”, “corticoids” buru ezigbo ibu ma ọ bụ na-ezughị ezu, ya mere akwadoghị iji ya.

N'ime omume ụlọ ọgwụ taa, a na-eji glucocorticoids sịntetik emekọ ihe, nke nwere nnukwu mgbochi mkpali, immunosuppressive na mgbochi nfụkasị na-adịghị ike ma ọ bụ na-enweghị mmetụta mineralocorticoid, ya mere ha so na ọgwụ ndị a na-ejikarị n'ọtụtụ ebe ọgwụ.

Nhazi nke glucocorticoids site na nhazi nke mmiri

Etu (endogenous) glucocorticoids:

* cortisol * hydrocortisone * hydrocortisone acetate

Sịntetik mmanụ nwere glucocorticoids:

* prednisolone * prednisone * methylprednisolone

Mkpụrụ ọgwụ nwere glucocorticoids:

* dexamethasone * triamcinolone * betamethasone

Nhazi nke glucocorticoids site na oge nke ihe

Ọgwụ dị mkpụmkpụ (awa 8-12):

Ọgwụ nke oge ihe eji arụ ọrụ (awa 12-36):

* prednisolone * methylprednisolone * triamcinolone

Ọgwụ dị ogologo oge (awa 36-72):

* parameterazone * betamethasone * dexamethasone

A na-amata oghere glucocorticoids site na ikpughekwu ogologo (iwepụ n'ime izu ole na ole).

2.Furglucocorticoid anism

Akụkụ hypothalamic-pituitary-adrenal na-etolite usoro dị mgbagwoju anya nke na-ahazi mwepụta nke glucocorticoids na ọnọdụ physiological yana ọnọdụ dị iche iche. ACTH na-achịkwa mmepụta cortisol site na mkpụrụ ndụ adrenal cortex. Ntọhapụ nke ACTH, n'aka nke ya, na-achịkwa homonụ na - ahapụ ọnụnọ, nke nzuzo nke usoro akwara, endocrine na cytokine na - achịkwa ya na ọkwa nke hypothalamus. A na-ebugharị homonụ Corticotropin na - ebugharị na obere akụkụ gaa n'inweta ikuku mpaghara nke pituitary gland, ma mesịa gaa na ihu ihu ya, ebe hormone corticotropin wepụtara na-akpali mmachi ACTH. glucocorticoid ọgwụ dị n'akụkụ

Tionzọ nzuzo nke cortisol kwa ụbọchị n’ime mmadụ bụ ihe dịka 20 mg. Ọzọkwa, a na-eji nzuzo ya mara ụbọchị mgbe enwere ọkwa kachasị elu na ụtụtụ ụtụtụ yana obere ụkpụrụ na mgbede. Otutu cortisol zoro ezo (ihe dika 90%) na-ewere okpokoro aru nke obara nke corticoid. Cortisol nke bu mmanu bu ihe omumu nke homonu na aru oru.

Hyperreactivity nke hypothalamic-pituitary-adrenal axis na enweghị ọnya (dịka ọmụmaatụ, yana ọrịa Cushing) na-akpata immunosuppression ma na-abawanye ọgụgụ isi na ọrịa. Mmegharị nke hypothalamic-pituitary-adrenal axis, na-eme ka mmụba nke ọkwa cortisol ma na-eduga immunosuppression, nwere ike ibute site na ihe nrụgide dị iche iche, gụnyere mgbu, ọgbụgbọ, oyi, mgbali anụ ahụ, ofufe ọrịa, mgbochi ịwa ahụ, ịmachi mmachi kalori nri, na ihe ndị ọzọ. Glucocorticoids na-adịghị agbanwe agbanwe, yana ọrụ homeostatic, na-agbanwekwa azịza mgbochi mkpali. E gosipụtara na-egosi na nzaghachi na-adịghị mma nke endogenous glucocorticoids na-arụ ọrụ dị mkpa na pathogenesis nke ọtụtụ usoro ọrịa nke anụ ahụ na-ejikọta ma ọ bụ na nnọgide nke usoro mkpali. Na ọrịa rheumatic dị ka ọrịa rheumatoid ọrịa ogbu na nkwonkwo, SLE, dermatomyositis na ndị ọzọ, mgbanwe ndị dị ukwuu na-apụta na hypothalamic-pituitary-adrenal axis, nke na-egosipụta na-ezughị ezu nzuzo nke ACTH na-ekesa cytokines, obere ala ala na mkpali nzuzo nke cortisol na mmeghachi nke mbufụt, yana oke androgen.

Ojiji nke glucocorticoids sịntetik na-eduga na mgbochi nke njikọta na ịtọhapụ homonụ corticotropin na ACTH, n'ihi ya kwa, mbelata nke mmepụta cortisol. Ogologo oge ọgwụgwọ glucocorticoid na-arụpụta ihe na adrenal atrophy na mgbochi nke hypothalamic-pituitary-adrenal axis, na-eme ka mbelata ikike nke imepụta glucocorticoids endogenous ọzọ na nzaghachi ACTH na ihe ndị na-akpata nchegbu.

Ugbu a, ọ bụ ọdịnala ịmata ọdịiche dị n'etiti usoro abụọ nke mmeju nke glucocorticoids - genomic and non genomic.

A na-ahụta usoro ahụ site na njikọta nke ndị na - anabata cytoplasmic kpọmkwem na usoro ọgwụ ọ bụla, ọ naghị apụta na nkeji iri atọ mgbe etinyere ogige hormone nke na-anabata ya.

Usoro dị mkpa nke ihe mkpụrụ ndụ ihe glucocorticoids bụ nhazi nke ntụgharị mkpụrụ ndụ ihe nketa nke na-achịkwa njikọ nke protein na DNA. Mmetụta glucocorticoids na ndị na-anabata glucocorticoid (nke bụ ndị òtù ezinụlọ membrane steroid receptor) na-eduga na mmepe nke ihe omume dị iche iche metụtara onye ozi kpọmkwem RNA, nuclear RNA, na ihe ndị ọzọ na-akwalite ihe. Nsonaazụ cascad a bụ mkpalite ma ọ bụ igbochi ịtụgharị mkpụrụ ndụ. Glucocorticoids metụtara ọnụ ọgụgụ buru ibu nke mkpụrụ ndụ, gụnyere mkpụrụ ndụ ihe nketa na-achịkwa ịmepụta cytokines dịka IL-la, IL-4, IL-6, IL-9 na gamma interferon. N'okwu a, glucocorticoids nwere ike ịkwalite ntụgharị nke mkpụrụ ndụ ihe nketa ma mechie ya.

Glucocorticoids na-ejikwa njikọ protein protein cellular. Na-esite n'ụzọ dị nfe na ngwa ngwa site na mkpụrụ ndụ, ha na-etolite ogige nke na-anabata ndị na-anabata steroid na cytoplasm nke na-akwaga na mpaghara sel, na-emetụta ntinye na ngwa ọrụ mkpụrụ ndụ.

onye ozi pụrụ iche RNA maka njikọ nke peptides na-edozi ahụ na protein, bụ nke ejikọtara ya na sistemụ enzymes, nke, n'aka nke ya, na-achịkwa ọrụ cellular.Enzymes ndị a nwere ike ịrụ ma ọrụ na-akpali akpali. Dịka ọmụmaatụ, ha nwere ike ịkwalite mmepụta nke protein na-egbochi n'ime mkpụrụ ndụ ụfọdụ, nke na-akwụsị iwepụ mkpụrụ ndụ ihe niile n’ime mkpụrụ ndụ lymphoid, si otú ahụ na-egosipụta mmerụ ahụ na azịza mkpali.

Glucocorticoids metụtara ọrụ mgbochi sel. Mmepe nke lymphocytopenia n'okpuru mmetụta ha bụ n'ihi mgbochi nke mmepụta na ntọhapụ nke mkpụrụ ndụ lymphoid site na ụmị ọkpụkpụ, mgbochi nke Mbugharị ya na itinyeghachi nke lymphocytes n'akụkụ akụkụ lymphoid ndị ọzọ. Glucocorticoids metụtara mmekọrịta nke mkpụrụ ndụ T na B na nzaghachi mgbochi ahụ. Ha na-eme ihe dị iche na ntanetị dị iche iche nke T-lymphocytes, na-eme ka mbelata ọkwa nke mkpụrụ ndụ T na-eburu ndị na-anabata mkpụrụ akwụkwọ IgM Fc, na-enweghị na-agbanwe ọkwa nke T-lymphocytes na-eburu ndị nabatara maka mpempe IgG Fc. N'okpuru mmetụta nke glucocorticoids, ikike proliferative nke mkpụrụ ndụ T na-agbanye ma vivo na vitro. A na-egosipụta mmetụta glucocorticoids na nzaghachi B-cell na obere obere karịa na mkpụrụ ndụ T-mkpụrụ ndụ. Yabụ, na ndị ọrịa na-anata usoro glucocorticoids, a na-ahụta azịza mgbochi nkịtị maka ọgwụ mgbochi. N'otu oge ahụ, obere oge nke nchịkwa glucocorticoids dị mkpirikpi na-akpata mbelata ọkwa IgG na IgA serum ma ọ dịghị emetụta ọkwa IgM. Mmetụta glucocorticoids na arụ ọrụ B-cell nwere ike ịgbanwu ya n'ihi nsonaazụ ya na macrophages.

N'adịghị ka genomic, mmetụta na-abụghị genomic nke glucocorticoids bụ nsonaazụ nke njikọta physicochemical kpọmkwem na akpụkpọ ahụ na / ma ọ bụ ndị na-anabata steroid. Mmetụta mkpụrụ sitere na mkpụrụ ndụ ihe glucocorticoids na-amalite n’okpuru mmetụta nke usoro dị elu ma na-apụta mgbe sekọnd ma ọ bụ nkeji ole na ole gasịrị.

Mmetụta na-abụghị genomic mgbochi mkpali nke glucocorticoids nwere njikọ na mmezi nke meyso, lysosomal membranes, mbelata na permeability mkpụrụ ndụ na mpaghara ọbara na mpaghara nke mbufụt, mbelata nke mgbaze mkpụrụ ndụ endothelial, mbelata ikike nke mgbochi nje intisoris intilitalis mkpokọ, mkpochapu mkpokọ mkpokọta mkpo, mkpokọta mkpo, mkpokọtara mkpokọta mkpo, mkpokọ mkpokọta mkpo, mkpokọta mkpo, mkpokọta mkpo, mkpokọta mkpo, mkpokọta mkpo, mkpokọta mkpo, mkpokọ mkpo, mkpo mkpokọ mkpo, mkpo, mkpo, mkpo, mkpo, mkpo, mkpo, mkpo. arịa dị iche iche nke mbufụt na mbelata na ha permeability (akụkụ ụfọdụ n'ihi

mgbochi nke prostaglandin njikọ), mbelata ọnụ ọgụgụ nke monocytes na mkpụrụ ndụ mononuclear na-elekwasị anya na mbufụt, yana mmetụta na polymorphonuclear leukocytes. N'ụzọ doro anya, ọrụ na-eduga na mgbochi mbufụt nke glucocorticoids bụ ihe mgbochi nke Mbugharị ya na nnakọta nke leukocytes na usoro nke mbufụt. N'okpuru mmetụta nke glucocorticoids, ọrụ nje ahụhụ, ihe nnabata Fc na ọrụ ndị ọzọ nke monocytes na macrophages na-akụghasị, na ọkwa nke eosinophils, monocytes na lymphocytes na mgbasa mgbasa. Na mgbakwunye, azịza sel maka kinins, histamine, prostaglandins, na ihe ndị na-agbanwe agbanwe na-agbanwe, na mwepụta nke prostaglandins site na mkpụrụ ndụ kpaliri. Usoro a na-amụghị nke ọma na-etinye aka na njikọta nke endothelial synthase nke nitric oxide.

Ọgwụ nke glucocorticoids na-ekpebi arụmọrụ ha, yana ugboro ole na ogo ogo nsonaazụ ndị ọzọ. Ihe mmetụta genomic nke glucocorticoids na-etolite na ntakịrị usoro ma na-abawanye ka a na-eru ihe dị ka 100 mg nke prednisolone kwa ụbọchị, ma kwụsie ike n'ọdịnihu. Ọ bụrụ na mgbe ị na-eji glucocorticoids na ọnụọgụ nke 30 mg nke prednisolone nke kwekọrọ, usoro ọgwụgwọ bụ ihe a na-ekpebisi ike site na usoro nke genomic, mgbe ahụ na usoro nke ihe karịrị 30 mg nke prednisolone kwekọrọ, mmetụta ndị na-abụghị mkpụrụ ndụ ghọrọ ihe dị mkpa, ọrụ nke ngwa ngwa na-abawanye site na ịba ụba dose.

A na-ahụzigharị Glucocorticoids maka ụdị dị iche iche nke ojiji ha, i.e., maka ọnụ, intramuscular, intravenous ma ọ bụ intraarticular. Mgbe nchịkwa ọnụ gasịrị, ihe dị ka 50-90% nke glucocorticoids na-abanye. Njikọ nke glucocorticoids na protein ndị metụtara ọbara dị ihe dị ka 40-90%. A na - eme metabolism nke glucocorticoids tumadi na imeju, na excretion - kachasị site na akụrụ n'ụdị metabolites. Nsonaazụ kachasị elu nke glucocorticoids n'ime ọbara mgbe nchịkwa ọnụ pụtara mgbe awa 4-6 gachara. Site na nhazi nke intravenic nke glucocorticoids, a na-enweta ọnụ ọgụgụ kachasị nke uche ha ngwa ngwa. Yabụ, na ntinye nke 1.0 g nke Solomedrol® (methylprednisolone sodium succinate), a na-ahụ ọnụ ọgụgụ dị elu na plasma ịta ahụ mgbe nkeji iri na ise gasịrị. Site na nchịkwa intramuscular nke glucocorticoids, ọnụ ọgụgụ kachasị nke uche ha na plasma na-eme nke ọma

emechaa. Iji maa atụ, n’ịnyịnya intramuscular nke Depo-medrol® (methylprednisolone acetate), a na-atụnye ntinye ya kachasị na ọbara mgbe ihe dị ka elekere asaa gachara.

3. Ihe eji glucocorticoids

Thezọ akọwapụtara na usoro dị iche iche nke arụmọrụ glucocorticoids na isi ihe dị iche iche nke itinye n'ọrụ bụ ihe ndabere maka ojiji ha jigoro n'ọtụtụ ọrịa nke akụkụ ahụ, yana ọtụtụ ọnụọgụ ọrịa. Yana oria rheumatic na vasculitis system, ebe glucocorticoids na-abụkarị ọgwụ ndị bụ isi, a na-ejikwa ọgwụgwọ glucocorticoid na endocrinology, gastroenterology, resuscitation, cardiology, pulmonology, nephrology, traumatology and more.

N’okpuru, anyị na-ewetara ọrịa na ọnọdụ pathologies ebe ejiri glucocorticoids:

1.Ọrịa ogbu na nkwonkwo - na enweghị ọrịa pụtara ọrịa (systemal vasculitis, serositis, myocarditis, fibrosing alveolitis, bronchiolitis obliterans), obere doses glucocorticoids na-emegide ndabere nke ọrịa-mgbanwe ọgwụgwọ. Site na mmepe nke ngosipụta ndị ọzọ dị n'elu rheumatoid ogbu na nkwonkwo, na-ajụ ase na, ọ bụrụ na ọ dị mkpa, a na-eji usoro dị elu nke glucocorticoids.

2. Ankylosing spondylitis - na usoro nọ n'ọrụ, a na-eji ọkara ma ọ bụ usoro dị elu nke glucocorticoids.

3. systemic lupus erythematosus - na sistemu na-arụ ọrụ nke ọrịa, yana mgbe akụkụ na sistemụ dị mkpa na-etinye aka na usoro pathologies (pericarditis na / ma ọ bụ pleurisy na oke oke nke exudate, na / ma ọ bụ myocarditis, na / ma ọ bụ mmebi nke etiti ụjọ usoro, na / ma ọ bụ pulmonary pneumonitis , na / ma ọ bụ akwara ọbara, na / ma ọ bụ hemolytic anaemia, na / ma ọ bụ thrombocytopenic purpura, na / ma ọ bụ lupus glomerulonephritis III, IV, klas morphological) na-egosi iji ihe glucocorticoids ọkara ma ọ bụ nke dị elu, ma ọ bụrụ na ọ dị mkpa - oke elu Igwe.

4. Nnukwu ọkụ rheumatic ma ọ bụ iwe ọkụ rheumatism - usoro dị elu ma ọ bụ nke glucocorticoids (karịsịa na mmepe nke ọrịa rheumatic carditis).

5. Rheumatic polymyalgia - glucocorticoids bụ ọgwụ ịhọrọ. N'ime ọkwa siri ike, a na-eji usoro dị elu ma ọ bụ nke dị elu nke glucocorticoids.

6. Polymyositis na dermatomyositis - glucocorticoids bụ ọgwụ ịhọrọ. N'ime ọkwa dị njọ, a na-enye ọtụtụ ọgwụ glucocorticoids dị elu.

7. Sistem scleroderma - etinyere glucocorticoids na usoro dị ala na nke etiti na mmepe nke myositis.

8. Ọrịa butere - na nnukwu oge, yana mgbe akụkụ dị iche iche na sistemụ dị mkpa (myocarditis, pericarditis, epilepsy) na-etinye aka na usoro pathologies - usoro dị ala ma ọ bụ oke nke glucocorticoids.

1.Nnukwu sel arteritis - na nnukwu ọnọdụ, glucocorticoids bụ ọgwụgwọ nke oke ma edere ya na usoro dị elu.

2. Ọrịa Takayasu - na nnukwu ọnọdụ, a na-eji usoro glucocorticoids dị ala.

3. Nodular polyarteritis na microyangcopic polyangiitis - na nnukwu usoro, a na-eji usoro glucocorticoids dị elu.

4. Ọrịa Wegener - na oke - oke ọnụọgụ glucocorticoids.

5. Charge-Strauss Syndrome - nnukwu usoro ọgwụgwọ oke - oke usoro glucocorticoids.

6. Behcet's syndrome - na oke olu, etinyere ma ọ bụ nke dị elu nke glucocorticoids.

7. Cutaneous leukocytoclastic vasculitis - n'ọnọdụ ndị siri ike, a na-eji ọgwụ ndị dị elu glucocorticoids eme ihe.

8. Ọbara vasculitis Hemorrhagic (Shenlein-Genoch purpura) - glucocorticoids ka etinyere n’usoro ọkara ma ọ bụ nke dị elu na mmepe nke glomerulonephritis na ọrịa nephrotic syndrome na / ma ọ bụ ịmalite 50-60% nke glomeruli na karịa ọkara ọnwa. Dabere na ọtụtụ ndị ọrịa rheumatologists, enwere ike iji nkezi nke glucocorticoids maka ọrịa afọ.

1.Glomerulonephritis nwere obere mgbanwe (idiopathic nephrotic syndrome) - na nmalite mmalite nke ọrịa ahụ ma ọ bụ na ọ na-akpata ya, glucocorticoids edepụtara na usoro dị ala ma ọ bụ nke dị elu bụ ọgwụgwọ nke nhọrọ.

2. Focal-seleal glomerulosclerosis-hyalinosis - na nmalite nke ọrịa ahụ ma ọ bụ na-akpata iwe, a na-eji glucocorticoids.

3. A na-eji Mesangioproliferative glomerulonephritis ọkara ma ọ bụ usoro dị elu nke glucocorticoids na mmepe nke ọrịa nephrotic na / ma ọ bụ ọkara ọnwa na 50-60% glomeruli.

4. Mesangiocapillary glomerulonephritis - a na-eji glucocorticoids dị elu maka mmepe nke ọrịa nephrotic na / ma ọ bụ ọkara ọnwa na 50-60% glomeruli.

5. Membranous glomerulonephritis - na ọnụnọ nke nephrotic syndrome, a na-eji usoro etiti ma ọ bụ elu nke glucocorticoids.

6. glomerulonephritis na-aga ngwa ngwa (subacute, lunate) - a na-eji glucocorticoids dị elu.

Secondary glomerulonephritis (ya bụ, glomerulonephritis nke mepụtara na SLE, rheumatoid ogbu na nkwonkwo, polymyositis, dermatomyositis, vasculitis) na-eji usoro glucocorticoids na-ajụ ma ọ bụ nke dị elu.

1.Ure ACTH n'ọrịa dị iche iche nke gland-gland - hydrocortisone ma ọ bụ usoro iji obere glucocorticoids dị ka ọgwụgwọ ntụgharị.

2. Amiodarone na - akpata thyrotoxicosis - a na - eji glucocorticoids dị elu.

3. Ezughi oke adrenal - hydrocortisone ma ọ bụ uzo ozo glucocorticoids na-eji dị ka ọgwụ eji dochie ya.

1.Ọrịa Crohn - na nnukwu ọnọdụ, a na-eji ọtụtụ glucocorticoids dị elu.

2. Nonspecific ulcerative colitis - na ọkwa dị njọ, a na-eji glucocorticoids dị ala.

3. Autoimmune ịba ọcha n'anya - eji glucocorticoids ọkara ma ọ bụ nke dị elu.

4. Agba nke mbu nke cirrhosis - tinye nkezi nke glucocorticoids.

5. Aria na-egbu egbu na-egbu egbu - a na-eji usoro glucocorticoids ọkara ma ọ bụ oke.

1.Post-viral na nompecific lymphocytic myocarditis - enyere iwu nke glucocorticoids.

2. pericarditis na-enweghị purulent purulent na mkpo nke exudate - a na-eji usoro ọkara ma ọ bụ elu nke glucocorticoids.

1.A na - enye ọgwụ ụkwara ume ọkụ - glucocorticoids nke ọnụ (ọkara ma ọ bụ nke dị elu) maka ụkwara ume ọkụ buru ibu, oke ịba ụba nke ashma, ebe ikuku glucocorticoids na bronchodilators na-adịghị arụ ọrụ.

2. Cryptogenic fibrosing alveolitis - a na-eji ọnụọgụ glucocorticoids dị elu.

3. Na-ehichapụ bronchiolitis - a na-eji ọgwụ dị elu nke glucocorticoids.

4. Sarcoidosis nke ngụgụ - a na-eji ọkara nke ala glucocorticoids.

5. Eosinophilic pneumonia - usoro nke glucocorticoids nke na-ajụ ma ọ bụ nke dị elu.

1.Hemoblastoses - a na-eji usoro glucocorticoids dị elu ma dị elu.

2. Ọbara (hemolytic, autoimmune, aplastic) - a na-eji ọkara na elu nke glucocorticoids eme ihe.

3. Thrombocytopenia - usoro nke glucocorticoids na-enye usoro.

1. Ihe ojoo banyere uzo di iche iche - jiri otutu ogwu di elu nke glucocorticoids. A na-ahọrọ usoro ọgwụgwọ ọgwụ ụtọ.

2. A na-enye mmeghachi omume Allergic - usoro ọgwụgwọ glucocorticoids dị elu ma dị elu, ma ọ bụrụ na ọ dị mkpa, "usoro ọgwụgwọ".

3. Ọrịa mgbu nke akụkụ iku ume - a na-eji usoro glucocorticoids dị elu.

1.Dabere na ọnọdụ a na-adakarị, a na-eji glucocorticoids si obere ala ruo oke oke usoro, na, ọ bụrụ na ọ dị mkpa, “usoro ahụ ike”

4.Ndaberensonaazụ nke glucocorticoids

Na usoro ọgwụgwọ dị mkpụmkpụ na glucocorticoids, mmetụta ndị dị njọ anaghị adịkarị. Patientsfọdụ ndị ọrịa na-ekwu na mmụba agụụ, oke ibu, oke iwe, yana nsogbu ihi ụra.

Site na nchịkwa corticosteroids ruo ogologo oge, ihe a na-akpọ Hisenko-Cushing's syndrome na-amalite na oke ibu, ihu "nke nwere ọnwa, oke ntutu na-eto n'ahụ yana ịba ụba ọbara. Site n’ibelata oke nke homonụ, ihe ịtụnanya ndị a gbanwere. Mmetụta kachasị dị ize ndụ nke glucocorticoids na akpụkpọ anụ mucous nke eriri afọ: ha nwere ike ibute ọnya nke duodenum na afọ. Ya mere, ọnụnọ nke onye ọrịa nwere ọnya afọ bụ otu n'ime ihe contraindications maka iji corticoids. Mgbe onye ọrịa na-a hormonụ ọgwụ homonụ steroid, ọ bụrụ na enwere mkpesa nke ịdị arọ ma ọ bụ ihe mgbu na oke olu, obi mgbu, ọ dị mkpa ịkọ ọgwụ ndị na-ebelata acidity nke ihe ọricụ gastụ afọ. Ọgwụgwọ na glucocorticoids ọ bụla nwere ntu oyi na-esochi ya, yabụ na-ewere ọgwụ prednisone ga-ejikọ ya na iwere ọgwụ potassium (panangin, asparkum). Corticosteroids na-akpata sodium na njigide mmiri n'ime ahụ, yabụ mgbe edema pụtara, naanị ọgwụ nwere ike iji ya (dịka ọmụmaatụ, triampur, trireside K). Site na nchịkwa ogologo oge nke corticosteroids ụmụaka, nsogbu na-eto eto na oge ntozu nwa nwere ike.

Glucocorticoids niile nwere mmetụta ndị ọzọ metụtara ya, nke dabere na nha na ọnụọgụ ọgwụgwọ.

1. Mwepu nke ọrụ nke cortex adrenal. Glucocorticoids na-ebelata ọrụ nke usoro hypothalamus-pituitary-adrenal cortex. Mmetụta a nwere ike ịdịgide ruo ọtụtụ ọnwa mgbe ịkwụsị ọrụ ọgwụgwọ ma dabere na usoro ejiri, ugboro ole nchịkwa na oge ọgwụgwọ. Enwere ike ịkụda nsonaazụ cortex adrenal ma ọ bụrụ na, kama ị drugsụ ọgwụ ogologo oge (dex-metazone), a na-eji ọgwụ ndị dị mkpụmkpụ dị ka prednisone ma ọ bụ methylprednisolone na obere doses. Ọ bụ ihe amamihe dị na ị takeụ ọgwụ kwa ụbọchị n'isi ụtụtụ, nke kachasị kwekọọ na usoro ọmụmụ nke endogenous cortisol secretion. Mgbe ewere ya ụbọchị ndị ọzọ, a na-eji glucocorticoids na-adị mkpụmkpụ, a na-atụkwa otu ịre n'isi ụtụtụ. N'okpuru mmetụta nke nrụgide (arụ ọrụ afọ, ọrịa na-efe efe nke ukwuu, wdg), hypofunction nke adrenal cortex na-egosipụta onwe ya mgbe niile, nke a na-egosipụta site na enweghị agụụ, oke ibu, iro ụra, ahụ ọkụ na hyperension orthostatic. A na-echekwa ọrụ mineralocorticoid nke adrenal cortex, ya mere, hyperkalemia na hyponatremia, njirimara nke isi izizi cortical insufficiency, anaghị anọkarị. Ndị ọrịa kwesịrị iyi mgbaaka pụrụ iche ma ọ bụ nwee ha ọgwụ ka ha nwee ike na mberede ka dọkịta mara banyere mkpa nchịkwa glucocorticoids dị ozugbo. N'ime ndị ọrịa na-ewere ọtụtụ izu karịa 10 mg nke prednisone kwa ụbọchị (ma ọ bụ otu ụdị ọgwụ ọzọ), otu ma ọ bụ ọkwa ọzọ nke ịkwụsị nke adrenal cortex nwere ike ịdịgide ruo otu afọ mgbe ịkwụsị ọgwụgwọ.

2. Mwepụ nke ihe mgbochi.Glucocorticoids na-ebelata iguzogide ọrịa, karịsịa nje, ihe ize ndụ nke ibute ọrịa na-adabere na dose nke glucocorticoids ma nọgide na-abụ isi ihe kpatara nsogbu na ọnwụ nke ndị ọrịa nwere SLE. N'ihi ọgwụgwọ steroid, ọrịa ọrịa mpaghara nwere ike ịghọ usoro, ọrịa latent nwere ike ịdị n'ọrụ, na microorganisms na-abụghị pathogenic nwekwara ike ịkpata ya. Na-emegide usoro ọgwụgwọ glucocorticoid, ọrịa nwere ike ibute na nzuzo, mana ọnọdụ ahụ na-ebili elu. Dika ihe mgbochi, oria ogwu na oria ojoo na pneumococcal, nke na adighi ebute igba SLE. Tupu ịmalite ọgwụgwọ glucocorticoids, ọ bụ ihe amamihe dị na ya ịme nyocha tuberculin akpụkpọ.

3. Mgbanwe dị iche iche gụnyere: ịgbanye ihu, iwelite ibu, iweghachị abụba anụ ahụ, hirsutism, ihe otutu, ọnya odo, imechi obere mmerụ ahụ. Mgbanwe ndị a na-ebelata ma ọ bụ na-apụ n'anya mgbe ọ nwusịrị ọgwụ.

4. Nsogbu nke ụbụrụ sitere na mgbakasị ahụ dị nro, obi ụtọ na nsogbu ihi ụra ruo na ịda mbà n'obi siri ike ma ọ bụ psychosis (nke a nwere ike ile anya na-ezighị ezi dị ka ọnya ọrịa lupus nke usoro ụjọ).

5. Hyperglycemia nwere ike ime ma ọ bụ mụbaa n'oge ọgwụgwọ na glucocorticoids, mana, dịka iwu, anaghị arụ ọrụ dịka contraindication maka nhọpụta ha. Iji insulin eme ihe nwere ike ịchọ, ketoacidosis adịkarịghị etolite.

6. Mmebi nke nguzo mmiri-electrolyte gunyere sodium njigide na hypokalemia. Ihe isi ike dị iche iche na ọgwụgwọ na-ebilite ma ọ bụ ọrịa ụbụrụ.

7. Glucocorticoids nwere ike ibute ma ọ bụ mee ka ọbara mgbali elu. Enwere m ọgwụ mgbu nke steepụ steroid mgbe niile na-eme ka ọbara mgbali elu na - eme ka ọ bụrụ ihe na - esighị ike ọgwụgwọ.

8. Osteopenia na mkpakọ nke akụkụ vertebral na-etolite site na ọgwụgwọ glucocorticoid ogologo oge. Ya mere, ndị ọrịa kwesịrị ịnata ion nke calcium (1-1.5 g / ụbọchị site n'ọnụ). Vitamin D na thiazide diuretics nwere ike inye aka. N'ime ụmụ nwanyị postmenopausal, n'ihe egwu dị elu nke osteopenia, a na-egosikarị estrogens, mana nsonaazụ ojiji ha na SLE na-emegide. Enwere ike iji Calcitonites na diphosphonates. A na-atụ aro mmega ahụ na - akpali akpali osteogenesis.

9. Amalitere myopathy steroid tumadi mmebi akwara nke n'ubu na pelvic n'apata. Mara adịghị ike, mana enweghi ihe mgbu, ọrụ nke enzymes ọbara nke sitere na uru ahụ na usoro electromyographic, n'adịghị ka mmebi akwara mgbu, adịghị agbanwe. A na - eme biopsy (akwara biops) na - eme naanị obere oge mgbe ọ dị mkpa iwezuga mbufụt ha. Ohere nke steepụ myopathy na-ebelata ka a na-ebelata glucocorticoids ma na-eme usoro mmega ahụ siri ike, agbanyeghị, mgbake zuru oke nwere ike were ọtụtụ ọnwa.

10. Nsogbu ọgbụgba ọbara gụnyere nrụgide intraocular na-abawanye (nke bụ oge ụfọdụ n'ihi nrịba nke glaucoma) na cataract posterior subcarsular.

11. Ischemic ọkpụkpụ necrosis (aseptic, avascular necrosis, osteonecrosis) nwekwara ike ime n'oge usoro ọgwụgwọ steroid. Ọkpụkpụ ndị a na-adịkarị ọtụtụ, ọ na-emebi isi nke anụ ahụ na humerus, yana ala nkebia. A na - achọpụta scormigraphy isotopic na MRI. Ọdịdị nke mgbanwe mgbanwe redio na-egosi usoro dị ukwuu. Nrụrụ ọkpụkpụ nwere ike ịbụ ihe dị mma na mmalite nke ischemic necrosis, mana atụmatụ nke usoro ọgwụgwọ a na-arụ ụka.

12. Nsonaazụ ndị ọzọ nke glucocorticoids gụnyere hyperlipidemia, enweghị nsogbu nwoke, ịsụsọ nke ukwuu, ọkachasị n'abalị, na oke ọgbụgba ọbara intracranial (pseudotumor cerebri). Ọdịdị nke thrombophlebitis, necrotizing arteritis, pancreatitis, na ọnya afọ na-esonye mgbe ụfọdụ na ọrụ glucocorticoids, mana ihe akaebe nke njikọ a ezughi.

5.Ingdọ aka na ntịglucocorticoids

1. Echiche doro anya maka iji glucocorticoids.

2. Ebumnuche echebara echiche nke ọgwụ glucocorticoid, nke na-egosipụta ma arụmọrụ dị elu ma na-enwe mmetụta dị nta dị ala. Methylprednisolone (Medrol, Solu-medrol na Depo-medrol) mezuru ihe ndị a, arụmụka nke enyere n'elu.

3. Nhọrọ nke uzo izizi nke glucocorticoid ọgwụ nke na-enye nsonaazụ ahụike dị mkpa na obere usoro ya kwesịrị dabere na nyocha dị omimi nke onye ọrịa, gụnyere nosology nke ọrịa, ọrụ ya, ọnụnọ nke mmebi ahụ na sistem dị mkpa, yana nkwenye n'ozuzu ya na ụzọ nke glucocorticoid ọgwụ na usoro ọgwụgwọ dị iche iche. ọnọdụ. Taa, a na-ahụta ọgwụgwọ glucocorticoid n'enweghị ọgwụgwọ dịka ọgwụgwọ nke nhọrọ maka ọtụtụ ọrịa rheumatic, gụnyere SLE, dermatomyositis na polymyositis, vasculitis, glomerulonephritis na ndị ọzọ. N'otu oge, usoro onunu ogwu mbu di iche iche dabere na njirimara nke onyonyo a na onyonye ya. Yabụ, dịka ọmụmaatụ, na nnukwu ọrụ nke SLE, dermatomyositis, polymyositis, system vasculitis na / ma ọ bụ itinye aka nke akụkụ ahụ na sistemụ dị mkpa na ọrịa ndị a, a na-egosipụta ojiji dị elu ma ọ bụ oke oke nke glucocorticoids. N'otu oge ahụ, yana obere ọrụ nke SLE, vasculitis, enwere ike ịrụpụta ezigbo ọgwụ na-adịghị mma site na usoro nke glucocorticoids, na enweghị mmebi nke akụkụ ahụ dị n'ime na usoro akwara, ọ dịghị mkpa ịdepụta usoro ọgwụgwọ glucocorticoid iji nweta mgbatị ahụ, ebe ọ bụ na enwere ike nweta mmetụta ọgwụgwọ zuru ezu site na iji NSAIDs , na-ejikọkarị ya na nhazi aminoquinoline. N'otu oge ahụ, ọtụtụ ndị ọrịa chọrọ ọzọ iji obere glucocorticoids dị ala (Medrol 4-6 mg kwa ụbọchị ma ọ bụ mgnastlone 5-7.5 kwa ụbọchị).

Ojiji nke ọgwụ mmezi ọrịa na-eme ugbua na mmalite nke ọrịa ogbu na nkwonkwo, enweghị data na nsonaazụ dị mma nke usoro glucocorticoids na ogologo oge na ndị ọrịa nwere ọrịa ogbu na nkwonkwo, na nnukwu ihe ize ndụ nke mmetụta ọjọọ mgbe ị na-eji ha, gbanwere ụzọ dị ukwuu maka ojiji nke glucocorticoids. Taa na enweghị

Achọpụtakarị ihe ngosi ndị ọzọ dị egwu nke ọrịa ogbu na nkwonkwo (dịka ọmụmaatụ, vasculitis, pneumonitis) maka iji glucocorticoids na usoro onyunyo gafere 7.5 mg kwa ụbọchị nke prednisone ma ọ bụ 6 mg nke methylprednisolone. Ọzọkwa, n'ọtụtụ ndị ọrịa nwere ọrịa ogbu na nkwonkwo, mgbakwunye nke 2-4 mg kwa ụbọchị nke Medrol na ọgwụgwọ mmegharị ọrịa ahụ bụ ezigbo nsonaazụ ụlọ ọgwụ.

1. Guzosie usoro maka iwere glucocorticoids: nke na-aga n'ihu (kwa ụbọchị) ma ọ bụ ngbanye (ọzọ na ngbanyeghị) nhọrọ.

2. N'ime ọtụtụ ọrịa rheumatic, vasculitis, glomerulonephritis, glucocorticoids ezughị ezu iji nweta ọgwụgwọ zuru oke ma ọ bụ akụkụ na mgbake, nke chọrọ ijikọ ha na ọgwụ cytotoxic dị iche iche (azathioprine, cyclophosphamide, methotrexate na ndị ọzọ). Na mgbakwunye, iji cytostatics nwere ike belata oke nke glucocorticoids (ma ọ bụ ọbụna kagbuo ha) ka ị na-enwe mmetụta a na-enweta n'ụlọ ọgwụ, nke na-ebelata ugboro ole na ogo nke mmetụta nke ọgwụgwọ glucocorticoid.

3. Ọtụtụ ndị ọrụ ụlọ ọgwụ na-atụ aro ka ị thatụ ọgwụ glucocorticoids ogologo oge (2-4 mg / ụbọchị nke Medrol® ma ọ bụ 2.5-5.0 mg / ụbọchị nke prednisolone) ga-aga n'ihu n'ọtụtụ ndị ọrịa nwere ọrịa rheumatic mgbe ha nwesịrị ọgwụgwọ mgbali na ụlọ nyocha.

Nandepụta nke akwụkwọ eji

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