Litlamorao tse ka sehloohong tsa glucocorticoids

Boiphihlelo ba lilemo tse ngata ka lithethefatsi tsa glucocorticoid ho mafu a fapaneng ho bana ha li a senola feela tse ntle, empa le likarolo tse mpe tsa mokhoa ona oa kalafo. Ho ile ha fumaneha hore ho bakuli ba bang, lintho tse bohloko tse etsahalang ka nakoana ke tsa tlhaho ebile li bonoa hanyane ka tlhaho ebe lia nyamela ntle le hore li ka ba teng.

Ho bana ba bang, kamora ho felisoa ha moemeli oa glucocorticoid, mathata a hlahileng, ka linako tse ling a le matla haholo, a phehella ka lilemo tse ngata, mme ka linako tse ling bophelong. Sebopeho le botebo ba maikutlo a mabe le mathata a teng li itšetleha ka tekanyetso ea letsatsi le letsatsi ea nako ea kalafo ka lithethefatsi tsa glucocorticosteroid, lilemo tsa ngoana le litšobotsi tsa motho ka mong tsa ho nchafala ha 'mele oa hae.

Mekhoa ea litlamorao tse bakoang ke glucocorticosteroids e rarahane, hobane lithethefatsi tsena li hlasela likarolo tsohle tsa ts'ebetso ea bohlokoa ea 'mele oa ngoana. Leha ho le joalo, ha ho pelaelo hore motho a ka bua ka litlamorao le litla-morao tsa lithethefatsi tsena, mabapi le bokhoni ba bona ba ho tlola molao oa boits'ireletso, ho baka tšenyo ea lisele le ho sitisa lits'ebetso tsa ho inchafatsa ho tsona, a ferekanya metabolism haholo. Liphetoho tse mpe le mathata a teng kalafong ea bana ba nang le glucocorticosteroids e ka ba ka tsela e latelang.

1.E 'ngoe ea lipontšo tsa khafetsa tsa lithethefatsi hypercorticism tse entsoeng ka boqhetseke' meleng oa ngoana ke lefu la Cushingoid: boima ba mmele o nang le matšoao a ho ba le botenya bo ikhethang (ho potoloha sefahleho, ho hlahisa mafura a mangata sefahlehong, molaleng, mahetleng) mpa hammoho le hypertrichosis, mofufutso kapa letlalo le omileng, letlalo la lona, ​​mokhoa o eketsehileng oa masapo oa letlalo, ponahalo ea makhopho le sefahleho.

Ho eketseha ha mafura (mofuta oa botena ba monna) ho amana le phello ea catabolic ea lithethefatsi tsa glucocorticosteroid, ts'ebetso ea gluconeogeneis e atolositsoeng, le phetoho ea lik'habohaedreite hore e be mafura. Ho thibela ts'ebetso ea mafolofolo a susumetsoang ke li-hormone tsa kholo le hona ho bohlokoa.

2. Khafetsa khafetsa khafetsa ho tsamaisang li-glucocorticosteroids ke seo ho thoeng ke steroid gastritis, e bonahatsoang ke ho putlama ha takatso ea pelo, pelo, ho nyekeloa ke pelo, ka linako tse ling ho hlatsa, acid belching, bohloko sebakeng sa epigastric.

Ho kenella ka tsela ea ho fifala le liso tsa ka mpeng le duodenum hoa khoneha (li ka hlaha le ka mala a manyane le a maholo). Lits'oaetso tsa ka mpeng le ka mpeng ka linako tse ling li thatafalloa ke ho tsoa mali le ho ntlafala. Ho ke ho hlokomeloe hore liso tsa ka mpeng le tsa ka mpeng li le maemong a mantlha a sebopeho sa tsona, e ka ba sesupo sa letho, 'me pontso ea ho ba teng ha tsona ke karabelo e ntle maling a boloi ka har'a maroba.

Khafetsa, mathata a ka mpeng a hlaha kamora ho nka lithethefatsi tsa glucocorticosteroid kahare, leha nts'etsopele ea tsona e sa khetholloe ka tsamaiso ea botsoali ea lithethefatsi tsena. Ho hlaha ha ts'ebetso ea ho ruruha ho na le monyetla o moholo ha ho laela li-prednisone le li-prednisone, haholo-holo ha li kopantsoe le li-agents tse ling tsa ulcerogenic (li-immunosuppressants, acetylsalicylic acid, tetracyclines, jj).

Lintho tse ling li kenya letsoho kholong ea liso:

Ho nka li-glucocorticosteroids pele ho lijo,

Taolo ea nako e telele ea lithethefatsi tsena ntle le tšitiso ea kalafo,

· Ho se lumellane le lijo ka nako ea kalafo ea glucocorticosteroid (ho ja lijo tse nang le linoko tse ngata kapa tse khopisang, linoko, lijo tse batang kapa tse chesang, jj).

Glucocorticosteroids e baka ho thehoa ha liso tsa ka mpeng le mala ka lebaka le latelang:

· Ba eketsa acidity le secretion ea lero la ka mpeng mme ka nako e ts'oanang ba senya sebopeho sa mucus, se sirelletsang lera la mucous la mpeng le mala ho tsoa liphellong tse senyehang (sebopeho sa li-polysaccharides tse etsang membrane ea mucous ea mala le mala e thibetsoe),

· Glucocorticosteroids e nyenyefatsa ts'ebetso ea pholiso ea li-ulcers tsa ka mpeng le mala, ke hore, tlasa ts'usumetso ea bona kholo ea lisele tsa glandular le li-tishu tse sebetsang tsa marako a litho tsena li thibetsoe. Tsela ea asymptomatic (e se nang bohloko) ea ts'ebetso ea ho ruruha e hlalosoa ke 'nete ea hore ulceration e etsahala khahlano le semelo sa litla-morao tsa anti-inflammatory tsa lithethefatsi tsa glucocorticosteroid.

3. Ts'ebetsong ea ho nka lithethefatsi tsa glucocorticosteroid, ho mpefatsa ha ts'oaetso ea methapo (tonsillitis, sinusitis, ho bola ha meno, cholecystitis le ba bang), kakaretso ea ts'ebetso ea tšoaetso e ka bonoa. Ho hlalosoa maemo a pneumonia le pulmonary supplement ea autoinfacter, ho eketsoa hoa maloetse a sa foleng (hepatitis, cholecystitis, pancreatitis, lefuba le a mang).

Ho hlokometsoe hore ho beoa ha li-glucocorticosteroids ho baka lera le matla la tšoaetso ea vaerase baneng, ho mpefatsa mosebetsi oa ho enta haholo. Litla-morao tse hlalositsoeng ka holimo li hlalosoa ke bokhoni ba li-glucocorticosteroids ho hatella karabelo ea ts'ireletso le ea lehae.

4. Phekolo ka li-glucocorticosteroids, ho ka etsahala liphetoho mokhoeng oa kelello le maikutlong: ho thatafala maikutlong, ho ruruha hoa kelello, ho ferekana kelellong, ho tšoenyeha ha boroko. Liphetoho tsena ho bana lia fetoha.

5. Karabelo e etsahalang khafetsa ka phekolo ea glucocorticosteroid ke keketseho ea khatello ea mali. Kamora ho tsoa sepetlele, khatello ea methapo ea kutlo ho bakuli e feta, leha ho le joalo ho bana ba bang keketseho ea khatello ea mali ka 15 - 20 mm RT. Art. o phehella bakeng sa 1 ho isa ho 3 lilemo tse ling ho sa be le litletlebo life kapa life (A. V. Dolgopolova, N. N. Kuzmina, 1963).

Mokhoa oa methapo ea methapo ea kutlo ho lithethefatsi hypercorticism e ntse e sa hlaka. Khafetsa, karabelo e joalo e tlalehiloe pele ho bohlankana kapa boroetsaneng.

6. Li-glucocorticosteroids tse ling (cortisone, hydrocortisone, prednisone, prednisone) li na le bokhoni ba ho boloka sodium le metsi 'meleng oa mokuli, e leng se etsang hore ho shebahale edema le ho eketseha ha boima ba' mele. Lithethefatsi tse joalo tsa glucocorticosteroid tse kang dexamethasone, triamcinolone, methylprednisolone ha li liehe sodium le metsi.

7.Ka kalafo e kholo le e telele ea glucocorticosteroid ho banana ba lilemong tsa bocha, mathata a endocrine a atisa ho bonoa: ho lieha ho shebahala ho ea matsatsing a pele, ho hloka toka ha bona, ha ho se ho thehiloe. Hoa hlokahala ho bala sena mme ntle le matšoao a tiileng u se ke oa fana ka litlhare tsena ho banana nakong ea bokhachane, li hlakole ha matšoao a pele a liketsahalo tsena tse mpe a hlaha.

8. Lingolo li fana ka bopaki ba hore tlas'a tšusumetso ea taolo ea nako e telele ea lithethefatsi tsa glucocorticosteroid, ho khutla ha mmele oa ngoana ho ka etsahala. Ketsahalo ena e hlalosoa ke phello ea ho thibella ha glucocorticosteroids tlhahisong ea lihormone tsa kholo ke sebopeho sa pituitary le ho etsoa hoa somatomedin sebeteng, keketseho ea lits'ebetso tsa bo-catabolic liseleng, ho kenyeletsa le lesapo.

9. Bongoaneng, lefu la tsoekere le ka hlaha ho tsoa tšusumetsong ea glucocorticosteroids e tsoang ho prediabetes.

Mokhoa oa ho theha lefu la tsoekere la steroid e amanang le likarolo tsa ketso ea lithethefatsi tsa glucocorticosteroid ho metabolism ea carbohydrate: li sitisa ts'ebetso ea lisebelisoa tsa insulin tsa manyeme, li hlohlelletsa tlhahiso ea liprotheine tse tlamang insulin, li ntšetsa pele ts'ebetso ea tlhahiso ea tsoekere ho tsoa ho li-amino acid mme ka nako e ts'oanang e fokolisa ts'ebeliso ea lik'habohaedreite ke lisele.

Khabareng, hyperglycemia le glucosuria lia ntlafala, 'me le ho bana ba nang le ts'oaetso ea lefutso la lisebelisoa tse bolokiloeng - lefu la tsoekere. Ho bakuli ba bangata, kamora ho felisoa ha glucocorticosteroids, metabolism ea carbohydrate e tloaelehile. Dexamethasone e khona ho baka litšitiso tse phatlalalitsoeng haholo ho metabolism ea carbohydrate, e ka tlase ho triamcinolone, methylprednisolone, prednisolone, prednisone. Li-diabetogenicity tse nyane ke tšobotsi ea cortisone le hydrocortisone.

10. Karabelo e sa khaotseng ea 'mele oa ngoana ho tsamaiso ea li-glucocorticosteroids e eketseha excretion ea potasiamo ka moroto le nts'etsopele ea hypokalemic syndrome.

Matšoao a morao-rao: maikutlo a bofokoli, malaise, ho fokotseha ha molumo oa mesifa le matla (ka linako tse ling li-paresis tsa maoto le matsoho), ho fokolisa ts'ebetso ea myocardial, pelo ea pelo, ho nyekeloa pelo, ho hlatsa, ho sokela.

Monyetla oa ho ba le hypokalemic syndrome o eketseha le tsamaiso ea li-glucocorticosteroids hammoho le pelo gracosides le diuretics, ha o ntse o hlokomoloha lijo tsa potasiamo le matšeliso a sa lekanang bakeng sa tahlehelo ea potasiamo ea potasiamo ka lebaka la ts'ebetso e eketsehileng ea lithethefatsi tse nang le chemotherapy.

11. Ho hlokometsoe litlhahlobo tse ngata tsa bongaka ho bonts'a litlamorao tse mpe tsa lithethefatsi tsa glucocorticosteroid tsamaisong ea marapo ea 'mele oa ngoana ea ntseng o hola. Steroid osteopathy e bontšoa ka ponahalo ea masapo a masapo a malelele a li-tubular, likhopo le 'mele ea vertebral. Khafetsa, nts'etsopele ea lefufuru le epiphyseal le tšoenyeha, ka linako tse ling matšoao a aseptic necrosis ea masapo a hlaha.

Se thata haholo ke brevispondylia: sebopeho sa li-vertebrae tsa tlhapi (ka lebaka la tšenyo ea methapo ea methapo ea mokokotlo) le ho lateloa ha metsoako ea methapo, ho robeha ha lesapo la mokokotlo, khatello ea lesapo la mokokotlo.

Steroid osteopathy ke sesosa sa tlolo ea molao mabapi le sebopeho sa liprotheine tsa masapo a masapo (ho fokotseha ha palo ea li-collagen, mucopysaccharides, hexosamine), ts'ebetso e ntlafalitsoeng ea khalsiamo ho tsoa liseleng tsa masapo le ho pepeseha ha eona le phosphorus ka har'a moroto. Lits'ebetso tse fetohang ka har'a lithane tsa masapo tsa bakuli ba nang le li-osteopathy tsa steroid li tšoauoa ka mokhathala le nako.

12. Ho bakuli ba bang, myopathy e ba teng tlasa tšusumetso ea lithethefatsi tsa glucocorticosteroid.

Matšoao a hae: bofokoli ba mesifa (haholoholo lipakeng tse ka tlase tse ka tlase le mesifa ea kutu), hypotension, e fokotsehile ha tendon. Tlhahlobong, u ka hlokomela matšoao a hypertrophy ea mesifa, haholo-holo maemo a tlase (glycogen e fumanehang mesifa ea eketseha). Tlolo ea sebopeho sa methapo ea methapo ea methapo ea kutlo e bonahatsoa. Triamcinolone e nang le fluorine hangata e baka myopathy. Steroid myopathy ka mor'a ho tlohela lithethefatsi butle-butle e nyamela, mme ts'ebetso le sebopeho sa mesifa li khutlisoa ke cavity.

13. Ts'ebeliso ea li-glucocorticosteroids (haholo-holo maemong a taolo e telele ea litekanyetso tsa lithethefatsi) e tletse le kotsi ea mathata a tsoang mokheng oa pono ka mokhoa oa ho koahela lense le glaucoma. Liphetoho lense li ka fetoha tse ke keng tsa fetoloa ka lebaka la ho soasoa ha metsi a mangata, mokokotlo oa mokokotlo oa eona. Glaucoma bongoaneng ha e fumanehe seoelo.

14. Le ha lithethefatsi tsa glucocorticosteroid e le sesosa se matla sa kalafo ho allergies, maemong a mang bona ka bo bona ba hlahisa mefuta ea mafu, ho fihlela ho ts'oaroa hoa anaphylactic. Boitšoaro bo joalo bo atisa ho hlaha ka khafetsa lithuto tsa glucocorticosteroid kalafo mme li iponahatsa ka sebopeho sa urticaria, edema ea Quincke, erythema multiforme, letlalo le hlohlotsang le matšoao a mang.

15. Tšebeliso ea nako e telele ea lithethefatsi tsa glucocorticosteroid le boemo bo hlahisoang ke hypogorticism ea pharmacgenic e na le kotsi ea thibelo ea ts'ebetso ea mokokotlo oa cortical ea litsoelesa tsa adrenal le ntlafatso e hlophisitsoeng ea tsamaiso ea hypothalamic-gynephysial-adrenal.

Khahlano le semelo sena, ka ho tlohela moriana ka tšohanyetso, syndrome ea ho ntša mpa e ka hlaha ka tsela ea tlhaselo ea bofokoli bo matla, bofokoli, hlooho e bohloko, ts'ebetso ea kelello le mmele, le keketseho e leka-lekaneng ea mocheso oa 'mele.

Lefu la ho ntša mpa le kotsi haholo maemong a ha ts'ebetso ea ts'ebetso ea litekanyetso tse kholo tsa glucocorticosteroids e sa emisoe ntle le boitokisetso ba 'mele ba mokuli, e leng, ntle le ho fokotseha butle-butle ho lethal dose la letsatsi le leng le le leng la lithethefatsi, ho hlahisoa ha li-chemotherapeutic agents tse khothalletsang ts'ebetso ea adrenal cortex.

Kahoo, sehlopha sa lithethefatsi tsa glucocorticosteroid ha se khetholloe feela ka litlamorao tsa lona tse matla 'meleng oa mokuli, empa hape le ketsahalong e ngata e mpe, ho teba le botebo ba eona ho latela lithethefatsi ka botsona, mokhoa oa ts'ebeliso, lilemo le thobalano ea ngoana, le mabaka a mang, ka bomalimabe ha a so ithute.

Phekolo ea pharmacological bakeng sa HA e ka ba matla (nakoana), ea fokola (ka matsatsi a 'maloa kapa likhoeli) le ea nako e telele (kalafo bakeng sa likhoeli tse' maloa, lilemo, kapa esita le bophelo ba nako e telele).

Ha ua fumana seo u se batlang? Sebelisa patlo:

Litla-morao tsa li-glucocorticoids tsa systemic

Lethathamo la tse kahare

Litlamorao
■ Thibelo ea ts'ebetso le atrophy ea adrenal cortex, ho itšetleha ka steroid, "syndrome ea ho khaola" (ho mpefatsa ha lefu le ka tlase, ho hloka matla ha adrenal). Pheko ea nako e telele le li-glucocorticoids tsa systemic, haholo-holo tse etsoang ntle le ho nahana ka sebopeho sa mmele sa sephiri sa secretion ea bona, se lebisa ho thibelong le ho ateng ea adrenal cortex. Bakeng sa thibelo e felletseng ea adrenal cortex ho mokuli ea moholo, tekanyetso ea letsatsi le letsatsi ea glucocorticoid ea letsatsi le letsatsi e lokela ho ba 10-20 mg ho latela prednisone. Ho fokotseha ha ts'ebetso ea adrenal cortex ho qala ka la 4 - 7 letsatsi la tšebeliso ea letsatsi le letsatsi ea litekanyetso tse phahameng tsa li-glucocorticoids ha li laetsoe hoseng le ho tloha ka letsatsi la 2 ha li laetsoe ka shoalane. Litla-morao tsena li tsebahala haholo ka li-glucocorticoids tsa molomo tse telele le litokisetso tsa depo. Ho khutlisetsa ts'ebetso ea sephiri e tloaelehileng ea adrenal cortex, bonyane ho hlokahala likhoeli tse 69, 'me karabelo ea eona e lekaneng likhatellong e fihla ho lilemo tse 1-2.

■ Ho kuta ka letlalo, khoele, lehare.
■ Osteoporosis, masapo a mokokotlo le aseptic necrosis ea masapo, ho khutla ho hoholo. Osteoporosis e hlaha ho 30-50% ea bakuli mme ke eona phepelo e tebileng ka ho fetisisa ea kalafo ea glucocorticoid. Ke ka lebaka la phello ea bona e mpe sebopeho sa lisele tsa masapo le ts'ebetso ea resorption ea eona. Hangata ho hlaha basali nakong ea postmenopausal. Ha e le molao, ho fokola ha masapo ho ama likarolo tse bohareng ba lesapo (lesapo la mokokotlo, masapo a pelvic, likhopo) 'me hanyane ka hanyane ho fetela masapong a pherekano (matsoho, maoto, jj.) Liponahatso tsa eona tsa bongaka ke bohloko ba lesapo la mokokotlo le mokokotlo, ho fokotseha kholo le ho putlama ha lesapo la mokokotlo (thoracic e tlase le lumbar) mafapha), likhopo, molala oa basali, ho tsoa likotsi tse nyane kapa ho itšepa feela. Ho phekola bothata bona, ho sebelisoa litokisetso tsa khalsiamo, vithamine D3, calcitonin le bisphosphonates. Nako ea kalafo e joalo e lokela ho ba lilemo tse 'maloa.
• Myopathy, ho senyeha ha mesifa, ho nyekeloa ke mesifa. Li-steroid myopathies li bonahatsoa ke bofokoli le mokokotlo oa mesifa ea marapo, ho kenyelletsa le mesifa ea ho hema (mesifa ea intercostal, diaphragm), e thusang ho holisa ho hloleha ho phefumoloha. Hangata, khatello ena e baka triamcinolone. Mokhoa oa nts'etsopele ea myopathies o amahanngoa le phello e mpe ea li-glucocorticoids ho protheine le metabolism ea methapo. Li-anabolic acidids le litokisetso tsa potasiamo li sebelisoa bakeng sa kalafo ea bona.
■ Hypokalemia, sodium le ho boloka metsi, edema ke lipontšo tsa litlamorao tsa mineralocorticoid ea glucocorticoids.
■ Keketseho ea khatello ea mali e ka bonoa ho bakuli ba nkang li-glucocorticoids nako e telele. Ke ka lebaka la sensitivity e eketsehileng ea lebota la vascular ho catecholamines, sodium le ho boloka metsi.
■ Tšenyo leboteng la vascular le nts'etsopele ea "steroid vasculitis" hangata e bakoa ke lithethefatsi tse nang le feberu (dexamethasone le triamcinolone). E tšoauoa ka ho eketseha ha methapo ea methapo. E bonahatsoa ke ho ruruha letlalong la liatleng, li-membrane tsa mucous tsa mokokotlo oa molomo, conjunctiva ea mahlo, epithelium ea pampitšana ea ka mpeng. Bakeng sa kalafo, ho sebelisoa li-vithamine C le P, hammoho le li-anti-bradykinin vascular vascular.
■ Ho eketseha ha mali ho eketsehileng ho ka lebisa ho thehoeng ha methapo ea mali methapong e tebileng le thromboembolism.
■ Ho fokotsa ho nchafatsoa hoa litho tsa 'mele ka lebaka la litlamorao tsa anti-anabolic le catabolic ho metabolism ea protheine - ho fokotsa synthetiki ho tsoa ho liamino acid, ho matlafatsa ho phatloha ha protheine.
■ Li-ulp tsa Steroid tsa ka mpeng le mala, ho tsoa mali ka mpeng. Li-ulcerid hangata li na le asymptomatic kapa asymptomatic, li bonts'a ho tsoa madi le ho tlatsa. Ka hona, bakuli ba fumanang li-glucocorticoid tsa molomo ka nako e telele ba lokela ho hlahlojoa nako le nako (ho hlahlojoa ha li-futs bakeng sa mali a boloi). Mochine oa ketso ea ulcerogenic ea glucocorticoids e amahanngoa le phello ea bona ea catabolic le khatello ea motsoako oa prostaglandin mme o kenyelletsa ho eketsa secretion ea hydrochloric acid, ho theha sebopeho sa mucus le ho thibela ho nchafatsoa hoa epithelium. Phepelo ena hangata e bakoa ke prednisone.
■ Pancreatitis, sebete sa mafura, botenya, hyperlipidemia, hypercholesterolemia, embolism ea mafura ke litlamorao tsa phello ea anabolic ea glucocorticoids ho metabolism ea mafura - motsoako o eketsehileng oa triglycerides, mafura acid le cholesterol, phetiso ea mafura.
■ Ho eketseha ha ts'ebetso ea methapo e ka bang ho ruruha, ho hloka boroko, ho hlonama, khatello ea maikutlo, matšoao a ho ba le meningism, ho tsubella ho bakuli ba nang le lefu la ho akheha.
■ Posterior subcapsular cataract, glaucoma, exophthalmos.
■ Steroid lefu la tsoekere, hyperglycemia. Li-glucocorticoids li eketsa ho kenngoa ha lik'habohaedreite ho tsoa mpeng ea gastrointestinal, li ntlafatsa gluconeogeneis, li fokotsa mosebetsi oa insulin le hexokinase, hape li fokotsa kutloisiso ea lisele tsa mmele ho insulin le ts'ebeliso ea tsona ea tsoekere. Bakeng sa kalafo ea lefu la tsoekere la steroid, ho sebelisoa lijo tse thibetsoeng ke lik'habohaedreite, lithethefatsi tse fanoang ka molomo le insulin.
■ Tlas'a lebelo la ho ea matsatsing, mesebetsi ea thobalano, ho lieha ho hola ka thobalano, hirsutism, nts'etsopele ea bokhachane bo amanang le ho fokotseha hoa tlhahiso ea lihormone tsa thobalano.
■ Tlhatlhobo ea boits'ireletso, ho mpefatsa hoa ts'ebetso e sa foleng ea ts'oaetso le ho ruruha, ho kenyeletsa lefuba, ts'oaetso ea bobeli, kakaretso ea ts'oaetso ea lehae. Ha e le molao, mathata a tšoaetsanoang ke asymptomatic ka lebaka la phello ea anti-inflammatory ea glucocorticoids. Khōlo ea candidiasis ea molomo le molomo oa pharynx ke tšobotsi.
■ Cushing's syndrome (ho bokella mafura a tsoang mafura a tlisoang ke maoto le matsoho, ho hlahisa mafura a mangata sefahlehong, molaleng, senyepa sa mahetla le mpeng, hypertrichosis, striae, makhopho, mamello e fokolang ea tsoekere).
■ Liphetoho tsa lefu la kelello.
■ Ho bonahatsoa ke neutrophilic leukocytosis ntle le phetoho ea foromo ea leukocyte ho leqele. Ho lumeloa hore li bakoa ke phello e susumetsang ea li-steroid ho granulopoiesis.

Thibelo ea Mathata

■ Tšebeliso ea mofuta oa kalafo (oa alternating) oa kalafo.
■ Tšebeliso ea li-glucocorticoid tsa systemic bonyane ka tekanyetso e hlokahalang. Bakeng sa sena, ho asthma ea bronchial, tsamaiso ea bona e lokela ho kopantsoe le ts'ebeliso ea li-glucocorticoids tse nang le inhaled hammoho le li-agonists tsa nako e telele tsa β2-adrenergic agonists, theophylline, kapa lithethefatsi tsa antileukotriene.
■ Tsamaiso ea li-glucocorticoids ho latela moelelo oa 'mele oa letsatsi le letsatsi oa secretion ea cortisol.
■ Ts'ebeliso ea lijo tse nang le protheine le calcium e ngata, ka lithibelo tsa lik'habohaedreite tse bonolo tse tsoekere, letsoai (ho fihlela ho 5 g ka letsatsi) le metsi (ho fihlela ho lithara tse 1,5 ka letsatsi).
■ Ho nka li-glucocorticoid tsa litafoleng kamora lijo ho fokotsa phello ea tsona ea kolcerogenic.
■ Ho felisa ho tsuba le tšebeliso e mpe ea joala.

■ Ho ikoetlisa ka tsela e itekanetseng e seng kotsi.

Mohopolo oa li-glucocorticoids, ts'ebeliso ea tsona e le meriana, khethollo ka sebopeho le ketso. Mekhoa ea taolo ea motsoako le secretion ea lihormone tsa adrenal cortex Mokhoa oa ts'ebetso oa li-glucocorticoids, litlamorao tse kholo ho tloha ts'ebelisong ea bona.

Ho isa mosebetsi oa hau o motle motheong oa tsebo ho bonolo. Sebelisa foromo e ka tlase

Baithuti, baithuti ba tsoang sekolong, bo-rasaense ba banyenyane ba sebelisang setsi sa tsebo lithutong tsa bona le mosebetsing ba tla le leboha haholo.

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Lekala la Bophelo la Ukraine

Zaporizhzhya State University University

Lefapha la Pharmacology le Bongaka ba Bongaka

Ka sehlooho: "Pharmacology"

Sehloohong: "Litlamorao tsa li-glucocorticoids"

E phethiloe: Moithuti oa selemo sa 3

Saiko Roman Eduardovich

1. Tlhalo ea li-glucocorticoids

2. Mochine oa ts'ebetso oa li-glucocorticoids

3. Tšebeliso ea li-glucocorticoids

4. Litlamorao tse ka sehloohong tsa glucocorticoids

5. Thibelo ea litlamorao tsa glucocorticoids

Lethathamo la litšupiso

1.Sehlopha sa Glucocorticoidka

Li-Glucocorticoids ke lihormone tsa steroid tse entsoeng ka adrenal cortex. Li-glucocorticoids tsa tlhaho le li-analogu tsa tsona tsa maiketsetso li sebelisoa ho moriana bakeng sa ho hloka thari ea adrenal. Ntle le moo, maloetse a mang a sebelisa lithibela-mafu, li-immunosuppression, anti-allergic, anti-shock le thepa e meng ea lithethefatsi tsena.

Qaleho ea ts'ebeliso ea li-glucocorticoid e le meriana (PM) e qalile morao ho 40s. Lekholong la XX la lilemo. Morao koana bofelong ba 30s. ea lekholo la ho qetela la lilemo, ho ile ha bontšoa hore li-complex tsa li-hormone tsa mofuta oa steroid li thehoa ka cortex ea adrenal. Ka 1937, mineralocorticoid deoxycorticosterone e ile ea qheleloa ka thoko ho adrenal cortex, ka 40s. - glucocorticoids cortisone le hydrocortisone. Litholoana tse fapaneng tsa meriana le hydrocortisone le cortisone li ile tsa rera esale pele monyetla oa ts'ebeliso ea tsona joalo ka lithethefatsi. Ka mor'a nakoana, ba ile ba etsa joalo.

Glucocorticoid ea mantlha le e sebetsang ka ho fetisisa e entsoeng ka 'meleng oa motho ke hydrocortisone (cortisol), tse ling tse sa sebetseng haholo li emeloa ke cortisone, corticosterone, 11-deoxycortisol, 11-dehydrocorticosterone.

Tlhahiso ea lihormone ke litšoelesa tsa adrenal e tlas'a taolo ea methapo e meholo ea methapo 'me e amana haufi le ts'ebetso ea gland ea pituitary (bona sa feiga. 2). Adrenocorticotropic pituitary hormone (ACTH, corticotropin) ke sebui sa mmele sa ho hlasimolla cortex ea adrenal. Corticotropin e ntlafatsa sebopeho le secretion ea li-glucocorticoids. Ka lehlakoreng le leng, tsona li ama tšoelesa ea pituitary, e sitisang tlhahiso ea corticotropin 'me ka hona e fokotsa tsoalo-pele ea litšoelesa tsa adrenal (ka molao-motheo oa karabelo e seng ntle). Tsamaiso ea nako e telele ea li-glucocorticoids (cortisone le li-analogues tsa eona) 'meleng li ka lebisa ho thibeng le atrophy ea adrenal cortex, hammoho le thibelo ea sebopeho sa li-hormone tsa pituitary tse amang li-androgen feela.

Sa feiga.Tlhotlhomiso ea li-glucocorticoids le mekhoa bakeng sa ts'ebeliso ea tsona

Sa feiga.Mekhoa ea taolo ea motsoako le secretion ea lihormone tsa adrenal cortex

Ho tloha lilemong tsa bo-50 tsa lekholo la ho qetela la lilemo, li-glucocorticoids li nkile sebaka sa bohlokoa makaleng a fapaneng a meriana mme ka holim'a tsohle, ts'ebetsong ea kalafo. Mokhoa oa mefuta ea li-glucocorticoids bakeng sa tsamaiso ea methapo le methapo e atolositse haholo menyetla ea kalafo ea glucocorticoid. Lilemong tse 15-20 tse fetileng, mehopolo ea rona mabapi le mekhoa ea ts'ebetso ea li-glucocorticoids e atolositsoe haholo, hape ho bile le liphetoho tse kholo mahlaleng a ho sebelisa li-glucocorticoids, ho kenyelletsa le litekanyetso, mekhoa ea tsamaiso, nako ea ts'ebeliso le ho kopanya le lithethefatsi tse ling.

Ts'ebeliso ea li-glucocorticoid ho tsa bongaka tsa ho ikoetlisa li qalile ka 1949, ha phello e ntle ea nakoana ea cortisone ho bakuli ba nang le ramatiki e qala ho tlaleha. Ka 1950, sehlopha se tšoanang sa lipatlisiso se tlalehiloe ka litholoana tse ntle tsa kalafo ea ramatiki, rheumatism le mafu a mang a rheumatic a nang le cortisone le adrenocorticotropic hormone (ACTH). Haufinyane, letoto la litlaleho le bonts'itse phello e ntle ea kalafo ea glucocorticoid bakeng sa systemic lupus erythematosus (SLE), dermatomyositis, le systemic vasculitis.

Kajeno, glucocorticoids, leha ho na le kotsi e kholo ea litla-morao (ho kenyeletsa le tse mpe), e ntse e le lejoe la bohlokoa kalafong ea pathogenetic ea mafu a mangata a rheumatic. Ntle le moo, li sebelisoa haholo maloetseng a mangata a hematological, glomerulonephritis ea mantlha le ea sekhahla, hammoho le maloetse a mangata a ka mpeng le a ho hema, maemo a ho kula, litšabo tsa tšimoloho e fapaneng le tse ling. Motsoako oa li-glucocorticoids bakeng sa tšebeliso ea methapo, maiketsetso le marang-rang li atolositse boholo le maqeka tsa tšebeliso ea tsona.

Adrenal corticosteroids e arotsoe ka mekhahlelo e 'meli e meholo - glucocorticoids le mineralocorticoids. Tse pele li na le phello hoo e batlang e le litho tsohle le lits'ebetso tsa 'mele, ka ho susumetsa mekhoa ea methapo e bohareng, ts'ebetso ea boits'ireletso ba mmele le ts'oaetso ea ts'oaetso. Mosebetsi o ka sehloohong oa mineralocorticoids ke ho laola metabolism ea metsi a letsoai.

Tšebeliso e pharalletseng ea li-glucocorticoids e susumetsoa ke litlamorao tsa bona tse matla tsa anti-inflammatory, immunosuppression le anti-allergic.

Kopanong ea 1 ea European Symposium mabapi le kalafo ea glucocorticoid, ho khothalletsoa ho sebelisa li-glucocorticoids kapa glucocorticosteroids. Mantsoe a mang - "li-steroid", "corticosteroids", "corticoids" a pharaletse haholo kapa a sa nepahala ka lebaka leo, ka hona ha ho khothalletsoe ho li sebelisa.

Boikoetlisong ba bongaka kajeno, ho sebelisoa li-glucocorticoids tse entsoeng ka mokhoa o khethehileng, tse nang le ts'ebetso ea bohlokoa e khahlanong le ho ruruha, immunosuppression le anti-allergic ka litlamorao tse fokolang kapa esita le zero, ka hona ke tse ling tsa lithethefatsi tse sebelisoang haholo makaleng a fapaneng a meriana.

Phapang ea glucocorticoids ka sebopeho sa lik'hemik'hale

Li-glucocorticoids tsa tlhaho (tsa tlhaho):

* cortisol * hydrocortisone * hydrocortisone acetate

Li-glucocorticoids tsa maiketsetso:

* prednisolone * prednisone * methylprednisolone

Synthetic fluorine e nang le glucocorticoids:

* dexamethasone * triamcinolone * betamethasone

Tlhophiso ea li-glucocorticoids ka nako ea ketso

Lithethefatsi tse khutšoane (lihora tse 8-12):

Mekhoa ea maikutlo ea nako e tloaelehileng ea nako (lihora tse 12 ho isa ho tse 20):

* prednisolone * methylprednisolone * triamcinolone

Lithethefatsi tse sebetsang nako e telele (lihora tse 36-72):

* parlueazone * betamethasone * dexamethasone

Depot glucocorticoids e tšoauoa ka ho pepesetsoa nako e telele (ho felisoa kamora libeke tse 'maloa).

2.Furglucocorticoid anism

Hypothalamic-pituitary-adrenal axis e etsa sistimi e rarahaneng e laolang tokollo ea li-glucocorticoids maemong a mmele le maemong a fapaneng a pathological. Tlhahiso ea cortisol ke adrenal cortex e laoloa ke ACTH, e sirelelitsoeng ke gland ea ka ntle. Ho lokolloa ha ACTH, ka lehlakoreng le leng, ho laoloa ke hormone e fokotsang corticotropin, e leng secretion ea eona e laoloang ke methapo ea methapo, endocrine le cytokine maemong a methapo ea kutlo ea "periventricular" ea hypothalamus. Hormone e ntšoa ea Corticotropin e tsamaisoa ka likarolo tse nyane ho potoloha ea tšebetso ea moea ea pituitary, ebe e fetisetsoa kantle ho eona, moo lihormone tse tsoang corticotropin li tsosang secretion ea ACTH. glucocorticoid lithethefatsi lehlakoreng

Secretion ea letsatsi le letsatsi ea cortisol bathong e ka ba 20 mg. Ho feta moo, secretion ea eona e tšoauoa ka maemo a feto-fetohang nakong ea motšehare ka maemo a phahameng haholo hoseng le manane a tlase mantsiboea. Cortisol e sirelelitsoeng ka ho fetisisa (hoo e ka bang 90%) e potoloha le li-globulin tse tsamaisang mali tsa corticoid. Cortisol ea mahala ke mofuta o sebetsang oa bioloji.

Hyperreacaction ea hypothalamic-pituitary-adrenal axis ha ho na ts'oaetso (ka mohlala, ka lefu la Cushing) e baka ho ts'oaroa ha mmele mme e eketsa kutloisiso ea tšoaetso. Ts'ebetso ea hypothalamic-pituitary-adrenal axis, e bakang keketseho ea litekanyetso tsa cortisol le ho lebisa ho immunosuppression, e ka bakoa ke lintlha tse fapaneng tsa khatello ea maikutlo, ho kenyelletsa bohloko, ho sithabela maikutlong, ho bata, ho ikoetlisa 'meleng, ts'oaetso, ho kenella ha opereishene, ho fokotsa thibelo ea lijo tsa khalori, le tse ling. Li-glucocorticoids tsa ka ntle, hammoho le karolo ea homeostatic, le tsona li fetola likarabo tse khahlanong le ho ruruha. Ho fanoa ka bopaki ba hore karabelo e senyehileng ea li-glucocorticoids tsa endo native li bapala karolo ea bohlokoa ho pathogenesis ea maloetse a 'maloa a ramatiki a amanang le tiske e sebetsanang le phetoho ea ts'oaetso. Ho mafu a rheumatic a kang rheumatoid arthritis, SLE, dermatomyositis le a mang, liphetoho tse kholo li etsahala ho hypothalamic-pituitary-adrenal axis, e khetholloang ka ho boloka sekhahla se sa lekanang sa ACTH se amanang le li-cytokine tse potolohang, secretion e tlase e tlase le e hlohlellelitsoeng ea cortisol e le karabelo ea phokotso, hammoho le ts'oaetso ea bohlokoa. androgen.

Ts'ebeliso ea li-glucocorticoids tsa maiketsetso e lebisa ho thibeng synthesis le ho lokolloa ha li-hormone tse peli tsa corticotropin tse lokollang le ACTH, ka lebaka leo, ho fokotseha ha tlhahiso ea cortisol. Pheko ea nako e telele ea glucocorticoid e baka ho ruruha ha adrenal le khatello ea "hypothalamic-pituitary-adrenal axis", e bakang ho fokotseha hoa bokhoni ba ho hlahisa li-glucocorticoids tse ling tsa karabelo ho arabela ACTH le mabaka a khatello.

Hajoale, ke moetlo ho khetholla lipakeng tse peli tsa ts'ebetso ea li-glucocorticoids - genomic le e seng genomic.

Mochine oa genomic ka ho kopanya li-receptor tse ikhethang tsa cytoplasmic o bonoa ho litekanyetso life kapa life mme o hlahella e se pejana ho metsotso e 30 kamora ho thehoa ha mochini oa li-hormone-receptor.

Moetso oa mantlha oa ketso ea genomic ea li-glucocorticoids ke taolo ea phetisetso ea liphatsa tsa lefutso tse laolang mofuta oa liprotheine le DNA. Kameho ea li-glucocorticoids ho li-glucocorticoid receptors (tseo e leng litho tsa lelapa la membrane steroid receptor) e lebisa ho nts'etsopele ea liketsahalo tse ngata tse kenyelletsang RNA ea khethehileng ea RNA, RNA ea nyutlelie, le lintho tse ling tsa papatso. Liphello tsa bohlasoa bona ke ho hlohlelletsa kapa ho sitisoa ha sengoloa sa gene. Glucocorticoids e ama mefuta e mengata ea mefuta, ho kenyelletsa le liphatsa tsa lefutso tse laolang sebopeho sa li-cytokine tse kang IL-la, IL-4, IL-6, IL-9 le gamma interferon. Maemong ana, li-glucocorticoids li ka ntlafatsa ho hatisoa ha liphatsa tsa lefutso le ho li hatella.

Glucocorticoids e boetse e laola motsoako oa protheine ea methapo. Ha li kenella habonolo le kapele ka har'a lisele tsa 'mele, li theha mofuta oa li-cellid receptor ho cytoplasm e fetelang molek'hule ea sele, e leng se hlahisang phepelo ea lisebelisoa tsa liphatsa tsa lefutso

itseng RNA lenane bakeng sa motsoako oa li-peptide tse laolang le liprotheine, haholo-holo tse amanang le tsamaiso ea li-enzyme, tseo, le tsona li laolang tšebetso ea sele.Li-enzyme tsena li ka etsa mesebetsi e susumetsang le e thibelang. Mohlala, ba ka susumetsa tlhahiso ea liprotheine tse thibelang liseleng tse ling, tse emisang ka botlalo phetiso ea liphatsa tsa lefutso liseleng tsa lymphoid, ka ho etsa joalo ka ho fetola likarabo tsa boits'ireletso le tsa ts'oaetso.

Li-Glucocorticoids li ama mesebetsi ea boits'ireletso ea cellular le e tlotlollang. Nts'etsopele ea "lymphocytopenia tlasa ts'usumetso ea bona e bakoa ke ho thibela tlhahiso le ho lokolloa ha lisele tsa lymphoid ho tloha marong, thibelo ea ho falla ha bona le ho abuoa ha li-lymphocyte ho likarolo tse ling tsa lymphoid. Li-glucocorticoids li ama tšebelisano-'moho ea tšebelisano ea lisele tsa T le B ho arabello ea mmele. Ba etsa ka mokhoa o fapaneng liphoofolong tse fapaneng tsa T-lymphocyte, ba baka ho fokotseha hoa maemo a li-T-cell tse nang le li-IgM Fc fc, mme ntle le ho fetola boemo ba li-lymphocyte tse nang le li-receptor bakeng sa sekhechana sa IgG Fc. Tlas'a tšusumetso ea glucocorticoids, bokhoni bo bongata ba lisele tsa T bo hatelloa ka bobeli ho vivo le vitro. Kameho ea li-glucocorticoid ho likarabo tsa B-cell e bonahala ka tekanyo e nyane ho feta ho lisele tsa T. Ka hona, ho bakuli ba fumanang li-glucocorticoids tse mahareng, likarabo tse tloaelehileng tsa antibody ho ente lia hlokomeloa. Ka nako e ts'oanang, tsamaiso ea nakoana ea litekanyetso tse kholo tsa li-glucocorticoids e baka ho fokotseha ha maemo a serum IgG le IgA mme ha e ame maemo a IgM. Matla a li-glucocorticoids mosebetsing oa B-cell a ka arohanngoa ka lebaka la phello ea tsona ho li-macrophages.

Ho fapana le genomic, litlamorao tse seng tsa genomic tsa glucocorticoids ke litholoana tsa ts'ebelisano e tobileng ea "physicochemical" le li-membrane tsa tlhaho le / kapa li-receptor tsa cellul-selection. Litlamorao tse seng tsa genomic tsa glucocorticoids li hlaha tlasa ts'usumetso ea litekanyetso tse phahameng mme li hlahe kamora metsotsoana e seng mekae kapa metsotso.

Matla a seng a genomic a khahlanong le ho ruruha ha glucocorticoids a amana le ho ts'oaroa ha lysosomal membranes, ho fokotseha ha sekhahla sa membrane ea lisele, ho fokotseha ha sekhahla sa methapo ea mali le mali a lehae libakeng tsa ho ruruha, ho fokotseha ha ho ruruha ha lisele tsa endothelial, phokotseho ea bokhoni ba ho rarahana ha metsoako ea methapo le ho hola hanyane hanyane ka hanyane likepe tse shebaneng le ho ruruha le ho fokotseha ha boteng ba tsona (karolo e itseng ka lebaka la

inhibition of prostaglandin synthesis), ho fokotseha ha palo ea lisele tsa monocytes le lisele tsa mononuclear tse shebaneng le ts'oaetso, hammoho le phello ho li-leukocytes tsa polymorphonuclear. Ho hlakile hore karolo e etelletseng pele khahlanong le ts'oaetso ea "glucocorticoids" ke tšitiso ea ho falla le ho bokella ha leukocytes motheong oa ts'oaetso. Tlas'a tšusumetso ea li-glucocorticoids, ts'ebetso ea bactericidal, li-Fc receptor binding le mesebetsi e meng ea monocytes le macrophages lia senyeha, mme maemo a eosinophils, monocytes le lymphocyte ho potoloha ho potoloha. Ho feta moo, likarabo tsa cellular ho li-kinins, histamine, prostaglandins, le lintlha tsa chemotactic lia fetoha, 'me ho lokolloa ha li-prostaglandins liseleng tse susumetsoang hoa fokotseha. Mochine o ithutileng hantle o seng genomic o kenyelletsa ts'ebetso ea endothelial synthase ea nitric oxide.

Tekanyo ea li-glucocorticoids e lekanya katleho ea tsona, hammoho le khafetsa le ho teba ha litlamorao. Litlamorao tsa genomic tsa glucocorticoids li hola ka tekanyetso e nyane mme li eketseha joalo ka 100 mg ea prednisolone e lekanang ka letsatsi e fihlelloa, 'me e lule e tsitsitse nakong e tlang. Haeba ha u sebelisa li-glucocorticoids ka tekanyetso ea ho fihlela ho 30 mg ea prednisolone e lekanang, phello ea kalafo e batla e lekantsoe ka botlalo ke methapo ea genomic, ebe ka nako eo litekanyetso tse fetang 30 mg tsa prednisolone tse tšoanang le litlamorao tse seng tsa genomic li ba bohlokoa, karolo ea eona e eketseha ka potlako ka tekanyo e ntseng e eketseha.

Li-glucocorticoids li hlophisitsoe hantle bakeng sa mefuta eohle ea tšebeliso ea tsona, i.e. bakeng sa molomo, intramuscular, intravenous kapa intraarticular. Kamora ho tsamaisoa ka molomo, hoo e ka bang 50-90% ea li-glucocorticoids lia ananeloa. Ho tlangoa ha glucocorticoids ho liprotheine tsa mali ke hoo e ka bang 40-90%. Motsoako oa "glucocorticoids" o etsoa haholo-holo ka har'a sebete, le excretion - haholo-holo ke liphio ka mokhoa oa metabolites. Pherekano e phahameng ea li-glucocorticoids maling ka mor'a ts'ebetso ea molomo e etsahala ka mor'a lihora tse 4-6. Ka tsamaiso e kenelletseng ea li-glucocorticoids, tlhoro ea tlhaselo ea tsona e fihlella ka potlako haholo. Kahoo, ka ts'ebetso ea 1.0 g ea Solomedrol® (methylprednisolone sodium succinate), tlhoro e phahameng ea eona ea plasma e bonoa kamora metsotso e 15. Ka tsamaiso ea methapo ea glucocorticoids, tlhoro ea bona ea plasma e etsahala haholo

hamorao. Mohlala, ka ente ea methapo ea Depo-medrol® (methylprednisolone acetate), ho kenella ka bongata maling ho fihlella kamora lihora tse ka bang 7.

3. Tšebeliso ea li-glucocorticoids

Mekhoa e hlalositsoeng ea multifaceted ea ts'ebetso ea li-glucocorticoids le lintlha tse fapaneng tsa ts'ebeliso ea tsona e bile motheo oa ts'ebeliso ea bona e pharalletseng mefuteng e mengata ea litho tsa kahare tsa kahare, hammoho le maemo a mangata a pathological. Hammoho le mafu a rheumatic le vasculitis ea systemic, moo li-glucocorticoid hangata e leng lithethefatsi tsa mantlha, kalafo ea glucocorticoid e boetse e sebelisoa ho endocrinology, gastroenterology, restuscitation, cardiology, pulmonology, nephrology, traumatology le tse ling.

Ka tlase re hlahisa maloetse le maemo a methapo ea methapo moo ho sebelisoang li-glucocorticoids:

1.Rheumatoid ramatiki - ha ho na liponahatso tse matla tsa lefu lena (systemic vasculitis, serositis, myocarditis, fibrosing alveolitis, bronchiolitis obliterans), litekanyetso tse tlase tsa glucocorticoids li sebelisoa khahlano le semelo sa kalafo e fetolang mafu. Ka nts'etsopele ea lipontšo tse ka holimo tsa extraarticular tsa ramatiki e ruruumid, e bohareng le, haeba ho hlokahala, ho sebelisoa meriana e phahameng ea glucocorticoids.

2. Ankylosing spondylitis - karolong e sebetsang, ho sebelisoa litekanyetso tse bohareng kapa tse phahameng tsa glucocorticoids.

3. Systemic lupus erythematosus - karolong e sebetsang ea lefu lena, le ha litho tsa bohlokoa le ts'ebetso li kenella ts'ebetsong ea methapo (pericarditis e matla le / kapa pleurisy ka ho bokella ho hoholo ha exudate, le / kapa myocarditis, le / kapa tšenyo ea methapo ea methapo, le / kapa pulmonary pneumonitis) , le / kapa hemorrhages ea pulmonary, le / kapa hemolytic anemia, le / kapa thrombocytopenic purpura, le / kapa mafolofolo lupus glomerulonephritis III, IV, lihlopha tsa morphological) li bonts'a tšebeliso ea litekanyetso tse bohareng kapa tse phahameng tsa glucocorticoids, 'me haeba ho hlokahala - e phahame haholo. Hum kalse mohbat ka.

4. A hlobaetsang le rheumatic fever kapa ho mpefatsa ha rheumatism - lipakeng kapa tse phahameng tekanyetso ea glucocorticoids (haholoholo le nts'etsopele ea rheumatic Carditis).

5. Rheumatic polymyalgia - glucocorticoids ke lithethefatsi tsa khetho. Mohatong o thata, ho sebelisoa litekanyetso tse phahameng kapa tse phahameng tsa glucocorticoids.

6. Polymyositis le dermatomyositis - li-glucocorticoids ke lithethefatsi tsa khetho. Mohatong o thata haholo, ho fanoa ka litekanyetso tse phahameng tsa glucocorticoids.

7. Systemic scleroderma - li-glucocorticoids li ngotsoe ka litekanyetso tse tlase le tse mahareng ka nts'etsopele ea myositis.

8. Lefu la bokuli - karolong ea methapo, le ha litho tsa bohlokoa le lits'ebetso (myocarditis, pericarditis, lefu la sethoathoa) li kenella ts'ebetsong ea pathological - litekanyetso tse bohareng kapa tse phahameng tsa glucocorticoids.

1.Giant cell arteritis - sethaleng se matla haholo, li-glucocorticoids ke tsona kalafo ea khetho ebile li laetsoe ka litekanyetso tse phahameng.

2. Lefu la Takayasu - sethaleng se matla, ho sebelisoa litekanyetso tse phahameng kapa tse phahameng tsa glucocorticoids.

3. Nodular polyarteritis le microscopic polyangiitis - sethaleng se matla, ho sebelisoa litekanyetso tse phahameng tsa glucocorticoids.

4. Lefu la Wegener - sethaleng se matla - litekanyetso tse phahameng tsa glucocorticoids.

5. Charge-Strauss Syndrome - kalafo e matla ea sethaleng - litekanyetso tse phahameng tsa glucocorticoids.

6. Behcet's syndrome - mohato o hlobaetsang, ho lekantsoe litekanyetso tse bohareng kapa tse phahameng tsa glucocorticoids.

7. Cutaneous leukocytoclastic vasculitis - maemong a matla, ho sebelisoa litekanyetso tse phahameng tsa glucocorticoids.

8. Hemorrhagic vasculitis (Shenlein-Genoch purpura) - li-glucocorticoids li laetsoe ka tekanyetso e mahareng kapa e phahameng ka nts'etsopele ea glomerulonephritis ka nephrotic syndrome le / kapa ho thehoa ha 50-60% ea glomeruli le ho feta halofo ea khoeli. Ho latela litsebi tse ngata tsa rheumatologists, litekanyetso tse tloaelehileng tsa glucocorticoids li ka sebelisoa bakeng sa lefu la ka mpeng.

1.Glomerulonephritis e nang le liphetoho tse fokolang (idiopathic nephrotic syndrome) - methating e qalang ea lefu lena kapa ka ho phahama hoa lona, ​​glucocorticoids e behiloeng ka tekanyo e tlase kapa e phahameng ke kalafo ea khetho.

2. Focal-segmental glomerulosranceosis-hyalinosis - methating ea pele ea lefu lena kapa ka ho fetelletsa, ho sebelisoa litekanyetso tse bohareng kapa tse phahameng tsa glucocorticoids.

3. Mesangioproliferative glomerulonephritis e lipakeng kapa e phahameng litekanyetso tsa glucocorticoids li sebelisoa ho nts'etsopele ea nephrotic syndrome le / kapa halofo ea khoeli ho glomeruli ea 50-60%.

4. Mesangiocapillary glomerulonephritis - litekanyetso tse phahameng tsa glucocorticoids li sebelisoa bakeng sa nts'etsopele ea nephrotic syndrome le / kapa halofo ea khoeli ho glomeruli ea 50-60%.

5. Membranous glomerulonephritis - boteng ba nephrotic syndrome, ho sebelisoa litekanyetso tse bohareng kapa tse phahameng tsa glucocorticoids.

6. Glomerulonephritis e tsoelang pele ka potlako (li-subacute, lunate) - ho sebelisoa litekanyetso tse phahameng tsa glucocorticoids.

Second glomerulonephritis (i.e., glomerulonephritis e qalileng ka SLE, rheumatoid arthritis, polymyositis, dermatomyositis, vasculitis) sebelisa litekanyetso tse bohareng kapa tse phahameng tsa glucocorticoids.

1.Khaello ea ACTH mefuteng e fapaneng ea gland ea pituitary - hydrocortisone kapa ka tsela e 'ngoe litekanyetso tse tlase tsa glucocorticoids li sebelisoa e le pheko ea kalafo.

2. Amiodarone-induction thyrotooticosis - ho sebelisoa litekanyetso tse phahameng tsa glucocorticoids.

3. Ho haella ha adrenal - hydrocortisone kapa ka tekanyetso e tlase kapa e bohareng ea glucocorticoids e sebelisoa e le pheko ea phetoho.

1.Lefu la Crohn - sethaleng se matla, ho sebelisoa litekanyetso tse phahameng tsa glucocorticoids.

2. Nonspecific ulcerative colitis - sethaleng se matla, ho sebelisoa litekanyetso tse bohareng kapa tse phahameng tsa glucocorticoids.

3. Autoimmune hepatitis - ho sebelisoa litekanyetso tse bohareng kapa tse phahameng tsa glucocorticoids.

4. Mehato ea pele ea cirrhosis - sebelisa lethal dose e tloaelehileng ea li-glucocorticoids.

5. Hepatitis e matla ea joala - ho sebelisoa litekanyetso tse bohareng kapa tse phahameng tsa glucocorticoids.

1.Post-viral le nonspecific lymphocytic myocarditis - tekanyetso e bohareng kapa e phahameng ea li-glucocorticoids e laetsoe.

2. Phekolo e sa sebetseng hantle ea 'mele e sa hloekang - e sebelisoa ka bongata - litekanyetso tse mahareng kapa tse phahameng tsa glucocorticoids.

1.Bronchial asthma - li-glucocorticoids tsa molomo (lipilisi tse mahareng kapa tse phahameng) li laeloa ho ba le asthma e matla haholo, ho mpefala ho matla ha asthma, moo glucocorticoids le bronchodilators tse sa sebetseng li sa sebetseng.

2. Cryptogenic fibrosing alveolitis - ho sebelisoa litekanyetso tse phahameng tsa glucocorticoids.

3. Ho sitisa bronchiolitis - ho sebelisoa litekanyetso tse phahameng tsa glucocorticoids.

4. Sarcoidosis ea matšoafo - litekanyetso tse bohareng kapa tse phahameng tsa glucocorticoids lia sebelisoa.

5. Pneumonia ea Eosinophilic - tekanyetso e bohareng kapa e phahameng ea glucocorticoids e laetsoe.

1.Hemoblastoses - ho sebelisoa litekanyetso tse phahameng le tse phahameng haholo tsa li-glucocorticoids.

2. Anemia (hemolytic, autoimmune, aplastic) - ho sebelisoa litekanyetso tse mahareng le tse phahameng tsa glucocorticoids.

3. Thrombocytopenia - tekanyetso e mahareng le e phahameng ea li-glucocorticoids e laetsoe.

1. Tšabo ea tšimoloho e fapaneng - sebelisa litekanyetso tse phahameng le tse phahameng haholo tsa glucocorticoids. Pulse kalafo ea khethoa.

2. Karabelo ea mafu a ho kula - ho behiloe tekanyetso e phahameng le e phahameng haholo ea li-glucocorticoids, haeba ho hlokahala, "kalafo ea pulse".

3. Ho na le lefu le phahameng la khatello ea maikutlo le phahameng haholo - ho sebelisoa litekanyetso tse phahameng haholo tsa glucocorticoids.

1.Ho latela boemo ba tleliniki, ho sebelisoa li-glucocorticoids ho tloha ho tse tlase ho isa ho tse phahameng haholo, 'me, ha ho hlokahala, "kalafo ea pulse".

4.Motheo holitlamorao tsa glucocorticoids

Ka litlhahlobo tse khutšoane tsa kalafo ka li-glucocorticoids, litlamorao tse mpe hangata ha li etsahale. Bakuli ba bang ba tlaleha ho eketseha ha takatso ea lijo, boima ba 'mele, ho teneha ha kelello le mathata a ho robala.

Ka tsamaiso ea nako e telele ea corticosteroids, eo ho thoeng ke Itsenko-Cushing's syndrome e ba le botenya bo matla, "sefahleho se bopehileng joaloka khoeli", kholo ea moriri o feteletseng 'meleng le khatello e matla ea mali. Ka ho fokotseha ha tekanyo ea lihormone, liketsahalo tsena lia fetoha. Tšusumetso e kotsi ka ho fetisisa ea li-glucocorticoids ho mucous membrane ea gastrointestinal: li ka baka liso tsa duodenum le mpeng. Ka hona, boteng ba mokuli ea nang le ulcer peptic ke e 'ngoe ea li-contraindication tsa mantlha ts'ebeliso ea corticoids. Ha mokuli a ntse a nka li-hormone tsa steroid, haeba ho na le litletlebo tsa boima kapa bohloko bo ka mpeng, ho chesa hoa pelo, ho bohlokoa ho fana ka litlhare tse fokotsang acidity ea lero la gastric. Phekolo ka glucocorticoids efe kapa efe e tsamaisana le tahlehelo ea potasiamo, kahoo ho nka prednisone ho lokela ho kopantsoe le ho nka litokisetso tsa potasiamo (panangin, asparkum). Corticosteroids e baka ho bolokoa ha sodium le mokelikeli 'meleng, kahoo ha edema e hlaha, ho ka sebelisoa li-diuretics tse nang le potasiamo e le' ngoe feela (mohlala, triampur, trireside K). Ka tsamaiso ea nako e telele ea li-corticosteroids ho bana, ho sitisoa ha kholo le ho kena lilemong tsa bocha ho ka etsahala.

Li-glucocorticoids tsohle li na le litla-morao tse tšoanang, tse itšetlehileng ka tekanyetso le nako ea kalafo.

1. Khatello ea ts'ebetso ea adrenal cortex. Glucocorticoids e hatella tšebetso ea sistimi ea cortex ea hypothalamus-pituitary-adrenal. Matla ana a ka nka likhoeli tse ngata kamora ho khaotsa kalafo mme ho latela tekanyetso e sebelisitsoeng, khafetsa ea tsamaiso le nako ea kalafo. Tšusumetso ho adrenal cortex e ka fokotsoa haeba, ho e-na le lithethefatsi tse nkang nako e telele (dex-metazone), lithethefatsi tse nkang nakoana joalo ka prednisone kapa methylprednisolone ho litekanyetso tse nyane li sebelisoa. Ho bohlokoa ho nka tekanyetso eohle ea letsatsi le letsatsi hoseng haholo, e lumellanang haholo le morethetho oa 'mele oa secretion ea endo native cortisol. Ha ho nkuoa ka letsatsi le leng le le leng, ho sebelisoa li-glucocorticoids tse khutšoane 'me ho boetse ho fanoa ka lethal e le' ngoe hoseng. Tlas'a tšusumetso ea khatello ea maikutlo (ts'ebetso ea ka mpeng, mafu a hlobaetsang le mafu a mang, joalo-joalo), ho nahana ka bothata ba adrenal cortex hangata ho etsahala, ho bonahatsoa ke ho hloka takatso ea lijo, ho theola boima ba 'mele, ho otsela, feberu le hypotension. Ts'ebetso ea mineralocorticoid ea adrenal cortex e bolokiloe, ka hona, hyperkalemia le hyponatremia, e leng tšobotsi ea ho hloka tlhokomelo ea mantlha ea adrenal cortical, hangata ha e eo. Bakuli ba lokela ho roala borashe bo khethehileng kapa ba be le karete ea bongaka ho bona hore maemong a tšohanyetso ngaka e tseba ka tlhoko ea taolo ea li-glucocorticoids kapele. Ho bakuli ba nkang libeke tse 'maloa ho feta 10 mg ea prednisone ka letsatsi (kapa tekanyetso e lekanang ea moriana o mong), tekanyo e le' ngoe kapa e 'ngoe ea khatello ea adrenal cortex e ka phehella ho fihlela selemo se le seng kamora ho khaotsa kalafo.

2. Khatello ea ho itšireletsa mafung.Glucocorticoids e fokotsa ho hanela tšoaetso, haholo-holo ea baktheria, menyetla ea tšoaetso e ipapisitse le lethal dose la li-glucocorticoids 'me e lula e le sesosa se ka sehloohong sa mathata le lefu la bakuli ba nang le SLE. Ka lebaka la kalafo ea steroid, ts'oaetso ea lehae e ka fetoha ts'ebetso, ts'oaetso ea morao e ka fetoha mafolofolo, mme likokoana-hloko tse seng tsa pathogenic le tsona li ka e baka. Khahlano le semelo sa kalafo ea glucocorticoid, ts'oaetso e ka hlaha hantle, empa mocheso oa 'mele hangata oa phahama. E le mokhoa oa thibelo, ho khothaletsoa ente e nang le ntaramane le ente ea pneumococcal, e sa hlokeng ho ata ha SLE. Pele o qala kalafo ka glucocorticoids, ho eletsoa ho etsa tlhahlobo ea lefuba ea letlalo.

3. Phetoho ponahalong e kenyelletsa: ho potoloha sefahleho, ho nona ka boima ba 'mele, ho arolelana mafura a' mele, hirsutism, makhopho, lesapo le pherese, ho robeha likotsi tse mpe. Liphetoho tsena lia fokotseha kapa li nyamela kamora ho fokotsa tekanyo.

4. Mathata a kelello a tloha ho se tsitsinyehe ho matla, ho hloka thabo le boroko ho isa ho khatello e matla ea maikutlo kapa psychosis (e ka nkuoang ka phoso e nkuoa e le lupus lesion ea system ea methapo e bohareng).

5. Hyperglycemia e ka hlaha kapa ea eketseha nakong ea kalafo ka li-glucocorticoids, empa, joalo ka molao, ha e sebetse e le tlolo ea molao bakeng sa nako ea bona. Ts'ebeliso ea insulin e ka hlokahala, ketoacidosis ha e hlahe hangata.

6. Ho tlosoa hoa tekanyo ea electrolyte ea metsi ho kenyelletsa ho boloka sodium le hypokalemia. Mathata a ikhethang kalafo a hlaha ka ho nyekeloa ke pelo le edema.

7. Glucocorticoids e ka baka kapa ea eketsa khatello ea mali ea methapo. Mofuta oa kalafo ea "I / O" o nang le li-steroid hangata o mpefatsa khatello ea methapo ea kutlo haeba ho le thata ho e phekola.

8. Osteopenia e nang le khatello ea maikutlo ea 'mele ea vertebral hangata e hlaha ka nako e telele ea glucocorticoid kalafo. Ka hona, bakuli ba lokela ho amohela li-ion tsa calcium (1-1,5 g / letsatsi ka molomo). Vitamin D le thiazide diuretics di ka nna tsa thusa. Ho basali ba postmenopausal, kotsing e eketsehileng ea osteopenia, li-estrogen hangata li bontšoa, empa liphetho tsa ts'ebeliso ea bona ho SLE lia hanyetsana. Kalcitonites le diphosphonates le tsona li ka sebelisoa. Ho khothaletsoa boikoetliso bo matlafatsang ba 'mele.

9. Steroid myopathy e tšoauoa ka ho senyeha ha mesifa haholo-holo ka mahetla le senyepa sa pelvic. Ho fokola hoa mesifa hoa tsebahala, empa ha ho na bohloko, ts'ebetso ea li-enzyme tsa mali tsa tšimoloho ea mesifa le li-paramente tsa electromyographic, ho fapana le tšenyo ea mesifa e sa foleng, ha e fetohe. Biopsy ea mesifa e etsoa feela maemong a sa tloaelehang ha ho hlokahala ho khetholla ho ruruha ha bona. Monyetla oa hore steroid myopathy e fokotseha ha tekanyo ea li-glucocorticoids e fokotseha mme mohato o boima oa boikoetliso bo matla ba mmele o etsoa, ​​leha ho le joalo, ho hlaphoheloa ka botlalo ho ka nka likhoeli tse 'maloa.

10. Mathata a amanang le phofo a kenyeletsa khatello e eketsehileng ea methapo (eo ka linako tse ling e bang ka lebaka la ho eketseha ha glaucoma) le lefu la mokokotlo oa ka morao ho moo.

11. Ischemic bone necrosis (aseptic, avascular necrosis, osteonecrosis) e ka hlaha le nakong ea phekolo ea steroid. Liphetoho tsena li atisa ho ba ngata, li senya hlooho ea basali le humerus, hammoho le sehlaba sa tibia. Litla-morao tsa pele li fumanoa ka isotopic scintigraphy le MRI. Ponahalo ea liphetoho tse nang le tšibollo ea radiology li bonts'a ts'ebetso e kholo. Ts'oaetso ea masapo e buoang e ka sebetsa maemong a pele a ischemic necrosis, empa likhakanyo tsa mokhoa ona oa kalafo lia hanyetsana.

12. Litla-morao tse ling tsa glucocorticoids li kenyelletsa hyperlipidemia, ho se sebetse ka linako tsa ho ea khoeling, ho fufuleloa ho eketsehileng, haholo-holo bosiu, le benign intracranial hypertension (pseudotumor cerebri). Ketso ea li-glucocorticoid ka linako tse ling e amahanngoa le ponahalo ea thrombophlebitis, necrotizing arteritis, pancreatitis le peptic ulcer, empa bopaki ba khokahano ena ha bo lekane.

5.Tlhokomeliso ea ho otlaglucocorticoids

1. Morero o hlakileng oa tšebeliso ea li-glucocorticoids.

2. Khetho e nang le mabaka ea moriana oa glucocorticoid, o khetholloang ka katleho e phahameng le pono e fokolang ea litlamorao. Methylprednisolone (Medrol, Solu-medrol le Depo-medrol) e fihlella litlhokahalo tsena, mabaka a fanoeng kaholimo.

3. Khetho ea tekanyetso ea pele ea moriana oa glucocorticoid o fanang ka phello e hlokahalang ea kliniki maemong a eona a fokolang e lokela ho thehiloe tekong e tebileng ea mokuli, ho kenyelletsa le nosology ea lefu lena, ts'ebetso ea lona, ​​ho ba teng ha tšenyo ea litho tsa bohlokoa le lits'ebetso, hammoho le litlhahiso tse amoheloang ka kakaretso litekong tsa phekolo ea glucocorticoid bakeng sa tleliniki e fapaneng. maemo. Kajeno, kalafo ea glucocorticoid e tsejoa ka mokhoa o sa tsotelleng e le kalafo ea khetho bakeng sa maloetse a mangata a rheumatic, ho kenyelletsa SLE, dermatomyositis le polymyositis, vasculitis, glomerulonephritis le tse ling. Ka nako e ts'oanang, litekanyetso tsa pele li fapana haholo ho latela litšobotsi tsa setšoantšo sa kliniki le maemo a laboratori. Kahoo, mohlala, ka ts'ebetso e phahameng ea SLE, dermatomyositis, polymyositis, systemic vasculitis le / kapa ho kenella ha litho tsa bohlokoa le lits'ebetso tsa mafu ana, ts'ebeliso ea litekanyetso tse phahameng kapa tse phahameng haholo tsa glucocorticoids e bontšoa. Ka nako e ts'oanang, ka ts'ebetso e tlase ea SLE, vasculitis, phello e ntle ea kliniki e ka fumaneha ka litekanyetso tse tlase tsa glucocorticoids, mme ha ho na ts'enyeho ea litho tsa ka hare le tsamaiso ea methapo e kholo, ha ho hlokahale ho fana ka kalafo ea glucocorticoid ho fihlella tšoarelo ea bongaka, hobane ts'ebeliso e lekaneng ea kliniki e ka fihlelleha ho sebelisoa NSAIDs , hangata e kopantsoe le litokisetso tsa aminoquinoline. Ka nako e ts'oanang, bakuli ba bangata ba hloka ts'ebeliso e eketsehileng ea litekanyetso tse tlase tsa glucocorticoids (Medrol 4-6 mg ka letsatsi kapa prednisolone 5-7,5 mg ka letsatsi).

Tšebeliso e pharalletseng ea lithethefatsi tse fetolang mafu tse seng li ntse li le methating ea pele ea ramatiki, ho haella ha datha mabapi le litlamorao tse ntle tsa tekanyetso e phahameng le e phahameng ea li-glucocorticoids ho tsoelopele ea nako e telele ho bakuli ba nang le ramatiki ea ramatiki, le kotsi e kholo ea litlamorao tse mpe ha u li sebelisa, li fetotse haholo mekhoa ea ts'ebeliso ea glucocorticoids. Kajeno ka ho ba sieo

Matšoao a tebileng a hlakileng a ramatiki ea ramatiki (mohlala, vasculitis, pneumonitis) ha a khothalletsoe tšebeliso ea li-glucocorticoids ho litekanyetso tse fetang 7.5 mg ka letsatsi la prednisone kapa 6 mg ea methylprednisolone. Ho feta moo, ho bakuli ba bangata ba nang le ramatiki ea rheumatoid, ho eketsoa ha 2-4 mg ka letsatsi la Medrol ho kalafo e fetolang lefu ho bontšoa ke phello e ntle ea kliniki.

1. Theha mokhoa oa ho nka li-glucocorticoids: likhetho tse tsoelang pele (tsa letsatsi le letsatsi) kapa tsa nakoana (mefuta e meng).

2. Ho mafu a rheumatic a mangata, vasculitis, glomerulonephritis, li-glucocorticoids hangata ha li na ho lekana ho fihlella kapa ho lekana karolo ea tlhabollo ea bongaka le ea laboratori, e hlokang ho kopana ha bona le lithethefatsi tse fapaneng tsa cytotoxic (azathioprine, cyclophosphamide, methotrexate le tse ling). Ntle le moo, tšebeliso ea cytostatics e ka fokotsa haholo litekanyetso tsa glucocorticoids (kapa ea li hlakola) ha e ntse e boloka ts'ebetso e fumanoeng ea kliniki, e fokotsang khafetsa maqhubu le ho teba ha litlamorao tsa kalafo ea glucocorticoid.

3. Lingaka tse ngata li khothaletsa hore litekanyetso tsa nako e telele haholo tsa glucocorticoids (2-4 mg / letsatsi la Medrol® kapa 2,5-5.0 mg / letsatsi la prednisolone) li tsoelepele ho bakuli ba bangata ba nang le mafu a rheumatic kamora ho fihlela tlamo ea bongaka le ea laboratori.

Lelenane la lingoliloeng tse sebelisitsoeng

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