Litokisetso tsa Glucocorticoid: matšoao le li-contraindication bakeng sa tšebeliso, litheko tse ngata le litla-morao tse ka bang teng

Keketseho ea methapo ea kutlo.

Ho tsoa ho tsamaiso ea pelo le pelo:

Thrinosis e tebileng ea methapo.

Ho tsoa ts'ebetsong ea tšilo ea lijo:

Li-ulcers tsa Steroid tsa mala le mala.

Ho tsoa mali ho tsoa ho tšilo ea lijo.

Ho bola ha mafura a sebete.

Ho tsoa linthong tsa kutlo:

Posterior subcapsular cataract.

Ho tsoa tsamaisong ea endocrine:

Thibelo ea ts'ebetso le atrophy ea adrenal cortex.

Ka lehlakoreng la letlalo:

Ho tsoa ts'ebetsong ea musculoskeletal:

Li-Fractures le aseptic necrosis ea masapo.

Keketseho ea morao ea bana.

Ho tsoa molemong oa ho hlahisa bana:

Ho khaotsa ho ilela khoeli.

Ho tlola mesebetsi ea thobalano.

Ho lieha ho holisa thobalano.

Ho tsoa matšoao a laboratori:

Tlhokomelo ea sodium le metsi.

Exacerbations ea mekhoa e sa foleng ea tšoaetso le ea ho ruruha.

LITLHOKO LITLHAKISO.

Lisosa tsa mokokotlo oa molomo le pharynx.

Ho omella le ho chesoa ha mucosa ea nasal le pharynx.

Ponahalo ea septum ea nasal.

Phepelo ea hypothalamic-pituitary-adrenal axis (HPA)

Ho hatella HPA ke e 'ngoe ea litlamorao tse kotsi ka ho fetisisa tsa tšebeliso ea steroid. Bokhoni ba ho arabela khatello ea lefatše ea 'mele (ka mohlala, nakong ea ts'ebetso ea khatello ea maikutlo kapa khatello ea maikutlo) e ka fokotsoa, ​​e beha mokuli kotsing ea khatello ea maikutlo le hypoglycemia. Matšoao a kenyelletsa ho senyeha hoa boitšoaro, ho nyekeloa ke pelo, hypotension ea postural le hypoglycemia. Kotsi ea ho ba teng e ipapisitse le litekanyetso, nako le kalafo ea kalafo, leha lintlha tse ling li ka etsahala. Ho na le phapang e kholo ea motho ka mong litlamorao tsa steroid kalafo. Bakuli ba bang ba ne ba hatelloa ke HPA ha ba sebelisa limiligrama tse 15 tsa prednisone e nkuoa letsatsi le leng le le leng ka libeke tse 'maloa, ha ba bang ba ne ba sa bonts'e matšoao a khatello ea HPA leha ba ne ba sebelisa tekanyetso e phahameng ea letsatsi le letsatsi ka nako e telele. Ka hona, ho thata ho bolela esale pele kotsi ea khatello ea HPA ho mokuli ea itseng e thehiloeng feela ho litekanyetso le nako ea kalafo. Moralo oa dae o ama tekanyo ea khatello ea HPA. Litekanyetso tsa mmele tsa "glucocorticosteroids" (li-milligrams tse likete tse 5,5) tse nkuoeng hoseng ha li bake khatello ea HPA, empa haeba litekanyetso tse tšoanang li fanoa bosiu, ts'ireletso e tloaelehileng ea letsatsi le letsatsi ea cortisol e hatelloa. Litlhako tse kaholimo ho mmele li qala ho ba le phello e thibelang kamora khoeli e ka bang. Ka kalafo ka matsatsi a mang le a mang (tekanyetso ea matsatsi a mabeli e nooa ka 8 a.m. ka letsatsi le leng le le leng), ha ho na khatello e matla ea HPA ea bongaka. Hape, li-cyclic tsa matsatsi a 5 tsa kalafo ea matsatsi a 5 tse tsoang ho libeke tse 4 ha li lebise ho khatello. Leha ho le joalo, mokelikeli oa phekolo ea libeke tse peli le ho khaoloa ha libeke tse peli ho lebisa ho khatello ea HPA. Tekanyetso ea letsatsi le letsatsi ea meriana ea "glucocorticosteroids" e nkuoeng hoseng e hlahisa khatello e tlase ea HPA ho feta tekanyo e tšoanang e arotsoeng ebe e nkuoa motšehare.

Ho hlaphoheloa ha HPA ho ka etsahala nakong ea likhoeli tse 12. Ts'ebetso ea hypothalamic-pituitary e khutlela pele likhoeling tse 2-5 kamora ho khaotsa ho phekoloa, mme e bonahatsoa ke ponahalo ea plasma ea maemo a tloaelehileng a adrenocorticotropic hormone (ACTH). Matšoao a ho hlaphoheloa ha adrenal a tla qala ho hlaha kamora likhoeli tse 6-9, maemo a tloaelehileng a cortisol a khutla. Karabelo e phahameng ea adrenal ho ACTH e ke ke ea hlaha pejana ho likhoeli tse 9-12 kamora ho khaotsa kalafo. Ha ho na mokhoa o netefalitsoeng oa ho potlakisa ho hlaphoheloa hoa ts'ebetso e tloaelehileng ea HPA.

Keketseho ea maemo a ACTH ha e bonahale e potlakisa ho hlaphoheloa ha adrenal. Ho thata haholo ho lekola hore na ho ba sieo ha bohlokoa karabong ea karabo ea adrenal ho tla nka nako e telele hakae. Ka lebaka la litšobotsi tsa bohlokoa tsa bakuli, ho ne ho sa khonehe ho theha lengolo le tšepahalang pakeng tsa tekanyo ea khatello ea HPA le khatello ea cortisol maling. Ho sebetsana le sena se sa tsitsang, tlhahlobo ea axis ea HPA e fetoha moetsi oa liqeto tsa bohlokoa. Ho liteko tse fapaneng (insulin-induction hypoglycemia, joalo-joalo), tlhahlobo e sebelisoang haholo ke ACTH, ka hona, litlamorao tsa eona li lumellana hantle le litekanyetso tsa cortisol tse lekantsoeng nakong ea khatello ea maikutlo ka mor'a ho buuoa. Khokahano ea cortisol e reriloe, 'me ho ntšoa e' ngoe ea ampoule (250 mug) ea synthet ACTH (cosintropin). Cortisol mahloriso e lekanyetsoa ka har'a disampole tsa mali tse nkuoeng kamora metsotso e 30 le 60. Leha taba ea hore tlhahlobo ena e fana ka liperesente tse itseng tsa sephetho se hlahisang 'nete, batho ba bangata ba nahana hore e bonolo ebile e bolokehile ha e bapisoa le insulin-indied hypoglycemia - tlhahlobo e nkuoang e le `` standard standard ea khauta' 'bakeng sa tlhahlobo ea HPA.

Ho 'nile ha fanoa ka maikutlo a hore tlhahlobo e sebelisang li-corticotropin-releasing hormone (CRH) e kopanya maikutlo a tlhahlobo ea insulin e kentsoeng insulin le bonolo ba tlhahlobo ea ACTH. Le ha ho le bohlokoa ho fumana khatello ea HPA ka nako, ha se eona feela ntho e khethollang bokhoni ba bakuli ba fumanang kalafo ea corticosteroid ho arabela ka nepo khatello ea maikutlo. Bakuli ba bang ba na le karabelo e matlafatsang le ha ho se na khatello ea kelello ea HPA, mme bakuli ba nang le HPA e hatelletsoeng ba kanna ba se na matšoao a ho kula a adrenal.

Ho bakuli ba nang le hypothyroidism, cirrhosis, hypoalbuminemia, hammoho le ho bakuli ba tsofetseng, phello ea glucocorticosteroids e ka ntlafatsoa.

Ha ho fanoa ka li-glucocorticosteroids nakong ea kemaro, phello ea kalafo e lebelletsoeng ho mme le kotsi ea litlamorao tse mpe ho lesea e lokela ho tsotelloa, hobane tšebeliso ea lithethefatsi tsena e ka lebisa ho holngeng ha "fetus" boimana).

Ho bana le ho batho ba baholo ba nkang glucocorticosteroids, mafu a tšoaetsanoang a kang maselese le likhoho a ka ba thata.

Bakuli ba nkang litekanyetso tsa "immunosuppress" tsa glucocorticosteroids ba tšoaetsanoa ka har'a ts'ebetso ea liente tsa 'mele.

Osteoporosis e hlaha ho 30-50% ea bakuli ba nkang li-glucocorticosteroids tsa system ka nako e telele (lifomete tsa litekanyetso tsa molomo kapa tse ente). E le molao, lesapo la mokokotlo, masapo a pelvic, likhopo, matsoho, maoto lia ameha.

Litlhoko tsa li -teroid nakong ea kalafo ka li-glucocorticosteroids e kanna ea ba li-asymptomatic kapa asymptomatic, li bonts'a ho tsoa madi le ho tlatsa. Ka hona, bakuli ba fumanang li-glucocorticosteroids tsa nako e telele ba lokela ho feta tlasa tlhahlobo ea mali ea fibroesophagogastroduodenoscopy le fecal occult.

Ho mafu a fapa-fapaneng a ruruhileng kapa a autoimmune (rheumatoid arthritis, systemic lupus erythematosus, le lefu la bowel), linyeoe tsa ho hanyetsa kaididone li ka hlaha.

Ka tšebeliso e tšoanang ea li-glucocorticosteroids le lithethefatsi tse ling, ho ka lemohuoa litlamorao tse latelang:

Ka li-antacids - ho fokotseha ho kenngoa ha glucocorticosteroids.

Ka barbiturates, hexamidine, diphenin, carbamazepine, diphenhydramine le rifampicin - e potlakisitse biotransformation ea glucocorticosteroids ka har'a sebete.

Le isoniazid le erythromycin, ho fokotseha butle-butle ho biotransformation ea li-glucocorticosteroids ka har'a sebete.

Ka li-salicylates, butadione, barbiturates, digitoxin, penicillin le chloramphenicol - ho felisoa hoa lithethefatsi tsena.

Le isoniazid - mathata a kelello.

Ka pherekano, linaha tse sithabetsang.

Ka li-antidepressants tsa li-tricyclic - khatello e eketsehileng ea intraocular.

Ka li-agonists tsa adrenergic - ketso e eketsehileng ea lithethefatsi tsena.

Le theophylline - nts'etsopele ea litlamorao tsa pelo le ho eketseha hoa matla a khahlano le ho fokola ha glucocorticosteroids.

Ka diuretics, amphotericin, mineralocorticoids - kotsi e eketsehileng ea hypokalemia.

Ka li-anticoagulants tse sa tobang, fibrinolytics, butadione, ibuprofen le ethaconic acid - mathata a hemorrhagic.

Ka indomethacin le salicylates - lcerative ulcerative ea tšilo ea lijo.

Ka paracetamol - ho ata ha sethethefatsi sena.

Ka azathioprine, kotsi e eketsehileng ea myopathies, likatse.

Ka mercaptopurine, keketseho ea ho kenella ka har'a uric acid maling e ka etsahala.

Ka hingamine - hoa khoneha ho eketsa litlamorao tse sa rateheng tsa moriana ona (dermatitis, myopathy, corneal opacity).

Ka methandrostenolone - litla-morao tsa kalafo le tse sa rateheng tsa glucocorticosteroids.

Ka Androgens le litokisetso tsa tšepe - erythropoiesis e atileng ka lebaka la keketseho ea erythropoietin.

Ka lithethefatsi tse theolelang tsoekere - ho fokotseha hoa katleho ea lithethefatsi tsena.

Li-glucocorticosteroids tse telele le li-β 2 -adrenomimetics li na le phello e tlatselletsang le synergism. Theophylline e ka ntlafatsa ts'ebetso ea ho loants'oa ha mafu ea glucocorticosteroids e inhaled.

Ha u sebelisa li-glucocorticosteroids, ho hlokahala hore u fumane phaello e phahameng ea phekolo ka litlamorao tse fokolang. Maemong a mangata, li-steroid ha li phekole lefu lena, ho fapana le moo, li hatella kapa li fetola karabelo ea ho fokola le ea boits'ireletso ba mmele mme li fokotsa matšoao a lefu lena. Ka hona, melemo ea kalafo e lebelletsoeng le likotsi tse ka bang teng li hloka ho lekanngoa ka hloko. Kotsi e ke keng ea qojoa mabapi le phekolo e khutšoane ea matsatsi a 7- 14, esita le ts'ebeliso ea litekanyetso tse phahameng, tse ka sebetsang hantle maemong a mang (mohlala, ka asthma e mpe). Takatso e eketsehileng ea lijo le thabo e matla ke litlamorao tse kholo tse nang le lithuto tse khutšoane. Ha ho na litlamorao tsa nako e telele. Qeto ea ho qala lithuto tse telele tsa steroid e hloka ho nahanela likotsi tse hlalositsoeng ka holimo.

Corticosteroids e fapana haholo-holo ka nako le nako ea ketso. Basebeletsi ba potlakileng ba sebetsang ha ba na monyetla oa ho hatella mokokotlo oa HPA, haholo ha tekanyetso ea hoseng ea tekanyetso e tlase e le karolo ea mofuta o mong le o mong oa letsatsi. Litho tse sebetsang butle li rata maemo moo litekanyetso tse kholo li lokelang ho sebelisoa. Ts'ebetso ea Mineralocorticoid ea lithethefatsi e lakatseha ho lekana ha adrenal, empa eseng bakeng sa lits'ebetso tsa bohlokoa tsa ho ruruha kapa ho ts'oaroa ke matla. Ho sa tsotelehe moriana o khethiloeng, ho hlokahala hore o tsoele pele ka kalafo e seng ea steroid, haeba sena se lumella tšebeliso ea litekanyetso tse fokolang tsa corticosteroids.

Prednisone e sebelisoa haholo hara glucocorticosteroids. Bophelo ba eona bo bokhutšoanyane le theko e tlase e etsa hore sethethefatsi sena e be sa bohlokoa ka ho fetisisa ts'ebetsong ea immunosuppression le anti-inflammatory. Prednisone ke metabolite e sebetsang ea sebete sa "prednisone" mme e sebelisoa maemong a mathata a sebete. Dexamethasone e batla e le makhetlo a supileng ho feta prednisone mme e na le bophelo ba halofo ea lihora tse 24. Sena se etsa hore e be bohlokoa bakeng sa ho leka axis ea HPA. Hydrocortisone (cortisone), setlhare se ka bang matla a makhetlo a mane ho feta a prednisone. E sebelisoa haholo litekanyetso tsa meriana ea kalafo bakeng sa bakuli ba hatelloang ke HPA. Florinef (9-alpha-fluorohydroxycortisone) ke mineralocorticoid e matla (hoo e batlang e se na phello ea glucocorticoid), 'me e sebelisoa haholo-holo bakeng sa kalafo ea ho khutlisa bakeng sa ho hloka tsebo ea adrenal cortical.

Ka mohopolo, ts'ebeliso ea ACTH e ka bonahala e khahla hobane e ka qoba khatello ea HPA, empa ACTH e boetse e tsosa karabo e sa rateheng ea mineralocorticoid le androgen. Ntle le moo, ha ho tsejoe hore na karabelo ea glucocorticoid e tla fumanoa ho tsoa ho eng e laetsoeng. Litšitiso tsena li fokotsa ts'ebeliso ea ACTH.

Khetho ea morero: letsatsi le letsatsi kapa ka letsatsi le leng le le leng

Phekolo ea mafu a mangata a hlokang phekolo ea corticosteroid (asthma, sarcoidosis le ba bang), morero o mong le o mong o sebelisoa ka katleho, le hoja hangata qalong ea kalafo e lokela ho ba letsatsi le letsatsi. Melemo ea bohlokoa ea regimen letsatsi le leng le le leng ke thibelo ea khatello ea bohlokoa ea axis ea HPA le ho fokotsa kotsi ea Cushingoid ntle le tahlehelo e kholo ea ts'ebetso e khahlanong le ts'oaetso. Kotsi ea litlamorao tse ngata tse hlalositsoeng kaholimo ea fokotsoa kapa ho felisoa ka botlalo ka ho sebelisa sesebelisoa letsatsi le leng le le leng.

Mokhoa oa letsatsi le letsatsi o le mong o ke ke oa thibela khatello ea axPA ea HPA haeba, ka mohlala, dexamethasone e sebelisetsoa kalafo. Ntle le moo, mofuta oa kalafo o lokela ho bonoa ka hloko. Ho sitoa ho latela kemiso kapa phapang ea litekanyetso tsa letsatsi la pele ha ho thibele khatello ea HPA.

Phekolo ea corticosteroid ea letsatsi le letsatsi e sebelisetsoa ho eketsa lefu lena le kalafo ea mafu a mang a ka amehang feela ke mofuta oa letsatsi le letsatsi (ka mohlala, arteritis ea nakoana, pemphigus vulgaris). Ketsahalong eo mofuta oa letsatsi le letsatsi o ke keng oa qojoa, khatello ea HPA e ka fokotsoa haeba tekanyetso e felletseng ea letsatsi le letsatsi e ka nkuoa ka nako hoseng, ka tekanyo e tlase ka ho fetisisa. Mokhoa o le mong oa lethal dose o batla o sebetsa hantle joaloka mofuta o le mong oa lethal dose. Leha ho le joalo, ho fapana le leano le leng le le leng letsatsi le leng le le leng, menyetla ea ho ba le lefu la Cushing e kholo le ho feta.

Ho fetoha letsatsi le letsatsi ho isa matsatsing a mang a mang

Boholo ba bakuli ba nang le mekhoa e metle ea phekolo ea letsatsi le letsatsi ke ba khethang ho chencha mofuta o mong le o mong ka letsatsi le leng (ntle le bona ka holimo). Sena se o lumella ho fetohela morerong o sa utloiseng bohloko ntle le ho lahleheloa ke taolo ea lefu lena. Ho fapana le phokotso ea litekanyetso, litekanyetso li nkuoe ha li fetohe. Phetoho e etsoa ka keketseho ea butle-butle ea lethal dose ea letsatsi la pele le ho fokotseha ha tekanyetso ka letsatsi la bobeli, ho fihlela tekanyo e habeli e nkuoa letsatsi le leng le le leng, ntle le lithethefatsi tse ling ka letsatsi le bohareng.

Sekhahla sa phetoho se ipapisitse le ts'ebetso ea lefu le tlasa khatello ea nako, nako ea kalafo, tekanyo ea khatello ea HPA, le boemo ba mokuli. Sesebelisoa sa phetoho se hakanyetsoang se kenyelletsa ho eketsa tekanyetso ea letsatsi la pele le ho fokotsa tekanyetso ea letsatsi la bobeli ho tlatsetso ea limiligrame tse 10 tsa prednisone (kapa e lekanang) ha litekanyetso tsa letsatsi le letsatsi li ne li feta limiligrama tse 40, le ka likhakanyo tsa limiligrama tse 5 ha litekanyetso tsa letsatsi le letsatsi li ne li tloha ho li-milligram tse 20 ho isa ho tse 40. Ka tekanyetso e ka tlase ho li-milligram tse 20, mohato o lokela ho ba li-milligram tse 2,5. Nako e arohaneng pakeng tsa liphetoho e qala ka letsatsi le le leng ho isa ho libeke tse 'maloa' me e ikemiselitsoe ka matla ho latela karabelo ea kliniki ea mokuli. Ho bohlokoa ho hopola hore bakuli ba bangata ba sebelisang mofuta oa letsatsi le letsatsi oa corticosteroid letsatsi le leng le le leng bakeng sa libeke tse fetang 2-4 ba na le khatello ea HPA.

Phokotso ea litekanyetso le ho khaotsa ho phekoloa

Ho khaotsa ka tšohanyetso kalafo ea corticosteroid e tšoarellang khoeli e fetang khoeli e nang le litekanyetso tsa limiligrama tse fetang 20-30 tsa prednisone ka letsatsi ho ka lebisa ho eketseha ka tšohanyetso ha lefu lena le ka tlase kapa ho lebisa matšoao a ho khaoha. Ha ho na mekhoa e netefalitsoeng ea ho potlakisa ho hlaphoheloa ha HPA. Hoa hlokahala ho laola lipontšo tsa lefu lena le ho fokotsa litekanyetso, ho shebella ho phahama ha lefu kapa matšoao a ho hloleha ha adrenal (khatello ea kelello ea mokokotlong, bofokoli le ho senyeha hoa mpa).

Mokhoa o matlafatsang oa ho fokotsa litekanyetso ho litekanyetso tsa 'mele ke ho etsa liphetoho mesebetsing ea li-milligram tse 10 tsa prednisone kapa e tšoanang le ka libeke tse 1 le tse ling haeba litekanyetso tsa pele li feta limiligrama tse 40 ka letsatsi. Haeba litekanyetso li ne li le ka tlase ho li-milligram tse 40, mohato ke li-milligram tse 5.Hang ha tekanyo ea 'mele ea "prednisone" (5-7,5 mg) e fihlelle, mokuli a ka fetoloa matlapeng a 1 mg ea prednisone kapa lethal dose le lekanang la hydrocortisone, e le hore litekanyetso tse eketsehileng tsa litekanyetso li ka etsoa ka lintlafatso tse nyane. Phokotso e eketsehileng ea beke le beke kapa tse peli joale e ka etsoa ka nyolohelo ea milligram e le 'ngoe.

Nakong ea phokotso ea litekanyetso, bakuli ba bang ba ba le lefu la ho itlosa bolutu, le tšoauoang ke khatello ea maikutlo, myalgia, arthralgia, anorexia, hlooho le hlooho ea mokokotlo. Boithuto bo sitiloe ho tseba kamano pakeng tsa matšoao ana le maemo a cortisol kapa 17-hydroxycorticosteroid. Maemong a mangata, litletlebo li etsahetse ha maemo a ne a tloaelehile. Karabelo ea HPA e ne e boetse e tloaelehile ho ba bangata ba bakuli bana. Mekhoa e ikarabellang bakeng sa lefu lena ha e tsejoe, empa ho bonahala e amana le tekanyo eo litekanyetso li fokotsoang ka eona.

Steroid kalafo-e susumetsa ho tsebahala ka ho hloka tlhokomelo ea adrenal

Ha u emetse khatello ea maikutlo (ho kenyelletsoa nakong ea ts'ebetso ea ho buoa), ho bohlokoa ho tseba boemo ba axel ea HPA le hore na ho tla hlokahala kalafo e eketsehileng ea steroid. Joalokaha ho hlokometsoe pejana, ho thata haholo ho tseba esale pele ho qaleha le nako ea khatello ea HPA, e leng se etsang hore ho hlahloba axis ea HPA ho be le thuso ho etsa qeto ea hore na mokuli o tla hloka kalafo e eketsehileng ea steroid. Maemong ana, tlhahlobo ea cosintropin (synthet ACTH) ke mokhoa o bonolo, o bolokehileng le o sebetsang oa ho leka axis ea HPA. Haeba khatello ea "cortisol kamora metsotso e 60 e feta 18 mug / dL kapa ho na le keketseho ho tsoa boemong ba pele ba bonyane 10 mug / dL, karabelo ea adrenal e lekane e le hore mokuli a khone ho mamella khatello ea maikutlo e lekanang le ho hlobaela ka kakaretso. Tlhahlobo e ka etsoa ka ho sebelisa 100 mug CRH ka methapo. Haeba mokuli a se na karabelo e lekaneng ea adrenal, kalafo e eketsehileng ea corticosteroid e lokela ho etsoa ho hlola khatello ea maikutlo e matla. Hydrocortisone e sebelisoa hangata. Ho latela boholo ba khatello ea maikutlo, li-milligrams tse 100-400 tsa hydrocortisone ka letsatsi e sebelisoa ho litekanyetso tse 'maloa. Moeli o tlase oa lethal dose (li-milligram tse 100) o ts'oana le khatello ea maikutlo haeba ho na le bothata ba ka mpeng, feberu, kapa leino. Maemong a khatello ea maikutlo (ho sithabela kapa ho buuoa), mokuli o lokela ho fuoa li-milligram tse 100 tsa hydrocortisone motsoali ka mong le e mong lihora tse 6-8. Syringe e lokiselitsoeng esale pele e nang le li-milligram tse 4 tsa dexamethasone e lokela ho sebelisoa bakeng sa tšebeliso ea batsoali maemong a tšohanyetso, haeba tlhokomelo ea bongaka ea tšohanyetso e sa fumanehe, mokuli ha a tsebe letho kapa a ke ke a nka li-steroid ka molomo.

Li -teroids li lokela ho sebelisoa ka hloko ho bakuli bao boemo ba bona ba kelello kapa bohlale bo ka amehang ka lebaka la kotsi ea khatello ea HPA. Bakuli ba nkang mofuta oa mofuta oa corticosteroid letsatsi le leng le le leng ba lokela ho fumana litaelo mabapi le bohlokoa ba ho latela mokhoa le ho sebelisa moriana pele ho 8 hoseng ho fokotsa kotsi ea khatello ea HPA. Bakuli ba lokela ho tsebisoa ka tlhokahalo ea ho eketsa tekanyetso haeba ho na le khatello ea maikutlo kapa bokuli nakong eohle ea kalafo ea corticosteroid. Bakuli ba lokela ho utloisisa tlhoko ea ho ikopanya le ngaka le ho eketsa litekanyetso tsa moriana haeba ba imetsoe kelellong kapa kelellong.

Bakuli ba bangata ba tšaba ho felisoa ha steroid kalafo kapa ba hana ho fokotsa tekanyetso ea li-steroid ka lebaka la ho tšaba ho khutlela morao ho lefu lena le tlase. Tlhahlobo e qaqileng ea litlamorao tsa kalafo ea nako e telele hoa hlokahala ho hlalosa tlhokeho ea phokotso ea litekanyetso le ho lakatsa ha qetellong ho khaotsa li-corticosteroids.Maemong moo ho hlokahalang phekolo ea letsatsi le letsatsi e nang le litekanyetso tse phahameng, litlamorao tse bohloko tsa kelello (ho kenyeletsa le lefu la Cushing) li ka fokotsoa ka ho tsebisa mokuli ka monyetla oa ketsahalo ea tsona le ho fetoha ha tsona.

Lithethefatsi tse potlakileng tse sebetsang butle-butle tse sebelisang methapo ea methapo: methotrexate, sulfasalazine, chloroquine, auronofin

Methotrexate tsepamisa maikutlo bakeng sa ho hlophisoa ha tharollo ea ente, lyophilisate bakeng sa ho hlophisoa ha tharollo ea ente, tharollo ea ente, matlapa, matlapa a koahetsoeng - moemeli oa antitumor - antimetabolite.

Mokhoa oa ketso. Moemeli oa antitumor, cytostatic ea sehlopha sa antimetabolite o thibela dihydrofolate reductase, e amehang ho khutlisetsong ha dihydrofolate acid ho tetrahydrofolate acid (e tsamaisang lijana tsa khabone tse hlokahalang bakeng sa motsoako oa purine nucleotides le lihlahisoa tsa tsona).

E thibela sethala, tokiso ea DNA le methapo ea sele. Haholo-holo e shebile ketso ea lisele tse atisang ho ata: lisele tsa mahlaba a mabe, moko oa masapo, lisele tsa embryonic, lisele tsa epithelial tsa mucosa ea ka mpeng, lesapo la mokokotlo le mokokotlo oa molomo. Hammoho le antitumor, e na le phello ea immunosuppression.

Mofumahali Ho amoheloa ka molomo ho latela tekanyetso: ha ho nkuoa 30 mg / m2 e amoheloa hantle, bioavailability e tloaelehileng ke 60%. Ho chona ho fokotseha ha ho nooa ka tekanyetso e fetang 80 mg / m2 (eo ho lumeloang hore e ka baka la ho tlala).

Ho bana ba nang leukemia, ho monya ho tloha ho 23 ho isa ho 95%. TCmax - 40 min-4 h ka molomo le 30-60 min - ka tsamaiso ea i / m. Lijo li liehisa ho monya le ho fokotsa Cmax. Puisano le liprotheine tsa plasma - e ka bang 50%, haholo-holo ka albin. Boholo ba phepelo - 0,18 l / kg.

Ha e nooa ka tekanyetso ea kalafo, ho sa tsotelehe tsela ea tsamaiso, ha e kenelle BBB (kamora taolo ea intrathecal ho CSF, ho tsepamisa mohopolo o phahameng). E kenella ka lebeseng la matsoele.

Kamora ho tsamaisoa ka molomo, e tšelisoa ka karolo e itseng kahare ho karolo ea mantlha - karolong ea lesapo (ho sa tsotelehe tsela ea tsamaiso) ka sebopeho sa polyglutamine e sebetsang le pharmacologically, eo hape e thibelang ho senyeha ha dihydrofolate le thymidine.

T1 / 2 ho bakuli ba fumanang meriana e ka tlase ho 30 mg / m2 karolong ea pele ke lihora tse 2-4, 'me karolong ea ho qetela (e telele) - lihora tse 3-10 ha u sebelisa lihora tse nyane le tse 8-15 ha u sebelisa tekanyetso e kholo ea moriana. Ha a sa sebetse hantle hantle haholo ka mokhatlong, re ka holisoa haholo ka linako tsohle.

E hloekisoa haholo ke liphio ka sebopeho se sa fetoheng ka mokhoa o sa fetoloang ka ho kenella ka sekhahla sa glomerular le secretion ea mothapo (ka tsamaiso ea iv ea 80-90% e qotsitsoeng ka nako ea lihora tse 24), ho fihla ho 10% e ts'oeroe ka bile (ka ho kenella hape ka mpeng ka popelong). Ho tlosoa hoa lithethefatsi ho bakuli ba nang le bothata ba ho ruruha ba fig, e hlahisoang e le ascites kapa transudate e fokotseha haholoholo. Ka tsamaiso e pheta-phetoang, e bokellana liseleng ka sebopeho sa polyglutamates.

Matšoao. Kankere ea matsoele, mofets'e oa lefu la hlooho le molala, mofets'e oa "cell cell" le sele e nyane), trophoblastic tumors (uterine chorionepithelioma, cystic Drift, ho kenyelletsa timetso), mofets'e oa "Cancer", "Cancer" ea kankere ea senya, mofets'e esophagus, kankere ea ka mpeng, kankere ea pancreatic, kankere ea methapo ea methapo, leukemia e kenang ea leukemia, leukemic inferrative ea meninges (thibelo le kalafo), acute myeloid leukemia, e seng Hodgkin lymphoma (haholo-holo lymphosarcoma, haholoholo baneng, le Burkitt's limm. phogranulomatosis, fungal mycosis, osteosarcoma e seng metastatic, sarcoma ea lisele tse bonolo, mofets'e oa meninges.

Mefuta e matla ea psoriasis, ramatiki ea ramatiki, ramatiki ea rheumatoid, dermatomyositis, SLE, ankylosing spondylitis.

Contraindication Hypersensitivity, ho se sebetse hantle, boimana, ho nyeka.

Ka kalafo ea psoriasis le mafu a rheumatic (a boikhethelo): thibelo e matla ea masapo a hematopoiesis, ho hloleha ho matla hoa hepatic / renal.

Ka tlhokomeliso. Ascites, ho omella, ho thibela mafu a ka mpeng ea mafu a ka mpeng, ho kenella ka mpeng kapa ho kenella ka mpeng, ho se sebetse hantle ha real, mafu a tšoaetsanoang a vaerase, fungal kapa bacterial - kotsi ea ho ba le lefu le matla le akaretsang (le sa tsoa fetoloa kapa ho kenyeletsoa ho kopana haufinyane le mokuli) - herpes simplex, herpes zoster herpes (karolo ea viremic), khoho, maselese, amoebiasis, matla (a tsebahala kapa a belaelloa), gout (ho kenyeletsa nalane) kapa urate nephrourolithiasis (ho kenyeletsa nalane), ts'oaetso le ho ruruha song ix molomo mucosa, ho hlatsa, letshollo (ho lahleheloa ke mokelikeli ka ntlha ya go ho hlatsa haholo 'me letšollo ka' na lebisa ho eketseha toxicity ea methotrexate), gastric seso le 12 duodenal seso, ulcerative colitis, phekolo ea lik'hemik'hale pele kapa radiotherapy, asthenia.

Ha ho phekoloa malopane neoplasms (a boikhethelo): aciduria (urine pH e ka tlase ho 7), thibelo ea masapo a hematopoiesis.

Tekanyetso Ka hare, intramuscularly, intravenly, intraathera kapa intrathecally (ho thibetsoe ho sebelisa lithethefatsi tse nang le setlolo se sirelletsang joala se nang le benzyl bakeng sa taolo ea intrathecal le kalafo e phahameng ea lethathamo).

Matlapa a nooa ka molomo pele ho lijo, a sa hlafuna. Litekanyetso le linako tsa kalafo li beoa ka mokhoa o fapaneng ho latela mofuta oa chemotherapy regimen, matšoao, regimen ea kalafo, "karabelo" ea mamello le mamello, tse baloang motheong oa sebaka sa 'mele kapa boima ba' mele.

Litlhako tse kaholimo ho 100 mg / m2 li tsamaisoa feela kahare (tharollo kapa ho tsepamisa mohopolo ho tlosoa pele ka tharollo ea 5% dextrose (10 mg - 0.5-1 l ea tharollo ea dextrose) le tlasa sekoaelo sa calcium folrate.

Ho ramatiki ea rheumatoid: tekanyetso ea pele hangata hangata e le 7.5 mg hang ka beke ka nako kapa 2,5 mg hang ka lihora tse 12 (makhetlo a 3 feela ka beke). Ho fihlella phello e nepahetseng, tekanyetso ea beke le beke e ka eketsoa (eseng ho feta 20 mg), joale tekanyetso e lokela ho fokotsoa ho e tlase haholo e sebetsang.

Ho psoriasis, litekanyetso tsa pele ke ka molomo, i.v. kapa iv, 7.5-25 mg / beke, hang, kapa 2,5 mg ka linako tse ling tsa lihora tse 12 makhetlo a 3 ka beke ho fihlela phello e lekaneng e ka fihlelleha, empa eseng ho feta 30 mg / beke. Hangata lethalinyana le eketsoa hanyane ka hanyane, ha phello e nepahetseng e fumaneha, tekanyo e fokotsoa hore e sebetse hantle haholo.

Litla-morao.Ho tsoa lithong tsa hemopoietic: leukopenia le thrombocytopenia, pancytopenia, anemia (ho kenyeletsa aplastic), neutropenia, agranulocytosis, eosinophilia, lymphadenopathy, mafu a lymphoproliferative, hypogammaglobulinemia.

Ho tsoa ts'ebetsong ea tšilo ea lijo: anorexia, ho nyekeloa ke pelo, ho hlatsa, stomatitis, gingivitis, pharyngitis, enteritis, ho ruruha le maqeba a emeng le mali ho tsoa mokokotlong oa mpa (ho kenyeletsa melena, hemathemesis), hepatotoxicity (hepatitis e hlobaetsang, fibrosis le cirrhosis ea sebete, ho hloleha ha sebete, ho eketseha ha sebete. ketsahalo ea "sebete" transaminases), pancreatitis.

Ho tsoa tsamaisong ea methapo: hlooho, ho otsela, dysarthria, aphasia, hemiparesis, paresis, tsitsipano ea maikutlo, ha e sebelisoa ka tekanyetso e phahameng - tlolo ea nakoana ea mesebetsi ea kelello, lability ea maikutlo, maikutlo a sa tloaelehang a cranial, encephalopathy (ho kenyelletsa leukoencephalopathy).

Ka lehlakoreng la letlalo: erythematous rash, letlalo la ho hlohlona, ​​urticaria, photosensitivity, letlalo le sa bonahaleng, alopecia, ecchymosis, telangiectasia, makhopho, furunculosis, erythema multiforme (ho kenyeletsa le Stevens-Johnson syndrome), chefo e matla ea methapo ea methapo, ho ruruha le ho ruruha ha letlalo.

Ho tloha lehlakoreng la setho sa pono: conjunctivitis, ho senyeha ha pono (ho kenyeletsa bofofu ba nakoana).

Ho tsoa ts'ebetsong ea phefumoloho: ka seoelo - pulmonary fibrosis, ho hloleha ho phefumoloha, alveolitis, pneumonitis ea methapo (ho kenyeletsa le ho bola), COPD.

Ho tsoa ho CCC: pericarditis, pericardial effusion, ho fokotseha ha khatello ea mali, thromboembolism (ho kenyelletsa le arterial thrombosis, cerebral vascular thrombosis, vein thrombosis e tebileng, vein thrombosis, thrombophlebitis, pulmonary embolism).

Ho tsoa ts'ebetsong ea genitourinary: nephropathy kapa ho se sebetse hantle ke lefu la mokokotlo, azotemia, cystitis, hematuria, proteinuria, lesapo la sethoathoa le ovogeneis, oligospermia ea nakoana, ho fokotseha ha libido, ho hloka thari, dysmenorrhea, ho nyehla ka botšehali, ho hlonama, ho senyeha ha mpa.

Ho tsoa tsamaisong ea musculoskeletal: arthralgia, myalgia, osteoporosis, osteonecrosis, likhathatso.

Ts'oaetso: ts'oaetso e behang bophelo kotsing (ho kenyeletsa pneumocystis pneumonia), CMV (ho kenyelletsa le pneumonia ea CMV), sepsis (ho kenyeletsa le ho bolaoa), nocardiosis, histoplasmosis, cryptococcosis, ts'oaetso e bakoang ke Herpes zoster le Herpes simplex (ho kenyelletsa ho ajoa).

Tse ling: vasculitis, lefu la tsoekere, 'metso' (ho kenyelletsa le tsela e fetoloang), lefu la hlahala la tumor, lesapo le fokolang la methapo, ho se sebetse hantle ka tšohanyetso.

Phekolong ea ramatiki: ho feta 10% - ts'ebetso e eketsehang ea transaminase ea "sebete", ho nyekeloa, ho hlatsa, 3-10% - stomatitis, thrombocytopenia (ka tlase ho likete tse 100 / μl), 1-3% - lekhopho la letlalo, ho hlohlona, ​​dermatitis, lets'ollo, alopecia, leukopenia ( ka tlase ho 3000 / μl), parytopenia, kizungu, pneumonitis e arohaneng, ba bang - fokotsehile hematocrit, hlooho, tšoaetso (ho kenyeletsa le phepelo e phahameng ea ho hema), lefu la ho hlobaela, arthralgia, bohloko ba sefuba, khohlela, lets'ollo, bothata ba mahlo, nosebleeds, feberu, ho fufuleloa ho feteletseng, tinnitus, ho tsoa ka botšehaling.

Molemong oa phekolo ea psoriasis: alopecia, photosensitivity, ho chesa maikutlo a letlalo, ka seoelo - li-plaque tse bohloko tse bohloko letlalong.

Ha ho phekoloa ramatiki ea bana: ts'ebetso e eketsehileng ea "sebete" transaminases (14%), ho se sebetse hantle ka mpeng, (11%), ho kenyeletsa ho nyekeloa ke pelo, ho hlatsa, lets'ollo, stomatitis (2%), leukopenia (2%), hlooho e bohloko (1,2%), alopecia (0.5%), ho tsekela (0,2%), lekhopho la letlalo (0,2%).

Bongata. Phekolo: ho hlahisoa ha litlhare tse khethehileng - calcium folate, haeba ho khoneha hanghang, ka ho khetheha ka hora ea pele, ka tekanyetso e lekanang kapa e phahameng ho feta tekanyetso ea methotrexate, litekanyetso tse latelang li fanoa ka moo ho hlokahalang, ho latela bongata ba methotrexate serum. Ho thibela ho kenella ha methotrexate le / kapa metabolites ea eona ka har'a lipompo tsa 'mele,' mele o na le hydrate le alkalinized, e potlakisang tlhahiso ea methotrexate.

Tšebelisano. E eketsa ts'ebetso ea anticoagulant ea coumarin kapa li-indandion derivatives le / kapa e eketsa kotsi ea ho tsoa mali ka ho fokotsa ho qaptjoa ha ntho e ka 'nang ea hlaha bokong le sebopeho sa liplatelete tse senyehileng.

E eketsa khatello ea methapo ea uric acid maling, ka hona, ho kalafo ea bakuli ba nang le hyperuricemia e amanang le gout, phetoho ea litheko tsa lithethefatsi tse khahlanong le gout (allopurinol, colchicine, sulfinpyrazone) e ka hlokahala, ts'ebeliso ea lithethefatsi tsa uricosuric anti-gout li ka eketsa kotsi ea nephropathy e amanang le kalafo ea uric acid. (ho molemo ho sebelisa allopurinol).

Tsamaiso e ts'oanang ea li-salicylates, phenylbutazone, phenytoin, sulfanilamides, sulfonylurea derivatives, aminobenzoic acid, pyrimethamine kapa trimethoprim, lithibela-mafu tse 'maloa (penicillin, tetracycline, chloramphenicol), anticoagulants le hypolipidemic e itšetlehileng. kapa ho fokotseha ha secretion ea tubular, eo maemong a mang ho ka lebisang ho nts'etsopele ea litlamorao tse mpe, ka linako tse ling le ho bolaea.

Li-NSAIDs tse nang le tekanyetso e phahameng ea methotrexate li eketsa khatello ea maikutlo le ho fokotsa ho felisoa ha morao, tse ka lebisang lefung ho tsoa taolong e matla ea hematological le gastrointestinal.Ho kgothaletswa ho emisa ho nka phenylbutazone matsatsi a 7-12, piroxicam matsatsi a 10, diflunisal le indomethacin lihora tse 24-48, ketoprofen le NSAIDs ka nako e khuts'oane ea T1 / 2 12-24 lihora tse ngata pele ho ts'oaetso ea methotrexate ka tekanyo e phahameng le e phahameng le nakong ea bonyane lihora tse 12 (ho latela bongata ba methotrexate maling) kamora hore e phethoe. Ho lokela hore ho sebelisoe tlhokomeliso ha e kopanya li-NSAIDs le litekanyetso tse tlase tsa methotrexate (e ka fokotsa tlhahiso ea methotrexate ke li-renal tubules).

Lithethefatsi tse thibelang secretion ea tubular (mohlala, probenecid) li eketsa chefo ea methotrexate ka ho fokotsa tlhahiso ea eona ke liphio.

Lithibela-mafu tse seng li sa sebetse hantle ka har'a lijo tse silafatsang (tetracyclines, chloramphenicol), li fokotsa ho kenngoa ha methotrexate le ho senya metabolism ea lona ka lebaka la khatello ea microflora e tloaelehileng ea mala.

Li-retinoids, azathioprine, sulfasalazine, ethanol le lithethefatsi tse ling tsa hepatotoxic li eketsa kotsi ea hepatotoxicity.

Lithethefatsi tse nang le li-folate (ho kenyelletsa le li-multivitamine) li fokotsa phello e chefo ea methotrexate mokokotlong oa masapo.

L-asparaginase e fokotsa botebo ba phello ea antitumor ea methotrexate ka ho thibela ho phetoa ha sele.

Anesthesia e sebelisang dinitrogen oxide e ka lebisa ho nts'etsopele ea myelosuppression e matla e sa lebelloang le stomatitis.

Acyclovir bakeng sa tsamaiso ea batsoali le tsamaiso e amang methapo ea methotrexate e eketsa kotsi ea ho holofala ka lebaka la khatello ea methapo.

Ts'ebeliso ea cytarabine lihora tse 48 pele kapa kamora metsotso e 10 kamora ho qala kalafo ea methotrexate e ka baka nts'etsopele ea synergistic cytotoxic athari (ho kgothaletsoa ho fetola regimen ea litekanyetso ho latela taolo ea li-paramente tsa hematological).

Lithethefatsi tsa Hematotoxic li eketsa kotsi ea hematotoxicity ea methotrexate.

E fokotsa tumello ea theophylline.

Neomycin bakeng sa tsamaiso ea molomo e ka fokotsa ho amoheloa ha methotrexate bakeng sa tsamaiso ea molomo.

Bakuli ba 'maloa ba nang le psoriasis kapa mycosis fungoides ba phekoloang ka methotrexate hammoho le PUVA kalafo (metho likarolon le UFO) ba ne ba na le mofetše oa letlalo.

Ho kopana le kalafo ea radiation ho ka eketsa kotsi ea khatello ea maikutlo ea masapo.

Methotrexate e ka fokotsa karabelo ea 'mele ea ho itšireletsa mafung, ka hona nako ea nako pakeng tsa ho kenyelletsa ente ea vaerase e phelang le e sa sebetseng e fapana ho tloha likhoeli tse tharo ho isa ho tse 12.

Lebitso la lik'hemik'hale. (1 - thio - beta - D - glucopyrazinato) (triethylphosphine) khauta 2, 3, 4, 6 - tetraacetate

Ketso ea pharmacological. Litokisetso tsa khauta bakeng sa tsamaiso ea molomo (li na le 29% Au), li na le ts'oaetso. Mokhoa oa ts'ebetso ha o utloisisoe ka botlalo: ho lumeloa hore khatello ea boits'ireletso ba cellular e bakoa ke ho ts'oaroa ha Au 3+ ka li-monocytes le polymorphic leukocytes ea nyutlelie, e lebisang ho thibeng phagocytosis le blockade ea enzymes tsa lysosomal. E fokotsa ts'ebetso ea sisthydryl sistimi le li-enzyme complexes tsa leukocytes le lymphocyte, e lebisang ho fokotseha hoa khatello ea Ig le rheumatoid factor, e thibelang ho hlophisoa ha collagen le Pg.

Phekolo ea kalafo e hlaha butle butle mme e shejoa kamora likhoeli tse 3-4 (ka linako tse ling likhoeli tse 6) ho tloha nakong ea ho sebelisa moriana.

Mofumahali Ho fufuleloa ka mora tsamaiso ea molomo - 25%. Puisano le liprotheine tsa plasma - 60%. Css e tsejoa likhoeli tse 3 kamora ho qala kalafo, ka tekanyo ea 6 mg / letsatsi ke 68 μg / ml.

E kenngoa ka potlako ka har'a sebete "(auranofin e sa fetoheng ha e sa fumanehe maling). T1 / 2 maling - matsatsi a 21-31, liseleng - matsatsi a 42-128. E pepisoa ke liphio (60%) le bile.

Matšoao. Rheumatoid arthritis (kalafo le thibelo ea ho fumana liphetoho tsa radiology lihokahanong), ramatiki ea masapo a mokokotlo, lefu la Felty.

Contraindication Hypersensitivity, CHF, ho ba le ramatiki e sa foleng, hepatitis (karolo e sebetsang), thibelo ea masapo a hematopoiesis, dermatitis e tsoang ka ntle, ho ima, ho nyekeloa, cachexia, urticaria, eczema, lekhopho la letlalo.

Melemo ea litekanyetso.Ka hare: batho ba baholo - 6 mg / letsatsi, bana - 0,1 mg / kg / letsatsi ho litekanyetso tse peli tse arohaneng.

Haeba kamohelo e sa sebetse likhoeli tse 4 'me e mamellehile hantle, hoa khoneha ho eketsa tekanyetso ho batho ba baholo ho fihlela ho 9 mg / ka letsatsi ho litekanyetso tse 3 tse arohaneng, le ho bana ho fihlela ho 0,5 mg / kg / ka letsatsi. Maemong a ho hloleha ho phekoloa nakong ea likhoeli tse 3 tse latelang, moriana o hlakotsoe.

Litlamorao. Ho tsoa ho tsamaiso ea methapo ea kutlo le litho tsa kutlo: lethargy, hallucinations, sethoathoa sa sethoathoa, conjunctivitis.

Ho tsoa ts'ebetsong ea phefumoloho: pharyngitis, tracheitis, pneumonia e kenang pakeng tsa mokokotlo, pneumofibrosis.

Ho tsoa ho tsamaiso ea tšilo ea lijo: gingivitis, glossitis, stomatitis, ho hlatsa, lets'ollo kapa ho sokela, gastralgia, gastritis, necrotic enteritis, ulcerative enterocolitis, colitis, gastrointestinal, cholestasis, cholelithiasis, hepatitis, ho hloleha ha sebete.

Ho tsoa ho tsamaiso ea genitourinary: lefu la nephrotic le protheine e kholo, ho se sebetse hantle ha masapo, vaginitis.

Ho tsoa tsamaisong ea hematopoietic: agranulocytosis, pancytopenia, anemia, leukopenia, thrombocytopenia.

Litla-morao tsa ho nyekeloa: makhopho a letlalo, ho hlohlona ha letlalo, eosinophilia, dermatitis, hyperthermia.

Tšebelisano. Ha e lumellane le penicillin, levamisole, chloroquine, e lumellanang le NSAIDs.

Litla-morao li ntlafatsoa ke lithethefatsi tsa cytostatics, hepato- le nephrotoxic, penicillamine.

Lithethefatsi tsa Myelotoxic li ntlafatsa phello ea hematotoxic ea lithethefatsi.

Litaelo tse khethehileng. Pele le nakong ea kalafo, ho hlokahala hore u laole setšoantšo sa mali a potoloha (Hb dikahare, palo ea liplatelese), ts'ebetso ea liphio (urea mahlaseli, creatinine, liprotheine tsa moroto), ts'ebetso ea sebete (tšebetso ea "ini" transaminases) selemong sa pele sa kalafo - khoeli le khoeli, ea bobeli - likhoeli tse ling le tse ling tse 2-3. Ka proteinuria e fetang 1 g / ka letsatsi, kalafo e lokela ho khaotsa.

Sulfasalazine, matlapa a koahetsoeng a kopantsoeng

Sehlopha sa pharmacological ke moemeli oa mala le lithibela-mafu tse khahlanong le ho ruruha.

Ketso ea pharmacological. Moemeli oa mala a antimicrobial, sulfonamide, le eona e na le phello e khahlanong le ho ruruha. Monyetla oa ho sebelisa colitis e seng e ikhethang kalafong e amahanngoa le bokhoni ba sulfasalazine ho bokellana ka mokhoa o ikhethileng ka har'a tishu e kenang ea lebokose la mala le ho lokolloa ha 5-aminosalicylic acid (5-ASA), e nang le ts'ebetso ea ho hlekefetsa, le sulfapyridine, e nang le antimicrobial bacteriostatic effect, antabicistist antaba.

E sebetsa khahlanong le diplococci, streptococci, gonococci, E. coli.

Mofumahali Ho fufuleloa - 10%, ho kenngoa ka har'a metsoako ka microflora ea ka mpeng ho entsoe ka sulfapyridine - 60-80 le 25% 5-ASA. Puisano le liprotheine tsa plasma tsa sulfasalazine - 99%, sulfapyridine - 50%, 5-ASA - 43%.

Sulfapyridine e tšeloa ka har'a sebete ka hydroxylation ho theha metabolites e sa sebetseng, 5-ASA ka acetylation. T1 / 2 ea sulfasalazine - lihora tse 5-10, sulfapyridine - lihora tse 6-14, lihora tse 5-ASA - 0,6-1.4. E sibolloa ka har'a mala - 5% sulfapyridine le 67% 5-ASA, liphio - 75-91% ea sulfasalazine (ho nakong ea matsatsi a 3).

Matšoao. Nonspecific ulcerative colitis.

Contraindication Hypersensitivity, sebete le / kapa ho hloleha ha renal, phokolo ea mali, porphyria, bofokoli ba tlhaho ba tsoekere-6-phosphate dehydrogenase, lebone, lilemo tsa bana (ho fihlela lilemo tse 5).

Sehlopha sa ketso ho fetus. B

Tekanyetso Ka hare, makhetlo a 1 g ho isa ho a 4 ka letsatsi, bakeng sa libeke tse 2-3, tse lateloang ke ho fokotseha butle-butle ha litekanyetso ka 0.5-1 g ka matsatsi a mang le a mang a mang le a mang, thupelo ea kalafo e ka nka likhoeli tse tšeletseng. Bana ba lilemo li 5-7 - 0,25-0,5 g makhetlo a 3-6 ka letsatsi, ba baholo ho feta lilemo tse 7 - 0,5 g makhetlo a 3-6 ka letsatsi.

Litla-morao. Hlooho, ho tsekela, dyspepsia: ho nyekeloa, ho hlatsa, lets'ollo, bohloko ba ka mpeng, ho felloa ke takatso ea lijo, motsoako o mongata oa mali mokhoeng, pneumonitis ea methapo, "hepatitis" e amanang le lithethefatsi, "colouritivity", 'mala oa lamunu o mosehla oa urine, agranulocytosis, leukopenia, thrombocytopenia karabelo: Lintho tse nang le chefo: lefu le nang le chefo ea sethoathoa (lefu la Lyell), erythema e matla (Stevens-Johnson syndrome), ho thothomela hoa kelello.

Tšebelisano.E ntlafatsa phello ea lithethefatsi tsa anticoagulants, antiepileptic le molomo tsa hypoglycemic, hammoho le litlamorao tsa cytostatics, immunosuppressants, hepato- le lithethefatsi tsa nephrotootic.

Lithethefatsi tse thibelang hematopoiesis ea masapo li eketsa kotsi ea myelosuppression.

Chloroquine (Delagil) matlapa. Sehlopha sa pharmacological ke sethethefatsi sa antimalarial.

Ketso ea pharmacological. Antiprotozoal hape e na le phello ea immunosuppress le anti-inflammatory. E baka lefu la mefuta e meng ea erythrocyte ea mefuta eohle ea plasmodia. E na le phello ea gametocidal, ntle le Plasmodium falciparum (e bonts'a phello ea anti-gametocidal). Ka lebaka la thibelo ea syntic acid e kopantsoeng, e na le phello e ntle ea immunosuppression le e seng e tobileng ea ho thibela mafu.

Mofumahali Kamora ho tsamaisoa ka molomo, e tsoa ka potlako ebile e batla e anngoe ka botlalo ho tsoa ho tšilo ea lijo. Cmax e fihlelloa kamora lihora tse 2-6. 55% e tlama ho plasma albin. E namela ka potlako ho litho le lisele tsa 'mele (sebete, meno, lesapo, mapheo). E kenella habonolo BBB le placenta.

E tšelisoa ka tekanyo e nyane (25%). E pepisoa ke liphio (70% - e sa fetoheng) butle butle. T1 / 2 - likhoeli tse 1-2.

Ha e sa sebetse hantle, re ka ipokella. Ka karabelo ea acidic ea moroto, tekanyo ea ho felisoa ea eketseha, ka karabelo ea alkaline, ea eketseha.

Matšoao. Malaria (thibelo le kalafo ea mefuta eohle), amoebiasis ea lesapo la mokokotlo, mefuta ea lesapo la mokokotlo oa mokokotlo, SLE (mefuta e sa foleng le e sa sebetseng), ramatiki, ramatiki, scododerma, photodermatosis, porphyria ea morao.

Contraindication Hypersensitivity, sebete le / kapa ho hloleha ha renal, thibelo ea hematopoiesis ea masapo, tšitiso e matla ea morethetho, ramatiki ea psoriatic, neutropenia, porphyrinuria, boimana.

Tekanyetso Ka hare, bakeng sa thibelo ea mala - 0.5 g bekeng ea pele makhetlo a 2, ebe nako e le 1 kamehla ka letsatsi le le leng la beke. Phekolo ea lefu la mala e etsoa ho ea ka morero o latelang: letsatsi le le leng hang 1 g, kamora lihora tse 6-8 - 0.5 g, ka matsatsi a 2 le 3 a kalafo - 0,75 g letsatsi le letsatsi ka tekanyetso e le 'ngoe. Haeba ho hlokahala - iv drip.

Bakeng sa amoebiasis, makhetlo a 0.5 g makhetlo a 3 ka letsatsi bakeng sa matsatsi a 7, ebe 0,25 g makhetlo a 3 ka letsatsi bakeng sa matsatsi a mang a 7, ebe 0,75 g makhetlo a 2 ka beke bakeng sa likhoeli tse 2-6.

Ka ramatiki e nyarosang - 0,25 g makhetlo a 2 ka letsatsi matsatsi a 7, ebe - 0,25 g letsatsi le letsatsi bakeng sa likhoeli tse 12.

Ka SLE - letsatsi le letsatsi 0,25-0,5 g.

Ho Photodermatosis, 0,25 g letsatsi le letsatsi bakeng sa beke e 1, ebe 0.5-0.75 g beke le beke.

Litla-morao. Ho tsoa ho ts'ilo ea lijo: ho nyekeloa, ho hlatsa, gastralgia.

Ho tsoa ts'ebetsong ea methapo: ho tsekela, ho opeloa ke hlooho, likhathatso tsa boroko, psychoses, ho ts'oaroa ke sethoathoa.

Ho tsoa ho CCC: tšenyo ea myocardial le liphetoho ECEC, ho fokotseha ha khatello ea mali.

Ho tsoa lithong tsa kutlo: ka tšebeliso ea nako e telele - ho koaheloa ke makhopho, tšenyo ea mokokotlo, pono e sa senyehang, e lla litsebeng.

Boitlhotlhollo bo tsoang ka bongata: dermatitis, photosensitivity.

Tse ling: myalgia, leukopenia, khanya ea letlalo le moriri.

Matšoao a ts'ebeliso ea li-glucocorticoids

Matšoao a ts'ebeliso ea li-glucocorticoids a latelang:

1. kalafo ea maloetse a adrenal (glucocorticoids e sebelisetsoa ho haelloa ke matla haholo, mokhoa o sa foleng oa ho haella, congenital cortical hyperplasia), moo ba sa khoneng ho hlahisa ka botlalo (kapa esita le) ho hlahisa lihormone ka bongata,
2. kalafo ea mafu a autoimmune (rheumatism, sarcoidosis) - e ipapisitse le bokhoni ba lihormone tsena tsa ho susumetsa ts'ebetso ea boits'ireletso, ho li hatella kapa ho li kenya. Glucocorticoids le eona e sebelisoa bakeng sa ramatiki,
3. kalafo ea maloetse a urinary system, ho kenyelletsa le a tšoaetsang. Lihormone tsena li ka loana ka katleho le ho ruruha ho hoholo,
4. glucocorticoids bakeng sa allerg e sebelisoa e le mahlahana a amang tlhahiso ea metsoako e sebetsang e hlahisang le ho ntlafatsa karabelo ea motho ka mong,
5. kalafo ea maloetse a tsamaiso ea ho hema (glucocorticoids e laeloa hore asthma, pneumocystis pneumonia, allergic rhinitis). Re lokela ho hlokomela hore lithethefatsi tse fapaneng li na le li-pharmacodynamics tse fapaneng. Lithethefatsi tse ling li sebetsa ka potlako, tse ling lia lieha.E bolela ka phello e liehang, ea nako e telele e ke ke ea sebelisoa haeba ho hlokahala ho tlosa liponahatso tse mpe (mohlala, ka tlhaselo ea asthmatic),
6. li-glucocorticoids ka har'a meno li sebelisoa kalafo ea pulpitis, periodontitis, liketsahalo tse ling tse fokolisang, hammoho le sebopeho sa litlatsetso tsa ho tlatsa le ho ba moemeli oa litlatsetso tsa ho thothomela hoa anaphylactic tse bakoang ke lithethefatsi,
7. kalafo ea mathata a dermatological, ts'oaetso ea manonyeletso ka har'a dermis,
8. kalafo ea mafu a ea gastrointestinal pampitsana. Tšoaetso ea glucocorticoids ke lefu la Crohn,
9. Phekolo ea bakuli kamora ho tsoa likotsi (ho kenyeletsa le morao) e bakiloe ke litlamorao tsa anti-shock, anti-inflammatory.
10. e le karolo ea kalafo e rarahaneng - e nang le edema ea "cerebral".

Motheong oa lintho tsa sehlopha sa li-glucocorticosteroids, litokisetso tsa bongaka li entsoe ka mokhoa oa litlolo, matlapa, tharollo ka ampoules, lino tse tahiloeng:

• Cortisone
• Prednisone
• Dexamethasone
• Hydrocortisone
• Beclomethasone
• Triamcinolone.

Ke ngaka feela, motheong oa lipontšo, e ka fanang ka li-glucocorticoids tsa lehae mme li nke qeto ka nako ea kalafo.

Litlamorao

Boholo ba litlamorao tse ntle tseo li-glucocorticoids li bakileng tšebeliso ea tsona e atileng ho tsa bongaka.

Phekolo ea Hormone e ne e sa sireletseha ho hang, e tsebahala ka boteng ba ba bangata:

1. ho senyeha hoa boleng ba moriri le letlalo, ponahalo ea matšoao a otlolohileng, lihlooho tse ntšo,
2. Kholo e kholo ea moriri libakeng tsa 'mele tsa basali.
3. ho fokotseha ha matla a vascular,
4. ponahalo ea liphetoho tsa lihormone,
5. ho tsosa matšoenyeho, psychosis,
6. tlolo ea metabolism ea metsi a letsoai.

Tšebeliso ea li-glucocorticoids e ka lebisa ho hlaheng ha maloetse a mangata:

1. uleptic ulcer
2. botenya
3. immunodefitness
4. dysmenorrhea.

Ho na le maemo ha glucocorticosteroids e baka kholo e potlakileng ea ts'oaetso, li-activation tsa causative tseo e neng e le 'meleng pele, empa li sena bokhoni ba ho ata haholo ka lebaka la ts'ebetso ea boits'ireletso ba mmele.

Litlamorao tse mpe ha li hlahisoe feela ke tšebeliso ea nako e telele ea li-glucocorticosteroids kapa litekanyetso tsa tsona tse ngata. Li boetse li bonoa ka pheliso e bohale ea lithethefatsi, hobane ha li fumana li-analogue tsa lihormone, litšoelesa tsa adrenal li li emisa ka bo tsona.

Kamora ho fela ha phekolo ea li-hormone, pontsho e ka khona:

1. mefokolo
2. ponahalo ea bohloko ba mesifa
3. tahlehelo ea takatso ea lijo
4. mocheso o eketseha
5. ho mpefala ha li-pathologies tse ling tse teng.

Tšusumetso e kotsi ka ho fetesisa e bakiloeng ke ho hlakoloa hoa lihormone tse joalo ke ho se leka-lekane ho hoholo ha adrenal.

Letšoao la eona le ka sehloohong ke ho theoha ha khatello ea mali, matšoao a mang - mathata a amanang le tšilo ea lijo, a tsamaeang le bohloko, ho bolaoa ke sethoathoa.

Ho kotsi hore ka boithatelo ho hlakola ho nka li-glucocorticosteroids e le ho iphekola ka tšebeliso ea tsona.

Contraindication

Boholo ba litlamorao tse bakoang ke tsamaiso ea li-glucocorticosteroids le tsona li baka likhang tse ngata bakeng sa ts'ebeliso ea tsona:

1. khatello e matla ea mali
2. ho hloleha ho potoloha
3. boimana
4. syphilis
5. lefuba
6. lefu la tsoekere
7. endocarditis
8. jade.

Ts'ebeliso ea lithethefatsi tse nang le li-glucocorticoids bakeng sa kalafo ea ts'oaetso ha e lumelloe haeba ts'ireletso e eketsehileng ea 'mele nts'etsopele ea mafu a mang a tšoaetsanoang e sa fanoe. Mohlala, ho tsuba letlalo ka litlolo tse nang le li-glucocorticoids, motho o fokotsa ts'oaetso ea lehae mme o kotsing ea ho ba le mafu a fungal.

Ha ho fana ka li-glucocorticoids, basali ba lilemo tsa ho ba le bana ba lokela ho etsa bonnete ba hore ha ho na bokhachane - kalafo e joalo ea li-hormone e ka lebisa ho feteng ha adrenal ka popelong.

Livideo tse amanang

Mabapi le litla-morao tse ka bang teng tsa glucocorticosteroids ho video:

Li-Glucocorticoids li hlile li lokeloa ke tlhokomelo e haufi le tumello ho lingaka, hobane li ka thusa maemong a joalo a fapa-fapaneng. Empa lithethefatsi tsa li-hormonal li hloka tlhokomelo e khethehileng ha ho ntlafatsoa nako ea kalafo le litekanyetso. Ngaka e lokela ho tsebisa mokuli ka li-nuances tsohle tse ka hlahang ha u sebelisa li-glucocorticoids, hammoho le likotsi tse letetseng ka ho hana lithethefatsi ka matla.

Lihlopha tse fapaneng tsa lithethefatsi li sebelisoa ho phekola mafu a liphio. E 'ngoe ea tsona ke glucocorticosteroids. Meriana e na le tšusumetso e fapaneng 'meleng. Hangata li sebelisoa e le mokhoa oa tlhokomelo ea maemo a tšohanyetso bakeng sa mathata le ho eketseha ha mafu.

Glucocorticosteroids (GCS) - lebitso le akaretsang la lihormone tse hlahisoang ke sebopeho sa cortical sa litsoelesa tsa adrenal. Sehlopha sena se kenyeletsa glucocorticoids (cortisone, hydrocortisone) le mineralocorticoids (aldosterone). Kajeno, li-corticosteroids tsa maiketsetso li sebelisoa ka mafolofolo kalafo. Empa ho fihlela joale, polokeho ea bona le katleho ea 'mele e ntse e ithutoa, likarolo tse ngata tsa ts'ebeliso li phehisana haholo.

Classified le mofuta oa tokollo

Li-glucocorticosteroids li hlahisoa ke adrenal cortex e tlas'a tšusumetso ea tsamaiso ea methapo e bohareng le gland ea pituitary. E laola tsela eo li-hormone li sebetsang ka eona - hypothalamus. Ka lebaka la ho haella ha GCS maling a hydrocortisone le maemong a sithabetsang (ts'oenyeho, ts'oaetso), e hlophisa corticoliberin, e leng se khothalletsang ho ntšoa ha ACG gland ea pituitary. Tlas'a tšusumetso ea hormone ena, li-glucocorticosteroids li hlahisoa ka cortex ea adrenal.

GCS e na le matla a ho thibela ho ruruha, laola lik'habohaedreite, lipid, metabolism ea protheine, laola ts'ebetso ea liphio, karabelo ea 'mele maemong a sithabetsang. Ho tsa bongaka, ho sebelisoa lihormone tsa tlhaho le li-analogues tsa tsona tsa maiketsetso.

Ha lithethefatsi GCS e qala ho sebelisoa bohareng ba lekholo le fetileng la lilemo. Lihormone tsa maiketsetso li na le thepa e tšoanang le ea tlhaho. Ba hatella ts'ebetso ea ho ruruha, empa ha e ame li-causative agents tsa ts'oaetso. Hang ha li-corticosteroids li khaotsa ho sebetsa, ts'oaetso e ka boela ea qala.

Glucocorticosteroids ka lehlakoreng le leng e hlahisa phello e matla ea kalafo, e u lumella ho fihlela sephetho se nepahetseng ka nako e khuts'oane. Ka lehlakoreng le leng, ts'ebeliso ea bona e na le liphetoho tse ngata tse fapaneng tse tsoang litsamaisong le litho tse fapaneng.

Lihormone li baka khatello ea maikutlo, e lebisang ho fokoliseng tsamaiso ea 'mele ea ho itšireletsa mafung, kaha hangata e fuoa maemong a khutsitseng. Ntle le moo, li-corticosteroids tsa maiketsetso li hatella mosebetsi oa tlhaho, o ka lebisang ts'ebetsong ea litšoelesa tse sa sebetseng hantle. Ka hona corticosteroids e lokela ho laoloa ka tieo ke ngaka 'me li lokela ho fuoa taelo haeba lithethefatsi tse ling li sa sebetse.

Glucocorticosteroids e lokolloa ka mokhoa oa:

• lipilisi
• tharollo ea ente
• aerosol
• litlolo, litlolo.

Matšoao le contraindication

Ketso ea GCS e fapane haholo:

• anti-inflammatory
• antiallergic,
• immunomodulatory.

Lithethefatsi li sebelisetsoa ho emisa ts'ebetso ea ho ruruha maloetseng a mangata:

• rheumatism
• mafu a mali
• systema lupus erythematosus,
• asthma ea lefu la bronchial,
• pneumonia
• dermatitis
• mafu a methapo
• allergy le ba bang ba bangata.

Corticosteroids e ka sebelisoa bakeng sa li-pathologies tsa renal tsena:

• ho ruruha ha monoana
• mathata a amanang le tlhaho ea adrenal cortex,
• lupus erythematosus
• nephrotic syndrome.

• motho ka mong,
• khoho
• phela ente
• tšoaetso e matla.

Lihormone li fanoa ka hloko haholo ha ho e-na le mafu a latelang:

• lefu la tsoekere
• khatello ea mali
• seso sa ka mpeng
• ho nyekeloa ke pelo
• thrombosis
• glaucoma le koluoa
• lefuba
• mathata a kelello.

Mineralocorcoids e ke ke ea nkuoa ka hepatic,, khatello e matla ea mali, lefu la tsoekere le khaello ea potasiamo ho plasma ea mali.

Hlokomela! GCS e ka baka litlamorao tse ngata libakeng tse fapaneng tsa 'mele. Lihormone tse fokolang le tse sebetsang ka mokhoa o itekanetseng tse nang le tšebeliso ea nako e khuts'oane, joalo ka molao, ha li baka mathata a maholo. Ho fokotsa kotsi ea ho ba le litlamorao tse sa batleheng, o hloka ho araba ka nako ea liphetoho life kapa life 'meleng le ho fetola litekanyetso tsa lithethefatsi.

Lefu la sethoathoa

Ha ho na litlhahiso tse tobileng mabapi le ts'ebeliso ea GCS. Ha se mekhoa ea phekolo e khethehileng. Phapang ke ho hloka tlhokomelo ea adrenal, moo li-glucocorticoids li etsang mosebetsi oa phekolo e ncha. Pele a fana ka moriana o mong le o mong oa li-hormonal bakeng sa mafu a tsamaiso ea urine, ngaka e lokela ho lekanya melemo le mathata.

Bakeng sa mokuli e mong le e mong, litekanyetso li khethoa ka mokhoa o matla ho fihlela sephetho se lakatsehang. Nako le nako, e ea nchafatsoa, ​​e ipapisitse le phetoho ea matšoao le nts'etsopele ea litla-morao. Tekanyetso e le 'ngoe ea corticosteroids e bolokehile bakeng sa bophelo bo botle. 'Me thupelo ea libeke tse 1 ea ho amoheloa ntle le li-contraindication ha e utloise' mele bohloko. Ka lehlakoreng le leng, haeba ho belaelloa ka ho hloka tlhokomelo e matla ea adrenal, tsamaiso e le 'ngoe ea methapo ea GCS e ka pholosa bophelo ba mokuli.

Re lokela ho hopola hore ho khaotsa ka matla ha lithethefatsi tsa lihormone ho ka etsa hore iatrogenic adrenal e haelloe. Haeba taolo ea nako e telele ea corticosteroids ho lefu la liphio e lebelletsoe, tekanyetso e fokolang e lekaneng ho fihlela matla a matla a khethoa. Empa ho fanoa ka lithuto tse telele, joalo ka molao, haeba lefu le tšosa bophelo ba mokuli ka kotloloho.

Phekolo ea maloetse a renal ka corticosteroids e ka ba:

• E matla - E sebelisoa maemong a behang bophelo kotsing, e fanoa ka matla.
• Meeli - Bakeng sa mafu a sa foleng a nako e telele, ho khethoa ho fuoa matlapa a hlokang ho nkuoa nako e telele. Morero o amohelang oa kamohelo o sebelisoa.
• Ho fapanyetsana - Sebelisa corticosteroids e sebetsang ka nako e khuts'oane le nako e telele ea ketso, hang hoseng, hang ka matsatsi a mabeli.
• Tlhokahalo - nka matsatsi a 3-4, ebe u khefutsa matsatsi a 4.
• Pulse kalafo - ente e le 'ngoe ea li-corticosteroids ka mothapong oa bonyane 1 g joalo ka tšohanyetso.

Phekolo ea maloetse a renal a nang le lithethefatsi tsa lihormone e lokela ho tlatselletsoa ka vithamine D le calcium ho thibela lefu la ho fokola ha masapo. Ho fokotsa phello ea li-corticosteroids ka mpeng, ho khothalletsoa ho sebelisa Almagel, Fosfalugel.

Ho na le likhohlano tse ngata har'a litsebi mabapi le tšebeliso ea li-glucocorticosteroids ho mafu a liphio. foromo e bonolo hangata e ka sebelisoa ho phekola ka corticosteroids; meriana ke litlhare tsa pele tsa lefu lena. Bekeng ea pele, bakuli ba fuoa prednisone ka litekanyetso tsa 1-2 mg / kg. Ho feta libeke tse 6-8, palo ea lithethefatsi tse nooang e ea fokotsoa butle-butle. Lingaka tse ling li khothaletsa ho nka moriana ona letsatsi le leng le le leng.

Hangata kamora ho felisoa ha glucocorticosteroids, ho khutla hape ho etsahala. Bakuli ba joalo ba nkuoa ba sa khone ho sebetsana le GCS 'me ba tšoaroa ka li-immunosuppressants tse ling (Azathioprine). Lupus nephritis le eona e ka alafshoa ka meriana ea lihormone. Ha li-membranous, lihormone (prednisone 120 mg) li laeloa likhoeli tse 2-2,5 letsatsi le leng le le leng, ka phokotso ea butle-butle ea lethal dose likhoeling tse latelang tse 1-2.

Bona lenane le litšoaneleho tsa theko e tlase tsa renal.

Litaelo tsa tšebeliso ea lithethefatsi Nolicin bakeng sa cystitis li hlalositsoe leqepheng.

Atereseng, bala ka se bonts'ang molora oa senya ho banna le hore na o ka itokisetsa thuto joang.

Melao ea ho khaotsa lithethefatsi

Haeba ho nka lihormone ho telele, joale u lokela ho li hlakola butle butle. Mekhoa ea litlhare e thibela mosebetsi oa adrenal cortex, haeba ka tšohanyetso o sitisa ho ja, joale sena se tšosa mokuli ka lebaka la ho hloka thari ea adrenal.

Ha ho na morero o hlakileng oa ho fokotsa litekanyetso tsa GCS. Tsohle li itšetlehile ka hore na o qetile nako ea kalafo hakae le hore na ke mosebetsi oa mofuta ofe.Haeba kalafo e phela nako e khuts'oane, ho nka GCS ho ka fokotsoa ka 2,5ml ka matsatsi ohle a 3-4 (ho sebelisa Prednisolon e le mohlala). Haeba kalafo e le telele, ka nako eo, phokotso ea litekanyetso e lokela ho ba butle - 2,5 mg ka matsatsi ohle a 7-20.

Ka hloko o hloka ho fokotsa tekanyetso ho ea ka tlase ho 10 mg - 1,25 mg letsatsi le leng le le leng la matsatsi a 3-7. Haeba GCS e ne e laetsoe ka tekanyetso e phahameng, joale phokotso e ka etsoa ka matla haholoanyane (matsatsing a 3, 5-10 mg). Haeba tekanyetso ea 30% ea tekanyetso ea pele e fihlelloa, kamora libeke tse ling le tse ling tse 1,2 li fokotseha ka 1.25 mg. Kahoo, hoa khoneha ho fihlela tekanyo ea ts'ebetso ea lithethefatsi nako e telele e lekaneng.

Lenane la li-glucocorticosteroids

GCS e arotsoe ka lihlopha tse 'maloa ho latela nako ea ts'ebetso ea bona.

• Cortisone
• Hydrocortisone
• Mazipredon
• Solu Cortef,
• Fluticasone
• Cyclesonide.

• Dexamethasone (Dexamed, Megadexan),
• Betamethasone (Celeston),
• Triamcinolone (Kenalog, Berlicort, Triacort).

Litsenyehelo tsa li-glucocorticosteroids li ka fapana ho ea ka moetsi, mofuta oa tokollo le leano la theko la mokotla oa litlama.

Litsenyehelo tse tloaelehileng tsa lithethefatsi tse tloaelehileng:

• Prednisolone - 100 likotoana tsa matlapa a 5 mg a li-ruble tse 3, li-ampoules tse 3 tsa 1 ml (30 mg) li-ruble tse 48,
• Dexamethasone - tharollo ea 1 ml ea 25 ampoules li-ruble tse 130-180, matlapa a 0.5 mg, 10 likotoana tse 10 li-ruble,
• Hydrocortisone - ampoules 2 ml 2,5%% 10 likotoana 148 li-ruble,
• Metsred - 4, matlapa a 4 mg likotoana tse 30 tsa 175-190 li-ruble,
• Diprospan - 1 ampoule ea 1 ml ea li-ruble tse 217.

Li-glucocorticosteroids ke lihormone tse entsoeng ke litšoelesa tsa adrenal. Li ajoa likarolong tsohle tsa 'mele oa rona,' me li etsa mesebetsi e mengata. Mafu a mang, ho kenyelletsa le a liphio, a sebelisa li-corticosteroids tsa tlhaho le tsa tlhaho ho loants'oa ho ruruha le mathata a mang. Empa phekolo ea glucocorticosteroid e na le mahlakore a mabeli. Tšebeliso ea bona e ka lebisa liphellong tse ngata tse sa thabiseng. Ka hona, e lokela ho laoloa ka tieo ke ngaka.

Video - tlhahlobo le tlhahlobo ea likarolo tsa ts'ebeliso ea li-glucocorticosteroids le kamoo u ka qobang litlamorao ho ts'ebeliso ea lithethefatsi:

Mochine oa ts'ebetso le litlamorao tsa pharmacological

Mochine oa phello e khahlanong le ho ruruha ea corticosteroids ke ho hatella likarolo tsohle tsa ho ruruha. Ka ho tsitsisa li-membrane tsa sebopeho sa cellular le subcellular, incl. lysis, lithibela-mafu tse thibelang ho ruruha tsa cellidal li thibela ho lokolloa ha li-enzyme tsa protheine ho tsoa seleng, li sitisa ho thehoa ha li-radicals tsa oksijene tsa mahala le lipid peroxides kahara litho. Boemong ba ho ruruha, li-corticosteroids li qobella likepe tse nyane le ho fokotsa ts'ebetso ea hyaluronidase, ka tsela eo e thibela sethala sa exudation, thibela ho kenella ha li-neutrophils le monocytes ho vasotine endothelium, ho fokotsa ho kenella ha tsona liseleng, le ho fokotsa mosebetsi oa macrophages le fibroblasts.

Ts'ebetsong ea matla a khahlanong le ts'oaetso, karolo ea bohlokoa e bapaloa ke bokhoni ba GCS ba ho thibela ho kopanngoa le ho lokolloa ha babuelli ba tšoaetso (PG, histamine, serotonin, bradykinin, jj.). Ba kenya ts'ebetso ea lipocortins, phospholipase A2 biosynthesis inhibitors, mme ba fokotsa sebopeho sa COX-2 molemong oa ts'oaetso. Sena se lebisa tokollong e lekanyelitsoeng ea arachidonic acid e tsoang phospholipids ea membrane ea lisele le ho fokotseha ha sebopeho sa metabolites ea eona (PG, leukotrienes le elemente activation factor).

GCS e ka thibela karolo ea kholo, hobane ba thibela ho kenella ha monocytes ka har'a lithane tse tlotsitsoeng, ho thibela ho nka karolo ha bona mohatong ona oa ho ruruha, ho thibela ho hlophisoa ha li-mucopolysaccharides, liprotheine le ho thibela ts'ebetso ea li-lymphopoiesis. Ka ho ruruha ha lefu la tšoaetso ea corticosteroids, ho fanoa ka boteng ba phello ea immunosuppressive, ho bohlokoa ho kopanya le kalafo ea antimicrobial.

Tšusumetso ea immunosuppression ea corticosteroids e bakiloe ke ho fokotseha hoa palo le ts'ebetso ea T-lymphocyte e potolohang maling, ho fokotseha ha tlhahiso ea li-immunoglobulin le tšusumetso ea lisele tsa T-assist ho B-lymphocyte, ho fokotseha ha dikahare tse tlatselletsang maling, ho thehoa ha li-immune system tse thata le ho kenella ha lintho tse ngata tse potang. .

Tšusumetso ea khale ea GCS e bakoa ke ho fokotseha ha palo ea basophils ba potileng, tlolo ea ts'ebelisano ea li-receptor tsa Fc tse fumanehang ka holim'a lisele tsa methapo, ka sebaka sa Fc sa IgE le karolo ea C3 e tlatselletsang, e thibelang lets'oa ho kena ka seleng mme e tsamaisana le ho fokotseha ha tokollo ea histamine, heparin, le serotonin le babuelli ba bang ba mofuta oa hang-hang 'me ba thibela phello ea bona liseleng tsa moferefere.

Phello ea bohanyetsi e bakoa ke ho nka karolo ha GCS taolong ea molumo oa methapo, khahlano le semelo sa bona, kutloelo ea methapo ea mali ho li-catecholamine e eketseha, e lebisang keketseho ea khatello ea mali, liphetoho tsa metabolism ea metsi, sodium le metsi li bolokiloe, palo ea plasma e eketseha le hypovolemia e fokotseha.

Glucocorticosteroids (GCS) - ke eng ka meriana

Li-Glucocorticoids le glucocorticosteroids ke ntho e le 'ngoe, li-syonyms tse bonts'ang lihormone tse hlahisoang ke adrenal cortex, ea tlhaho le ea maiketsetso, ka linako tse ling li sebelisa GKS e hlalosang litlolo tse ncha.

Hammoho le mineralocorticoids, corticosteroids e theha sehlopha se pharaletseng sa corticosteroids, empa corticosteroids e hlokahala haholo joalo ka litlhare. U ka bala ka mofuta oa lithethefatsi - corticosteroids.

Li fa ngaka menyetla e metle ea kalafo ea maloetse a tebileng, "ho tima" sepheo sa ho ruruha, li ka ntlafatsa phello ea meriana e meng, ea fokotsa ho ruruha le ho thefula maikutlo a bohloko.

Ka ho eketsa ka nepo palo ea li-corticosteroids 'meleng oa mokuli, lingaka li rarolla mathata ao pele a neng a bonahala a sa khone.

Saense ea bongaka e boetse e fihletse hore kajeno GCS e ka sebelisoa "ho rereloa" - ho sebetsa feela sebakeng sa bothata, ntle le ho khathatsa ba bang ba phetseng hantle.

Ka lebaka la kopo ena ea li-topical, kotsi ea litlamorao e ea fokotseha.

Bophahamo ba lithethefatsi tsa glucocorticoid bo boholo bo lekaneng. Chelete ena e sebelisitsoe:

Ntle le moo, GCS e sebelisoa kalafo ea likotsi (li na le phello e sebetsang ea anti-shock), hape le ho khutlisetsa mesebetsi ea 'mele kamora ts'ebetso e rarahaneng, radiation le chemotherapy.

Mokhoa oa ho nka li-corticosteroids o nahana ka ho tlosoa hoa li-glucocorticoids, ke hore, kotsi ea ho senyeha ha bophelo bo botle ba mokuli kamora ho emisa ts'ebeliso ea lithethefatsi tsena.

Mokuli a ka ba a theha se bitsoang ho se lekane ha glucocorticoid.

Ho qoba sena, ke moetlo oa ho qeta kalafo ka li-glucocorticoids ka bonolo, o fokotsa tekanyetso ea litheko qetellong ea thupelo.

Bohlokoa ka ho fetisisa, lits'ebetso tsa kemiso li etsahala tlasa ts'usumetso ea corticosteroids seleng, ho kenyelletsa liphatsa tsa lefutso, boemo.

Sena se bolela hore ke litsebi feela tse ka sebetsang le litokisetso tsa bongaka tsa mofuta ona Mokhoa oa ho iphekola o thibetsoe ka hohle-hohle, kaha o ka baka mathata a mefuta eohle.

Mokhoa oa ts'ebetso oa li-glucocorticoids 'meleng ha o e-so utloisisoe ka botlalo. Ha bo-ramahlale ba khona ho fumana, corticosteroids e thehoa ho latela "taelo" ea tšoelesa ea pituitary: e ntsha ntho e bitsoang "corticotropin" maling, e romellang lets'oao la eona - ka bongata ba li-corticosteroids tseo grenicosteroids e lokelang ho fana ka tsona.

E 'ngoe ea lihlahisoa tsa bona tsa bohlokoa ke glucocorticoid e sebetsang e bitsoang "cortisol", e boetse e bitsoa "khatello ea maikutlo".

Lihormone tse joalo li hlahisoa ka mabaka a fapaneng, tlhahlobo ea bona e thusa lingaka ho lemoha litšila tsamaisong ea endocrine, li-pathologies tse tebileng le ho khetha meriana e joalo (ho kenyeletsoa GCS) le mekhoa ea kalafo e tla sebetsa hantle maemong ohle.

Glucocorticoids e ama 'mele ka litsela tse ngata hang. E 'ngoe ea bohlokoa ka ho fetisisa ke phello ea bona ea anti-inflammatory.

GCS e ka fokotsa ts'ebetso ea li-enzyme tse senyang litho tsa 'mele, li arola libaka tse amehileng ho tse phetseng hantle.

Ketso ea GCS ho li-membran tsa lisele, e li etsa coarser, e bolelang ho thatafatsa metabolism, ka lebaka la ts'oaetso ha e fane ka monyetla oa ho hasana hohle 'meleng, e e beha ka "sistimi e thata".

Har'a mekhoa e meng ea ts'usumetso ea li-corticosteroids 'meleng oa motho:

• immunoregulatory athari - tlasa maemo a fapaneng, boits'ireletso bo eketseha hanyane kapa, ho fapana le hoo, boits'ireletso bo hatelletsoe (lingaka li sebelisa thepa ena ea li-corticosteroids nakong ea phetisetso ea lisele ho tsoa ho bafani),
• antiallergic,
• antishock - e sebetsang, ho etsa mohlala, ka tšohanyetso ea anaphylactic, ha moriana o lokela ho fana ka sephetho se potlakisang lebone ho pholosa mokuli.

GCS e ka ama tlhahiso ea insulin (hona ho thusa bakuli ba nang le hypoglycemia), ho potlakisa tlhahiso ea ntho e joalo ka erythropoietin (ho nka karolo ha eona maling ho eketsa litaba tsa hemoglobin), ho ka phahamisa khatello ea mali, ho ama metabolism ea protheine.

Ha ho fanoa ka lithethefatsi, lingaka li lokela ho nahana ka li-nuances tse ngata, ho kenyelletsa le seo ho thoeng ke mokhoa oa ho kopitsa, ha lithethefatsi li kena maling a pharalletseng ka mor'a ho kenngoa, le ho tloha moo li kena ka har'a lithane. Mefuta e mengata ea corticosteroids e lumella ts'ebeliso ea lithethefatsi ho feta moo.

Ka bomalimabe, ha se "ts'ebetso" eohle ea li-glucocorticoids tse sebetsang ka botlalo ho batho.

Ho eketseha ha li-corticosteroids ka lebaka la tšebeliso ea nako e telele ea lithethefatsi, ka mohlala, ho latela taba ea hore liphetoho tsa ka hare tsa biochemistry - khalsiamo e hlatsuoa, masapo a fetoha mofoka, lefu la masapo le hlaha.

Li-glucocorticoids li khetholloa ke hore na li sebetsa ka nako e kae kahare ho 'mele.

Lithethefatsi tse nkang karolo e khuts'oanyane li lula maling a mokuli ho tloha lihora tse peli ho isa halofong ea letsatsi (mehlala ke Hydrocortisone, Cyclesonide, Mometasone). Litaelo tsa hydrocortisone li ka fumanoa.

GCS ea bohato ba mahareng - ho fihlela matsatsi a le mong le halofo (Prednisolone, Methylprednisolone), ketso ea nako e telele - lihora tse 36-52 (Dexamethasone, Beclomethasone).

Ho na le khethollo ho latela mokhoa oa ts'ebetso ea taolo:

Li-glucocorticoids tse nang le mafura li na le phello e matla 'meleng oa mokuli. Lichelete tsena le tsona li na le sehlopha sa tsona.

Ho latela palo ea fluorine e ho tsona, li monofluorine, di- and trifluorised.

Lithethefatsi tse fapaneng tse sebelisang GCS li fa lingaka monyetla oa ho khetha mofuta o nepahetseng (matlapa, tranelate, gel, setlolo, inhaler, patch, marotholi a nasal le "dikahare" tse lumellanang hantle ho fumana litlamorao tsa tlamahano tse hlokahalang, 'me ha ho joalo) Se ke oa mpefatsa boemo ba mokuli, 'me seo sa baka litla-morao tsa' mele.

Pharmacology ke pheletso ea litsebi, ke ngaka feela e utloisisang linthong tsohle tse poteletseng hore na sena se ka ba le tšusumetso efe 'meleng kapa neng ho latela tloaelo eo.

Mohlala, re fana ka mabitso a li-glucocorticoids:

Mekhoa ea kalafo

Mefuta e fapaneng ea mekhoa ea kalafo e sebelisang corticosteroids e se e hlahisitsoe:

• Phetolo - e sebelisoa haeba litšoelesa tsa adrenal li ke ke tsa hlahisa palo e hlokahalang ea lihormone bakeng sa 'mele,
• khatello - bakeng sa bana ba nang le mathata a tlhaho a ho sebetsa ha adrenal cortex,
• pharmacodynamic (e kenyelletsa kalafo e matla, e lekanyang le ea nako e telele) - ho kalafo e hanyetsang mmele le e khahlanong le ho ruruha.

Sebakeng ka seng, ho fanoa ka litekanyetso tse itseng tsa lithethefatsi le khafetsa ea tšebeliso ea tsona.

Kahoo, phekolo e 'ngoe e kenyelletsa ho nka li-glucocorticoids hang ka mor'a matsatsi a mabeli, kalafo ea pulse e bolela ho tsamaisa bonyane 1 g ea moriana bakeng sa tlhokomelo e potlakileng ho mokuli.

Hobaneng ha li-glucocorticoids li le kotsi 'meleng? Li fetola botsitso ba eona ba li-hormone mme ka linako tse ling li baka karabelo e sa lebelloang haholo. , haholoholo ka lebaka le itseng la lithethefatsi tse ngata li etsahetse.

Mafu a bakoang ke corticosteroids a kenyelletsa, mohlala, hyperfunction ea adrenal cortex.

Taba ke hore ts'ebeliso ea lithethefatsi tse thusang litšoelesa tsa adrenal ho etsa mesebetsi ea tsona, e ba fa monyetla oa ho "phomola." Haeba lithethefatsi li felisitsoe ka tšohanyetso, litšoelesa tsa adrenal ha li sa khona ho etsa mosebetsi oa nako eohle.

Ke mathata afe a mang a ka emang kamora ho nka GCS? Hona ke:

Haeba kotsi e lemohuoa ka nako, hoo e batlang e le mathata ohle a hlahileng a ka rarolloa ka katleho. Taba ea mantlha ha se hore u ba hodise ka litlhare, empa u sebetse feela ho latela litlhahiso tsa ngaka.

Tlhahisoleseling ka kakaretso

Cortex ea adrenal e hlahisa mefuta e 3 ea lihormone:

• ho laola metabolism ea potasiamo-sodium (mineralocorticoids),
• ea ikarabellang bakeng sa ts'ebetso ea ho beleha (li-steroid tsa thobalano),
• glucocorticosteroids, e ikarabellang bakeng sa taolo ea metabolism e bohareng.

Tlhahiso ea corticosteroids e laoloa ke pituitary le hypothalamus, empa e etsoa ka litho tsa 'mele tsa endocrine, tse fumanehang kaholimo ho liphio, tseo ba li fumaneng lebitso.

Ka lekhetlo la pele lihormone tsena li sebelisoa e le meriana lilemong tsa 40 tsa lekholo la ho qetela la lilemo, ba ile ba fumana lebitso la bona ka lebaka la bokhoni ba bona ba ho laola metabolism ea glucose. Boithuto bo eketsehileng ba kliniki bo bontšitse hore lihormone ha li ame feela lipid, carbohydrate, metabolism ea protheine, empa hape li laola tšebetso ea potoloho ea mali, liphio, boits'ireletso ba mmele, li nka karolo nts'etsopeleng le metabolism ea lisele tsa masapo, mme li ama haholo ts'ebetso ea methapo ea methapo.

Ts'ebeliso ea li-hormone ka sebopeho sa tsona sa tlhaho, leha ho na le ts'ebetso e kholo ea phello, e lekantsoe ka lebaka la palo e kholo ea litlamorao tse mpe.

Li-analogus tsa sebopeho le tse sebetsang

Glucocorticoids ke li-analogue tsa sebopeho le tšebetso tsa lihormone tseo tse hlophisitsoeng kahare ho adrenal cortex, sebakeng sa eona sa bongata. Lithethefatsi tse hlahisitsoeng sehlopheng sena li arotsoe ka:

• glucocorticoids ea tlhaho ea tlhaho (cortisone, e le setlhare se etsang metabolite e sebetsang),
• litokisetso tsa maiketsetso tse fumanoeng motheong oa hydrocortisone () ka ho kenyelletsa metsoako e fapaneng ea lik'hemik'hale ho molek'hule ea eona.

Ke bona ba khethang phapang lits'ebetsong tse sebelisitsoeng, phetoho ea bohlokoa meahong eo ntho e kentsoeng ea khemikhale e fanang ka eona.

Fludrocortisone, e thehiloeng ke kenyelletso ea atom ea fluorine ho cortisone, e phahame makhetlo a 12 mosebetsing oa glucocorticoid, le makhetlo a 125 ho mineralocorticoid cortisone.

Dexamethasone, sehlopha sa 16-methyl se kentsoeng molek'hule ea flucrocortisone, e boloka ts'ebetso ea glucocorticoid, empa e na le mineralocorticoid e nyane.

Methylprednisolone, eo 1 e matla e kenyellelitsoeng ho eona, e fetisa tlhahiso ka makhetlo a 5 ka tekanyo ea ts'ebetso ea glucocorticoid.

Li-analogia tsa maiketsetso tsa li-hormone tsa adrenal cortex li sebelisoa kalafong ea meriana maemong a matla ha melemo ea tsona ea bongaka e feta kotsi ho tsoa litlamorao tsa tsona. Ka linako tse ling, ka lebaka la boemo bo feteletseng, kapa ho teba ho hoholo ha lesapo, ha ho na mokhoa o mong ntle le ho sebelisa lithethefatsi tsa lihormone. Lithethefatsi tsa Corticosteroid li sebelisoa ho fana ka:

• anti-inflammatory
• ho nyahama
• antitoxic
• anti-makala,
• ketso ya ho thibela pelehi.

Tsena li hole le litlamorao tsohle tsa kalafo tse ka fumanoang ka tekanyetso e boletsoeng, le mokhoa o le mong oa ho khethoa. Ho mafu a lesapo la mokokotlo, meriana ea glucocorticoid e boetse e sebelisoa ka lebaka la bokhoni ba eona ba ho eketsa litlamorao tsa lithethefatsi tse sebelisoang nakong ea phekolo e rarahaneng ka tsela e tšoanang.

Molao-motheo oa mantlha oa ho fana ka litlhare tsa HA ke ho fihlella phello e phahameng, ka tekanyetso e tlase haholo.Bakeng sa morero ona, ho etsoa li-analogues tsa maiketsetso tse nang le phello e boletsoeng haholoanyane, e lumellang ho fokotsa tekanyo le nako ea thupelo e behiloeng.

Tlhotlhomiso le karohano ea lithethefatsi

Sehlopha sa litlhare tse amoheloang ka kakaretso se sebelisang lihormone tsa adrenal ha se e-so hlahisoe. Basebelisi ba arola GC ho latela sebaka le mokhoa oa ts'ebeliso. Ho ea ka sena, karohano e nang le maemo haholo ho ea ka lihlopha tse nyane, mefuta e latelang ea lithethefatsi e khetholloa:

• ente
• tafoleng
• litokisetso tsa bohlooho ka mokhoa oa litlolo, litlolo, li-gels le li-suspension.

Molao-motheo oa bobeli oa kabo ea lihlopha ke karohano ea ntho ea mantlha e sebetsang tlhahisong ea moriana. Litlhare li fapana ho ea ka motsoako o tsebahalang:

• prednisone
• methylprednisolone,
• betamethasone
• dexamethasone, jj.

Ho na le phapang ea kliniki ho lithethefatsi tsa lihormone ho latela nako eo motho a pepesehang ka eona, e thehiloeng ho sebelisoa lipatlisiso tsa mahlale. Glucocorticoids e arotsoe ka mekhoa:

• ponts'o e kgutshwane
• nako e mahareng
• ketso e telele (e telele).

Ka bokhuts'oanyane bo bokhuts'oanyane bo bolelang, e leng analogue ea maiketsetso. Ka lebaka la ho senyeha ha sebopeho sa eona, ha e ame tekanyo ea metabolite ea metsi le letsoai ebile ha e hatake metabolism ea cellular.

Betamethasone le dexamethasone, e nang le foromo e hlophisitsoeng ea sebopeho, ba khona ho ba le phello ea nako e telele, ha prednisolone le methylprednisolone ke lithethefatsi tsa nako e mahareng tsa tšusumetso.

Ho tsa bongaka, ho na le karohano e 'ngoe ea li-glucocorticoids, tse li khethollang ka tšebeliso ea ntho ea bohlokoa, mme e kenyelletsa kabelo:

• metsoako ea tlhaho ea tlhaho (tlhaho),
• analogue ea maiketsetso (mafura),
• analogue ea maiketsetso (e nang le fluorine).

Ha ho na gradation e teng, ka lebaka la tšebeliso e pharalletseng ea mefuta e fapaneng ea HA, e kenyeletsa litšobotsi tse felletseng tsa lithethefatsi tsa lihormone, mme e sebelisoa ho terminology ea profeshenale ea lihlopha tse itseng tsa saense tse tšoanelehang.

Litlhare tsa Hormonal tsa tšusumetso ea kahare

Lithethefatsi tsa khato ea kahare le tsona li arotsoe ka:

• intranasal (e sebelisoa ka nko),
• motsoali
• ka molomo (incheded)
• inhalation.

Karohano e joalo ea lithethefatsi e fana ka tlhaiso e hlakileng ea mafu ha o beha mofuta oa moriana. Li-Intranasal li tloaetse ho phekola:

• allergic rhinitis
• ho ruruha ha mucosa ea ka mpeng,
• e nang le polyp ka nko.

Parenteral e sebetsa bakeng sa mafu a adrenal cortex, maloetse a mang a qoqotho le mafu a mang a rarahaneng.

Lithethefatsi tse nang le moea o mong le o mong tse kenang ka hare li khethehile hore motho a pepese, 'me li laeloa bakeng sa ho hlobaela ka thata. Lerotholi la bronchial, COPD, le allergic rhinitis li alafshoa ka litlhare tsena, e le pheko ea mantlha. Bakeng sa lithethefatsi tse tloaelehileng haholo tsa ho hema, ho ka hlokomeloa:

• triamcinolone acetonide,
• beclomethasone dipropionate,
• mometasone furoate,
• budesonide
• fluticasone propionate.

Litaba tsa maloetse a tebileng a tsamaiso ea phefumoloho a qobelloang ho etsa liteko tsa tleliniki tsa lithethefatsi tse ncha tse fuoang kalafo bakeng sa kalafo ea asthma ea bronchial nakong ea kemolo. Ba bonts'itse hore kalafo e nang le mouoane oa lithethefatsi sebakeng sa pathological ha e eketse feela ts'enyo ea bana ba nang le mafu a endocrine, empa ba boetse ba etsa hore ho hlokomeloe ponahalo ea bona ho bana ba tsoaletsoeng ke bo-mme ba nang le asthma mme ba sa sebeliseng inhalers ho fokotsa maemo a bona.

Ho hlaha ha mofuta oa intranasal le ho inhaled oa ho lokolloa ha lithethefatsi ho pholositse bakuli ho tsoa ho tse ling tsa likotsi tse tloaelehileng ha ho sebelisoa meriana ea botsali e sebelisang HA.

Ka nts'etsopele ea mefuta ea pharmacotherapeutic, le li-analogue tse ncha tsa maiketsetso, tšebeliso ea lihormone tsa glucocorticoid, tse sebelisoang ntle le ho ama litho tsa kahare le methapo ea metabolic, ha e na kotsi.

Pharmacodynamics le mochine oa ts'ebetso

Khokahano ea tlhaho ea lihormone tse hlahisoang ke litšoelesa tsa adrenal e hokahanngoa ke pituitary gland le hypothalamus, mme e etsoa ho sebelisoa mangolo a tlatselletsang a khoutu e itseng ea lihormone ho receptor ea sele. Patlo ea mangolo pakeng tsa likarolo tse tlamang e ka etsoa kahare ho membrane ea sele le kantle ha lihormone li sa khone ho kena seleng. Li-HA li tlama ho li-receptor tse khethehileng tsa glucocorticoid kahare ho membrane ea sele, e bakang ponahalo ea RNA le liphatlalatso tse tsamaeang le tsona tsa liprotheine tse laoloang.

Ho na le mochine oa cytostatic o ka emisang litlamorao tsa lihormone, le lintho tsa enzymatic le lik'hemik'hale tse potlakisang ts'ebetso ea ho sebelisana.

Litlamorao tse kholo tse fumanoeng ke tšebeliso ea corticosteroids 'meleng oa motho li ka bitsoa tse latelang:

• tlolo ea motsoako oa babuelli ba tšoaetso (le lechotrienes), ka ho thibela le ho thibela enzyme ea phospholipase,
• ka litekanyetso tse fapaneng, phepelo ea litlamorao tsa immunosuppressive le immunostimulating, thibelo ea tlhahiso ea antibody, tlhahiso ea li-lymphokines le cytokines,
• ntho e sitisang motho ho e ntša, ho tiisa lera la semola ea sempa.
• phello ho metabolism ea protheine, lik'habohaedreite, calcium, mafura, metabolism ea methapo ea metsi,
• kutloisiso e eketsehileng ea marako a methapo ea mali, le mesifa ea pelo ho,
• ho susumetsa sebopeho sa lisele tse khubelu tsa mali le liplatelete,
• thibelo ea tlhahiso ea leukocytes, basophils le eosinophils,
• litlamorao ho li-hormone tse ling, ho kenyeletsa li-genital, luteinizing, lihormone tsa qoqotho.

Ha li nkuoa ka molomo, li kenella ka potlako, ka mpeng e nyane, li fihla sehlohlolong ka nako e ka tlase ho hora. Kenyelletso ke phapang ea botsoali, 'me e fanoa ke litšobotsi tsa moriana. Li pepesoa ka liphio, li tlama liprotheine tse maling, hape li silafalitsoe ke karolo ke karolo ea sebete. Tsela ea tsamaiso e its'etleha ho mofuta oa sethethefatsi le litšobotsi tsa lefu lena. Molemong oa kalafo ea musculoskeletal system, le ente ea intraarticular le eona e sebelisoa.

Lethathamo la lithethefatsi tsa lihormone

Lethathamo la lithethefatsi tsa sehlopha sa li-glucocorticoid li atile haholo, empa ho tsa bongaka tse latelang ho nkuoa ho tloaelehile haholo:

• Prednisone
• Triamcinolone
• Dexamethasone
• Betamethasone.

Litlhahlobo tsa lithethefatsi tlasa mabitso a khoebo, kapa mefuta e meng e nang le sebopeho se fetotsoeng, li nkuoa li sa tloaeleha, 'me li hloka ho ithuta litaelo, le litlhaloso tse hlakileng tsa sebopeho le lipontšo, sebopeho sa formula ea lik'hemik'hale le likarolo tsa morero.

Ho latela lethathamo la B, hloka maemo a itseng a polokelo. Pele ho ts'ebeliso e ikemetseng ea lithethefatsi tse joalo, o lokela ho bona ngaka ea hau, o ele hloko ka ho khetheha monyetla oa ho sebelisa lithethefatsi kapa lithethefatsi bakeng sa masea, bana, basali baimana.

Lithethefatsi tsohle tsa sehlopha sa lihormone tsa glucocorticoid li hlalositsoe ho Sehlopha sa Anatomical-therapeutic-chemical classication (ATX), se nang le sebopeho sa hierarchical le se nolofalletsang ho batla meriana e nepahetseng. Moriana leha e le ofe oa sehlopha sena o feta tlhatlhobo ea bongaka e bohlokoa haholo, mme o hlalosoa ke litsebi.

Matšoao a ho sebelisoa

Ho fihla joale, ha se feela lehlakore le litla-morao tsa kalafo tse ithutoang hantle, empa le tšebelisano ea HA ka lithethefatsi tse ngata, litekanyetso tse hlokahalang, le li-regimens tsa kalafo tse rarahaneng li se li hlahisitsoe. Sena se ile sa nolofalletsa tšebeliso ea lithethefatsi makaleng a mangata a meriana, e le lithethefatsi tsa mantlha le tse thusang.

Maemo a bohloko ba ho hloka thuso ntle ho pelaelo GK e tla etsa lethathamo le lelelele la li-pathologies tse sa foleng, tsa tsamaiso le tse mpe. Rheumatology li sebelisetsoa ho phekola:

• systema lupus erythematosus,
• ankylosing spondylitis,
• systemic scleroderma,
• rheumatic polymyalgia.

Glucocorticoids e sebelisoa kalafo ea vasculitis le pyelonephritis, ho endocrinology eo ba e phekolang:

• ho hloleha ha adrenal
• thyrotooticosis le bofokoli.

• ulcerative colitis,
• hepatitis e matla
• Lefu la Crohn le sethaleng se matla.

Empa tekanyo ea lithethefatsi tse nang le li-hormone ha e felle feela ho sena. Cardiology e sebelisa bakeng sa:

• mefuta e meng ea pericarditis,
• post-vaerase le e seng e khethehileng ea leukocyte myocarditis.

• le asthma ea lefu la bronchial,
• eosinophilic pneumonia,
• alveolitis le bronchiolitis,
• sarcoidosis ea matšoafo.

Ho hematology, lithethefatsi tsa li-hormone li phekola thrombocytopenia le anemia.

HA - sethethefatsi sa bohlokoahali sa boikhethelo maemong a hlobaetsang, le ho fetella. Leha ho na le li-contraindication le litla-morao, li-glucocorticoids ke tse ling tsa tse sebelisoang haholo, 'me ka linako tse ling li ke keng tsa fumaneha, litlhare bakeng sa liso tse matla le maemo a hlobaetsang. Phekolo ea mafu a lesapo la mokokotlo a sebelisoa bakeng sa kalafo:

• osteochondrosis,
• ho kokobetsa bohloko
• ramatiki e sa tšoaetsang,
• Ankylosing spondylitis,
• Tšenyo ea lesapo la mokokotlo le litho tsa kahare.

Ho thehoa ha lithethefatsi tse entsoeng ka maiketsetso ho potlakisitse le ho eketsa tekanyo ea ts'usumetso ea sehlopha sena sa lithethefatsi, ho eketsa leholo la mesebetsi ea bona.

Likarolo tsa tšebeliso ea kalafo ea li-hormone le lithibelo

Glucocorticosteroids, ka lebaka la ts'ebeliso e atileng, e sebelisoa makaleng a fapaneng a meriana bakeng sa kalafo ea bongata bo fapaneng ba mafu. Hoo e batlang e le maemong ohle a tsebahalang, mekhoa ea phekolo le protocol e se e entsoe ka libaka tse fapaneng.

Nako ea ts'ebetso ea lithethefatsi, tekanyo ea litlhahiso tsa eona, nako ea thupelo ea kalafo, nako e khuts'oanyane, kapa nako e telele, esita le litekanyetso tse itseng li ka tlasa bokhoni ba ngaka e tsebang ho sebetsana le moriana o itseng.

Ke ka lebaka leo ho buuoang haholo ka ho se khonehe ha taolo ea lithethefatsi tsa lihormone tsa maiketsetso, mabapi le ts'ebeliso e matla ea ts'ebeliso ea bona, ka hloko le ka tsela e nahanang ea lithethefatsi tsa sehlopha sena. Mokhoa leha e le ofe oa phekolo o ka fanang ka likotsi tse mpe 'meleng oa motho, o na le pheko e mpe ka ho fetesisa. Ka hona, kalafo e lokela ho etsoa feela ke ngaka e tsebang mathata ohle a litlamorao tsa lithethefatsi tse itseng.

Litaelo tsa ho sebelisoa:

Glucocorticosteroid - ntho ea tlhaho kapa ea tlhaho e tsoang ho subclass ea lihormone tsa adrenal cortex.

Tšusumetso ea li-glucocorticosteroids 'meleng

Ka tlhaho ea bona ea lik'hemik'hale, lintho tsena ke li-steroid. Ho batho le liphoofolo, sebaka sa mantlha sa sebopeho sa bona ke adrenal cortex. Li-glucocorticosteroids ka kakaretso li eketsa ho hanyetsa hoa 'mele ho litlamorao tse sithabetsang,' me sena ke bohlokoa ba tlhaho ba lintho tsena tsa lihormone.

Glucocorticosteroids e ama metabolism 'meleng, haholo-holo ho lik'habohaedreite, liminerale, proteni le metsi.

Mekhoa ea litlhare e entsoeng ka mokhoa o entsoeng ka sebopeho sa "glucocorticosteroid" e sebetsa e le lithethefatsi tse khahlanong le ho ruruha, tse nyahamisang, tse thibelang likokoana-hloko, tse thibelang likokoana-hloko le tse thibang lefu.

Litlamorao tse ka sehloohong tsa glucocorticosteroids

Glucocorticosteroids e hlokomela phello ea eona ka ho fapana ka lisele tsa cell ho cytoplasm. Ha ba le moo ba tlama ho li-receptor tse ikhethang tsa tlhaho tse ka tsona li amang synthetiki.Tšusumetso ea li-hormone tsena ho phospholipase A2 le hyaluronidase, e leng li-enzyme tsa ho ruruha, le tsona lia tsebahala.

Maemo a sehlopha sena a tsitsisa li-membran tsa lisele, tse thibelang ho lokolloa hoa lintho tse sebetsang (histamine, leukotrienes, thromboxane) ho lisele tsa methapo. Ba liehisa ho theha li-cytokine tsa pro-inflammatory tse tsoang arachidonic acid.

Phello e matla ea immunosuppression ea lihomone tsa glucocorticosteroid e sebelisoa kalafong ho thibela khatello e matla ea sesole sa 'mele se tsamaisoang ke' mele oa hau. Sena se hlokahala bakeng sa ho fetisoa ha litho (k.q., Liphi, moko oa masapo), bakeng sa maloetse a mabe, mafu a autoimmune. Tšusumetso e ntle ea kalafo e nang le glucocorticosteroids e fihlelloa ka ho hatella ho falla ha lisele tsa bakoang le li-lymphocyte, hammoho le tšebelisano ea lihlopha tse fapaneng tsa li-lymphocytee ka bomong.

Bokhoni ba li-glucocorticosteroids ho eketsa khatello ea mali bo bonoa ka ho eketsa ho ntšoa ha adrenaline le ho khutlisetsa kutloisiso ea li-receptor tsa adrenaline ho eona, e fokotsang lumen ea lijana le ho fokotsa boteng ba tsona. Thepa ena e ba lumella ho sebetsana le maemo a ts'ohanyetso maemong a mahlonoko.

Li-glucocorticosteroids li eketsa sebopeho sa tsoekere maling le ho phatloha ha liprotheine, tse eketsang litaba tsa amino acid le glucose ea mahala maling. Tabeng ena, 'mele o amohela lintho tse nang le matla a mangata.

Phekolo ea Glucocorticosteroid

Ka moriana, litokisetso tsa glucocorticosteroid ho latela nako ea ts'ebetso li arotsoe ka lihlopha tse 3: nako e khuts'oane, e bohareng le ketso ea nako e telele.

Li-glucocorticosteroids tse haufinyane li kenyelletsa hydrocortisone. Ena ke analogue ea hydrocortisone ea 'mele, ha e bapisoa le lithethefatsi tse ling, e na le phello e fokolang ho metabolism ea metsi a letsoai.

Litlhare tsa glucocorticosteroids tse mahareng - methylprednisolone le prednisolone.

Li-glucocorticosteroids tse sebetsang nako e telele li kenyelletsa betamethasone le dexamethasone.

Phekolo ea li-glucocorticosteroids, mefuta ea tsamaiso ea molomo, inhalation, intranasal le parenteral e sebelisoa.

Lithethefatsi bakeng sa tsamaiso ea molomo li kenelletse hantle ho tsoa ho tšilo ea lijo, maling a li tlama ho protheine ea plasma. Li sebelisetsoa ho phekola ho senyeha ha methapo ea kutlo ea adrenal cortex, ho hloka tlhokomelo ea mantlha le ea bohareng ea adrenal, ka subacute thyroiditis, lefu la Crohn, mafu a lipakeng tsa matšoafo le COPD sethaleng se matla.

Ho "glucocorticosteroids" a inhaled, budesonide, triamcinolone acetonide, beclomethasone dipropionate, mometasone furoate, proputate ea fluticasone hangata li sebelisoa. Li loketse hantle kalafo ea mantlha ea asthma le COPD, allergic rhinitis.

Li-glucocorticosteroids tsa kahare li kenelletsoa bakeng sa polyposis ea nasal, allergic le idiopathic rhinitis. Bohlokoa ba tsamaiso ea bona bo fana ka maikutlo a hore karolo ea lithethefatsi e tla kena mucosa ea nasal le pampiri ea ho phefumoloha, 'me karolo e' ngoe e tla metsoa le ho kenella ka mpeng ea tšilo ea lijo.

Li-glucocorticoids ke eng

Glucocorticoids ke mofuta oa lihormone tsa motho tse hlahisoang ke litšoelesa tsa adrenal, kapa ho e-na le makhapetla a tsona. Li nka karolo e mafolofolo lits'ebetsong tse etsahalang 'meleng. Lihormone tse joalo li qala ho sebetsa, haholo maemong a tšohanyetso: ho tsitsipana, khatello ea maikutlo, khatello ea maikutlo. Sena se etsa qeto ea ts'ebeliso ea bona ea bongaka e le ho fana ka litlamorao tse khahlanong le ho ruruha.

Mokhoa oa mosebetsi oa bona o batla o le ka tsela e latelang:

1. hormone, e kenang ka seleng, e ama li-receptor,
2. liphatsa tsa lefutso tse laolang karabelo ea 'mele ea ho itšireletsa mafung lia sebetsa,
3. mosebetsi o sebetsang oa liphatsa tsa lefutso o fokotsa ho ruruha le ho sitisa sesole sa 'mele.

Hape, lihormone tsa glucocorticoid li hlohlelletsa methapo ea mali ho etsa lintho tse ngata, tse tsoang ho tsona li ba tlase haholo, ha ts'ebetso ea lisele tsa sebete e butsoa. Kahoo, 'mele o sirelelitsoe linthong tse chefo le maemong a tšosang.

Matšoao a kalafo ea glucocorticoid:

• mathata a litšoelesa tsa adrenal,
• mafu a tsamaiso ea masculoskeletal,
• allergy
• asthma
• mafu a letlalo
• sarcoidosis
• Lefu la Crohn.

Haeba mokuli a imetsoe ke asthma kapa allergies, joale lihormone li laetsoe ka mokhoa oa ho inhalations.

Litlamorao

Li-Glucocorticoids li na le phello e ntle tlhahisong ea li-hormone tse ling 'meleng. Tšoelesa ea qoqotho e angoa habonolo ke sena. Tlas'a tšusumetso ea lihormone tsa adrenal, ts'ebetso ea eona ea fokotseha.

Litla-morao tsa glucocorticoid kalafo li ka aroloa ka lihlopha tse peli: ea lehae le ea methapo.

Litlamorao tsa tikoloho

Hangata, litlamorao tse sa rateheng tsa mofuta ona li hlaha kamora ts'ebeliso ea litokisetso tsa inhalation tsa li-hormone.

Ntlafatso ea lefu la tsoekere - e-nooa feela letsatsi le leng le le leng.

Mokuli a ka khathatsoa ke:

• nko ea lona
• ho tsitsipanya khafetsa
• mofufutso ka nasopharynx,
• candidiasis molomong
• khohlela.

E le molao, li lula li le teng ka nakoana 'me li nyamela ka ho felletseng ka mor'a hore phekolo ea li-hormone e felisoe.

Litlamorao tsa systemic

Lethathamo la litla-morao tsa mofuta oa tlhaho e ntle haholo. Haholo-holo ho ipapisitse le hore na ke tsamaiso efe e hlaselehang habonolo.

Lithethefatsi tsa Steroid li hatella ka botlalo phello ea litšoelesa tsa adrenal. Le ha kamora ho felisoa ha li-steroid, ka nako e telele ha ba sa khona ho sebetsa hape "ka matla a felletseng." Ho khaotsa ho ba le 'mele ho kotsi hobane' mele o ka ba le khaello e matla ea li-glucocorticoids. Le haeba ho lemala kapa ho imeloa kelellong ho ka baka likotsi tse mpe 'meleng. Motho ea nang le ho haelloa ke lihormone tse joalo o ikutloa a le kotsi, a e-na le kutloelo-bohloko. Ho na le khaello ea takatso ea lijo le ho fokotsa boima ba 'mele haholo.

Kameho e kholo ka ho fetisisa ke bokhoni ba ho sebelisa li-steroid. Ho fokotseha ha khatello tlasa tšusumetso ea bona ho thata haholo ho e phekola ka litlhare tsa setso.

Lithethefatsi tsa Steroid li hatella boits'ireletso ba batho, haholoholo ka ho fokotsa ho itšireletsa ha 'mele khahlanong le tšoaetso ea baktheria. Kotsi ea ts'oaetso e itshetlehile ka kotloloho ho lethal dose la li-glucocorticoids: tekanyetso e phahameng - kotsi e phahameng. Matla ana ke sesosa sa nts'etsopele ea mathata, hangata a nang le sephetho se bolaeang.

Ka kalafo e khutlisang li-hormone, ts'oaetso e ka mpefala, ho ka eketsoa mocheso oa mmele feela. Ho qoba litla-morao tse joalo, ente ea ente le pneumococcus e khothaletsoa ho bakuli pele ho kalafo. Hape, e ke ke ea ba phoso ho etsa tlhahlobo ea lefuba.

Hangata li-glucocorticoids li baka mathata a kelello ho bakuli. Sena se ka bonahatsoa ka bobeli ho halefeng hanyane, le khatello e matla ea maikutlo le psychosis.

Hangata litlamorao tsa kalafo ea lihormone e kanna ea ba phetoho ponahalong ea mokuli: boima ba 'mele, ho potoloha sefahleho, makhopho, matšoao a lilac, ho luma. E le molao, litlamorao tse joalo tse sa rateheng lia fokotsoa kapa li nyamela ka botlalo kamora ho fokotsa tekanyo.

Re fana ka theolelo ho babali ba sebaka sa rona sa marang-rang!

Bongata

Ho eketsa tekanyetso e hlokahalang, ea mofuta ofe kapa ofe oa moriana, ho ama bophelo ba mokuli hantle le bophelo ba hae. Mofuta o mong oa li-glucocorticoids ha o etsahale hangata.

• ho ruruha
• tlolo ea tekano ea motlakase 'meleng,
• cramps.

Maemong a sa tloaelehang haholo, bohloko ba ka mpeng, ho otla ha pelo, ho nyekeloa le pelo le ho hlatsa lia khonahala.

Ka matšoao a pele a moriana o feteletseng oa moriana oa li-hormone, tsamaiso ea ona e tlameha ho emisoa. Phekolo ke matšoao. Phekolo e khethehileng ha e etsoe.

Ho sebelisana le meriana e meng

Haeba mokuli a sebelisa moriana leha e le ofe khafetsa, ho hlokahala ho tsebisa ngaka ka sena pele ho khethoa ha glucocorticoids. Ho sebelisana ha lithethefatsi tse ling le e mong ho ka baka litlamorao tse sa batleheng.

Tšebeliso e tšoanang ea lithethefatsi ho fokotsa acidity ea ka mpeng ka li-steroid e nyenyefatsa phello ea eona. Ts'ebeliso e kopaneng ea lihormone le li-aspirini li ka baka sebopeho sa liso ka mpeng ea tšilo ea lijo, le ka paracetamol - keketseho e mengata ea chefo ea eona.

Meriana e etselitsoeng ho theola litekanyetso tsa tsoekere e felloa ke matla haeba e sebelisoa ka ho tšoana le glucocorticoids. Lihormone tsa steroid hammoho le diuretics li ka baka tsitsipano ea potasiamo ho tsoa 'meleng.

Ka tlhokomeliso, ho hlokahala hore u ise lithethefatsi tse joalo ho batho ba botsofe, bakuli ba nang le lefu la sebete la sebete, hobane maemong ana phello ea lihormone e ka matlafatsoa.

Bakuli ba nang le phekolo ea li-hormone tsa immunosuppressive ba tšoaetsanoa ka ente ea liente tsa 'mele.

Mokhoa oa ho fokotsa litla-morao

Ho na le lihlopha tse ling tsa bakuli ba kopantsoeng le phepo ea glucocorticoid.

Tsena li kenyeletsa:

• bakuli ba nang le lefu la tsoekere
• bakuli ba nang le nalane ea tlhekefetso ea kelello,
• bakuli ba gastrointestinal tract
• bakuli ba nang le khatello e matla ea mali le / kapa ho nyekeloa ke pelo.

Tse ling kaofela li ka sebelisoa kalafo ea lihormone. Ho fokotsa kotsi ea litlamorao, o lokela ho hlokomela bophelo ba hau ka hloko. Haeba ho fumanoe li-pathologies leha e le life, ngaka e lokela ho tsebisoa ka sena.

Bakuli bohle ba fumanang kalafo ea steroid, ho sa tsotelehe mofuta oa bona le mofuta oa bona, ba khothalletsoa ho nka li-vitamini-mineral complexes, tlhokomelo e khethehileng e lokela ho lefuoa calcium le vithamine D. Maemong a mang, o ka hloka ho nka insulin.

Bakeng sa ho hlaka le bonolo ba pono, litla-morao tsohle le mekhoa ea ho li emisa li hlahisitsoe ka har'a tafole.

Lethathamo: "Litlamorao tse sa rateheng tsa kalafo ea steroid le litsela tsa ho li fokotsa"

Litla-morao	Litšobotsi tsa bohlokoa	Lihormone tse nang le litlamorao tse mpe (linyeoe khafetsa)	Liphello tsa Phokotso ea Phello
Phokotso ea mouoane 'meleng	Ho ruruha, joalo ka molao, ho hlaha sefahlehong, maoto.	Cortisone, hydrocortisone.	Tšebeliso ea li-diuretics, ho khomarela lijo tse nang le sodium e tlase.
Osteoporosis	Bohloko bo boholo manonyeletsong, mokokotlong, masapo a masapo le vertebrae (haholo-holo maqheku)	Dexamethasone	Tšebeliso ea vithamini D, letsoai la calcium
Tšenyo ea mesifa	Ho utloa bofokoli ba maoto le matsoho, bofokoli.	Dexamethasone, Prednisone, Prednisone.	Tšebeliso ea li-anabolics, ho felisoa ha dexamethasone.
Alsa ea Peptic	Maemong a mangata, e asymptomatic. Khethong e le 'ngoe ho tse 10, ho tsoa mali ho ka hlaha.	Prednisone, prednisolone.	Ho khothalletsoa Methylprednisolone Mokhoa o nepahetseng oa tsamaiso ke oa batsoali.
Lefu la tsoekere la Hormonal	Ha e le molao, mathata a lefu la tsoekere ha a bonoe.	Betamethasone	Tšebeliso ea mefuta e meng ea kalafo.
Mathata a kelello	Matšoenyeho, ho ferekana ho feteletseng, ho hloka boroko, khatello ea maikutlo, psychosis.	E hlaha ka seoelo haholo ha u sebelisa methylprednisolone.	Haeba ho khonahala, kenyeletsa kalafo ea li-hormone ho batho ba nang le psyche e sa tsitsang. Ntle le monyetla o joalo oa ho sebelisa li-psychotropics ka li-steroid.
Ho phahamisa boima ba 'mele	Ho utloa tlala ea kamehla, takatso e eketsehileng ea lijo.	Dexamethasone	Phepo e nepahetseng ea phepo e nepahetseng, mokhelo oa eona oa lihormone tse hlahisang boima ba 'mele.
Ho fokotsa boima ba 'mele haholo	Ha ho na matšoao a hlakileng.	Triamcinolone	Tšebeliso ea li-anabolic steroids, li-amino acid.

Ka bomalimabe, kalafo e nang le glucocorticoids hangata e amana le ponahalo ea litla-morao tse itseng. Boikarabello ba sena bo ho ngaka le mokuli.Ngaka e hlokahala hore e ithute ka botlalo nalane ea mokuli ho sa kenyele monyetla oa menyetla ea meriana e nkuoeng. Mokuli le eena o lokela ho ela hloko litekanyetso le nako ea ho sebelisa litlhare.

Glucocorticoids ke meriana e tebileng. Ts'ebeliso ea bona e lokela ho hanyetsoa feela ka tlhoko e kholo. Phekolo e lokela ho ba khutšoanyane kamoo ho ka khonehang.

Ho amohela li-hormone maemong afe kapa afe ho khopisa botsitso 'meleng. Taba ea bohlokoa ke hore litlamorao ho mokuli ha li na letho.

Haeba ho na le monyetla oa ho etsa ntle le tšebeliso ea phekolo ea li-hormone, ho ka ba molemo ho e sebelisa.

Lefu la tsoekere le lula le baka mathata a bolaeang. Tsoekere e ngata haholo e kotsi haholo.

Aronova S.M. e fane ka litlhaloso mabapi le kalafo ea lefu la tsoekere. Bala ka botlalo

Mokhoa oa ketso le litlamorao

Li-corticosteroids ke lihormone tsa steroid ka tšimoloho ea tsona, ts'ebetso ea tsona ea ts'ebetso e fapane le lihormone tsa tlhaho ea protheine. GCS e kenella liseleng tse fumanehang ho eona, 'me e kenella ka hare ho cytoplasm ea eona ka har'a membrane ea sele, moo e tlamehang ho kenella ho li-receptor le ho hlahisa matla a tsona a ikhethang.

Lithethefatsi tsena tsa li-hormonal li ama ts'ebetso ea lisele tse ngata 'meleng mme li bohlokoa haholo. Litholoana tsa tsona tse kholo ke tse latelang:

1. 1. Kenya letsoho taolong ea metabolism e tloaelehileng:
   1. Li ama metabolism ea lik'habohaedreite (eketsa khatello ea tsoekere maling maling ka mekhoa e fapaneng).
   2. 2. Ho ama metabolism ea "protheine" (hlohlelletsa sebopeho sa RNA le protheine sebeteng, e khothaletsa ho phatloha ha liprotheine ho mesifa le lisele tse ling).
   3. 3. E ama metabolism ea mafura (libakeng tse fapaneng mekhahlelo e fapaneng ea 2 e etsahala - kholo le ho bola ha litamati tsa adipose).
2. Ts'ebetso ea mineralocorticoid. Li khona ho susumetsa li-receptors bakeng sa mineralocorticoids (leha e le ka tekanyo e tlase ho feta lihomere tsa mineralocorticoid), tseo ka lebaka leo li lebisang ho khutliseng ho sodium ea 'mele. Sena se baka ts'oarelo ea mokelikeli, ho eketsa molumo oa mali le ho eketsoa ha ion ea potasiamo.
3. Ho itoanela ha 'mele khatello ea maikutlo hoa eketseha. Keketseho ea tsoekere ea mali tlas'a ts'ebetso ea li-glucocorticoids e e fa matla a hlokahalang ho itšireletsa khahlanong le khatello ea maikutlo e bakoang ke khatello ea maikutlo, ts'oaetso, bokuli, jj.
4. Li na le phello ea immunosuppressive (fokotsa palo ea lihlopha tse fapaneng tsa lisele tse tšoeu tsa mali).
5. Li na le tšusumetso e matla e khahlanong le ho ruruha, e hlalosoang ke ho fokotseha ha maemo, ho abjoa ha ts'ebetso ea T- le B-lymphocyte le tlolo ea sebopeho sa babuelli ba methapo. Ba tsitsisa li-membrane tsa lysosome, ba fokotsa ho tsoa ha histamine ka basophils. Ka lebaka leo, mekhahlelo eohle e meraro ea ho ruruha e thibetsoe.
6. Kenya letsoho taolong ea tsamaiso ea endocrine: fokotsa butle-butle secretion ea ACTH le thyrotropin, eketsa tlhahiso ea lihormone tsa kholo.
7. Ama mokhoa oa ho hema. Ka popelong khoeling ea ho qetela ea bokhachane, corticosteroids e kenya letsoho ho thehoeng, e koahelang alveoli ea matšoafo kahare mme e hlokahala ka bobeli bakeng sa ho bula ha bona ka nako ea phefumoloho ea pele, le ho sireletsa lisele tsa bona hore li se ke tsa putlama nakong e tlang.
8. E ama tsamaiso ea pelo le pelo. GCS e eketsa khatello ea mali le ho e tsitsisa boemong bona bo phahameng. Tšusumetso e amahanngoa, ka lehlakoreng le leng, le keketseho ea molumo oa mali ka lebaka la ho bolokoa ha metsi ka lebaka la ts'ebetso ea mineralocorticoid, 'me ka lehlakoreng le leng, ka keketseho ea kutloisiso ea mesifa ea pelo le methapo ea mali ho endateo catecholamines (adrenaline le norepinephrine).
9. Ama ts'ebetso ea hematopoiesis. GCS e thibela ho thehoa hoa lintlha tsa hematopoietic tse hlokahalang bakeng sa ho arola lisele tsa bakoang ke 'moko o mofubelu. Khahlano le semelo sena, boemo ba basophils, eosinophils le monocytes maling bo fokotseha. Sebopeho sa neutrophils sea eketseha.

Hydrocortisone - mefuta ea litekanyetso le litaelo tsa ho li sebelisa

Glucocorticoids: sebaka sa kalafo

Bakeng sa phekolo ea pharmacodynamic (ho fapana le ho nkeloa sebaka), ho molemo ho sebelisa lithethefatsi tse nang le mosebetsi o fokolang oa mineralocorticoid. Glucocorticoids e sebelisitsoeng ts'ebetsong ea bongaka e na le phapang e itseng ho matla a litlamorao tse kholo tsa kalafo, pharmacokinetics le bongata ba litla-morao tse lokelang ho tsotelloa ha u fana ka taelo.

Glucocorticoids e sebelisoa ho sebelisoa ka mokhoa o thethebatsang le ho tsosa takatso maemong a latelang: hypotension le madi a maholo le liphokoletso tsa bona, bothateng ba khatello ea methapo ea pelo le mokokotlo,

• trauma, hemorrhagic
• Tšoaetso e kotsi
• karabelo kapa lintho tse sa fetoheng tse amang (edema ea Quincke, urticaria e hlobaetsang, boemo ba asthmatic, litla-morao tse kotsi le tse ling, jj.),
• karabelo ea ketso ea tlhaho ho li-narcotic analgesics kapa lithethefatsi tse ling tsa pharmacological,
• a hlobaetsang le adrenal ho haella.

Bakeng sa kalafo ea maemo a tšohanyetso a maemo a kang ho ts'oaroa, ho kula, ho tahoa, glucocorticoids li fanoa iv. Kenyelletso e ka ba e le 'ngoe kapa e phetoa ka matsatsi a' maloa.

Letšoao le ka sehloohong la ts'ebeliso ea li-glucocorticoids nakong ea ho hema le nakong ea ts'ebetso ea pele ea ts'ebetso ke ho fokotseha ha SBP ka tlase ho 80 mm Hg. Art., E ka bonoang maemong a mangata a pathological. Tsamaiso e kenelletseng ea li-corticosteroids nakong ea ho kenella ha anesthesia le tlhokomelo ea eona e lumella ho fihlella ka potlako ho tsitsisa ha hemodynamics Khahlano le nalane ea kalafo e rarahaneng nakong ea metsotso e 10 ho tloha ho hlahisoa ha lethal dose la pele.

Hangata nakong ea ts'ebetso ea opereishene, li-glucocorticoids li sebelisoa ka tekanyetso e fapaneng: ho tloha ho 20 ho isa ho 100 mg ha ho baloa ka lethal dose ea prednisolone. Ho feta moo, katleho ea ts'ebeliso ea bona kalafong e rarahaneng e ka fihla ho 96%. Ke maemong a fokolang feela moo lithethefatsi li sa sebetseng. Hangata, ho se be teng ha phello ea hemodynamic ho bonoa ho bakuli ba nang le ho fokotseha ha khatello ea mali ho arabela ho hlahisoa ha anesthetic ea lehae (mohlala, trimecain). Ha ho na phello ea litekanyetso tse le 'ngoe tsa glucocorticoids ho bakuli ba noang haholo haeba mohloli oa eona o ne o bolokiloe, le maemong a sa tloaelehang, ho hanyetsa ha' mele litabeng tsa lithethefatsi.

Mathateng a potoloha ka matla a mali, phello ea kalafo ea li-glucocorticoids e lemohuoa ka keketseho ea ho fokola hoa litho tsa 'mele, keketseho ea venous Outflow, normalization ea pherekano le ST, ho tsitsisa ha litho tsa kahare le lysosomal le litlamorao tse ling. Leha ho na le ts'ebeliso ea moetlo ea li-glucocorticoids ka mefuta e fapaneng ea tšabo, ts'ebetso ea tsona maemong ana e lula e sa buloa. Sena se bakoa ke ho rarahana ha akhaonto bakeng sa lintlha kaofela, tse tlasa nts'etsopele ea maemo a makatsang mme li ama katleho ea bongaka. Ts'ebeliso ea li-glucocorticoid maemong ana e lokela ho etsoa ka kopanelo le lets'oao lohle la litekanyetso tsa bongaka ba ho lokisa mathata.

Tšebeliso e pharalletseng ea li-glucocorticoids e fumanoa kalafong ea lintho tse kulang tse etsahalang nakong ea taolo ea meriana e amanang le ts'ebetso ea lingaka tse ling. Maemong a matla a lefu la IV, taolo ea litekanyetso tse lekaneng tsa glucocorticoids e na le phello e matla. Ho qala ha li-glucocorticoids ho mafu a allergic ho lieha. Kahoo, mohlala, litlamorao tse kholo tsa hydrocortisone li nts'etsapele lihora tse 2-8 feela kamora taolo. Ka hona, bakuli ba nang le karohano e matla ea ho kula ho qoba bronchospasm ba hloka ho tsamaisoa ha epinephrine hanghang.

Li-Glucocorticoids li na le phello e phatlalalitsoeng ea ho hloka thari ea adrenal, e qalileng pele le nakong ea ts'ebetso ea bongaka. Hydrocortisone, cortisone le prednisone li sebelisetsoa ho phekola.

Tsamaiso ea nakoana ea GCS e sebetsanang le nako e telele e etsoa bakeng sa thibelo ea khatello ea maikutlo ho masea a tlang pele ho nako, e fokotsang kotsi ea lefu le mathata a tsoang boemong bona ka 40-50%.

Carbohydrate metabolism

E 'ngoe ea litlamorao tsa bohlokoa tsa corticosteroids ke phello ea bona e susumetsang ho gluconeogenesis. Glucocorticoids e baka keketseho ea sebopeho sa tlhahiso ea glycogen le tsoekere maling, e thibela ketso ea insulin le ho fokotsa ho kenella hoa liphatsa tsa "glucose" liseleng tse ka thoko. Ka lebaka leo, hyperglycemia le glucosuria li ka hlaha.

Protein Exchange

Glucocorticoids e fokotsa ho kopana ha protheine mme e eketsa ho phatloha ha eona, e bonahatsoang ke tekanyo e fosahetseng ea naetrojene. Matla ana a tsebahala haholo ka har'a mesifa ea mesifa, letlalo le masapo. Lipontšo tsa tekano e fosahetseng ea naetrojene ke ho theola boima ba 'mele, bofokoli ba mesifa, ho ba teng ha letlalo le mesifa, striae le hemorrhage. Ho fokotseha ha motsoako oa liprotheine ke o mong oa mabaka a ho lieha hoa lits'ebetso tsa ho inchafatsa. Ho bana, ho etsoa ha lisele, ho kenyeletsa le masapo, hoa khathatseha, kholo e ea fokola.

Lipid metabolism

Glucocorticoids e baka phetiso ea mafura hape. Kameho ea metabolism ea mafura e bontšoa ke ketso ea lipolytic ea lehae sebakeng sa maoto le matsoho, ha polelo-lipogenis e seterekeng sa kutu e boetse e hlohlelletsoa. Ka lebaka leo, ka ts'ebeliso e hlophisehileng ea lithethefatsi, mafura a mangata a bokellana sefahlehong, karolo ea 'mele, mahetla ka ho fokotseha hoa lithane tsa adipose tsa lisosa. Glucocorticoids e eketsa motsoako oa mafura a acid le triglycerides, e bakang hypercholesterolemia.

Phapanyetsano ea letsoai la metsi

Tsamaiso ea nako e telele ea GCS e lebisa tlhokomelong ea mosebetsi oa bona oa mineralocorticoid. Ho eketseha ha reabsorption ea sodium ion ho tsoa ho distal renal tubules le keketseho ea secretion ea tubular ea ion ea potasiamo e bonoa. Ho lieha ha ion ea sodium 'meleng ho baka keketseho ea butle-butle ea bcc le keketseho ea khatello ea mali. Litlamorao tsa Mineralocorticoid tsa GCS li na le tlhaho ea tlhaho ea GCS - cortisone le hydrocortisone mme, hanyane hanyane, GCS e harelaneng.

Glucocorticoids e tloaetse ho baka tekanyo e mpe ea khalsiamo 'meleng, e fokotsa ho monya calcium ho tsoa ho lijo tse silang lijo le ho eketsa tlhahiso ea eona ke liphio, e ka bakang hypocalcemia le hypercalciuria. Ka tsamaiso ea nako e telele, tlolo ea metabolism ea calcium, hammoho le ho phatloha ha liprotheine tsa protheine, e lebisa nts'etsopele ea lefu la masapo.

Lisele tsa mali

Glucocorticoids e fokotsa bongata ba eosinophils, monocytes le lymphocyte maling. Ka nako e ts'oanang, litaba tsa lisele tse khubelu tsa mali, li-reticulocytes, li-neutrophils le liplatelete lia eketseha. Boholo ba liphetoho tsena li bonoa kamora ho nka tekanyetso e le 'ngoe ea li-corticosteroids ka botebo ba phello ka mor'a lihora tse 4-6. Ho khutlisetsoa ha boemo ba mantlha ho etsahala kamora lihora tse 24. Ka kalafo ea nako e telele le corticosteroids, liphetoho setšoantšong sa mali se ile sa qeta libeke tse 1-4.

Ho latela molao-motheo oa karabo, li-glucocorticoids li na le phello e sithabetsang tsamaisong ea hypothalamic-pituitary-adrenal (GGNS), ka lebaka leo tlhahiso ea ACTH e fokotsehang. Ho haella ha ts'ebetso ea adrenal cortex e hlahang nyeoeng ena ho ka hlaha ka ho felisoa ka matla ha glucocorticoids. Kotsi ea ho ba le ho haella ha adrenal e eketseha haholo ka ts'ebeliso e tloaelehileng ea li-glucocorticoids bakeng sa libeke tse fetang tse peli.

Ketso e khahlanong le khatello ea maikutlo

Li-Glucocorticoids ke lihormone tse feto-fetohang tse eketsang matla a 'mele a ho hanela khatello ea maikutlo. Tlas'a maemo a sithabetsang a matla, tlhahiso ea cortisol e eketseha haholo (bonyane makhetlo a 10). Ho na le bopaki ba khokahano lipakeng tsa tsamaiso ea ente ea mafu a tšoaetso ea mali le GNSS. Litšebelisano tsena li ka emela bonyane bo bong ba mehato ea ketso ea ho thibela khatello ea kelello ea glucocorticoids. Ho bontšitsoe hore ts'ebetso ea GNS e laoloa ke li-cytokines tse ngata (IL-1, -2, -6, tumor necrosis factor TNF-a). Kaofela ha tsona li na le phello e susumetsang.Tse ngata li na le litlamorao tse fapaneng. Mohlala, IL-1 e susumetsa ho lokolloa ha hormone ea corticotropin-e lokollang ka li-hypothalamic neurons, e ama ka kotloloho pituitary (e eketsa tlhahiso ea ACTH) le litšoelesa tsa adrenal (e eketsa ho lokolloa ha glucocorticoids). Ka nako e ts'oanang, li-glucocorticoids li khona ho thibela ho hlahisoa ha likarolo tse ngata tsa sesole sa 'mele, mohlala, tlhahiso ea li-cytokines. Kahoo, GGNS le sesole sa 'mele li na le khokahano ea mefuta e' meli nakong ea khatello ea maikutlo 'me litšebelisano tsena ke tsa bohlokoa haholo ho boloka homeostasis le ho sireletsa' mele liphellong tse ka behang bophelo kotsing tsa karabelo e ntlafalitsoeng ea ts'oaetso.

Ketso e lumellang

Glucocorticoids e ka ama ts'ebetso ea li-hormone tse ling, ea baka litlamorao tsa tsona. Matla ana a li-glucocorticoids litlamorao tsa lihormone tse ling tse laoloang a bitsoa a lumellehang mme a bonts'a liphetoho phetohong ea protheine e hlahisoang ke corticosteroids, e fetolang karabelo ea li-tishu ho susumetso e itseng.

Kahoo, litekanyetso tse nyane tsa glucocorticoids li baka ts'ebetso e kholo ea ketso ea lipolytic ea catecholamines. Glucocorticoids e boetse e eketsa kutloisiso ea li-adrenergic receptors ho li-catecholamines le ho ntlafatsa phello ea khatello ea angiotensin II. Ho lumeloa hore ka lebaka lena, glucocorticoids e na le phello ea tonic tsamaisong ea pelo le methapo. Ka lebaka leo, molumo oa vascular o tloaelehile, contractility ea myocardial ea eketseha le permeability ea capillary ea fokotseha. Ho fapana le hoo, ho haella ha tlhahiso ea GCS ea tlhaho ho tšoauoa ka SV e tlase, ho atoloha ha li-arterioles, le karabelo e fokolang ea adrenaline.

Ho ile ha bontšoa hore li-glucocorticoids hape li ntlafatsa phello ea bronchodilating ea catecholamines, ho khutlisetsa maikutlo a beta-adrenergic receptors ho bona, e amanang le keketseho ea biosynthesis ea li-adrenergic receptors tsa lerako la methapo.

Mofumahali

Li-glucocorticoids ke limolek'hule tse nyane tsa lipophilic tse fetang hantle ka litsing tsa sele ka ho kenella habonolo. Ha e tsamaisoa, li-glucocorticoids li kenngoa hantle ho tsoa ho jejunum e kaholimo. Cmax maling e thehiloe ka lihora tse 0.5-1,5. Tekanyo ea nts'etsopele ea litlamorao le nako ea ts'ebetso ea GCS e ipapisitse le mofuta oa litekanyetso, solubility le metabolism ea lithethefatsi.

Li-glucocorticoids li hlahisoa ka mefuta e mengata ea litekanyetso. Likarolo tsa liforomo tsa ente e bakiloe ke thepa ea glucocorticoid ka boeona le ester e amanang le eona. Li-vaccinates, hemisuccinates le phosphates li qhibilihang ka metsi mme li na le phello e potlakileng, empa e le ea nakoana. Li ka kenngoa ka / m le / ka. Li-acetate le acetonides ke litšitiso tse nyane tsa kristale, li na le metsi a mangata ebile li kenella butle ka lihora tse 'maloa. Li-esters tse sa keneleng metsi li etselitsoe ho kenngoa ka hara mokokotlo oa kopane le mekotla ea li-articular. Ketso ea bona e fihla sehlohlolong ka mor'a matsatsi a 4-8 mme e nka libeke tse 4.

'Meleng, li-glucocorticoids li rarahana ka liprotheine tsa plasma - albin le transcortin. Haeba li-glucocorticoids tsa tlholeho li tlama ho transcortin ka 90%, le ho albin ka 10%, li-glucocorticoids tsa maiketsetso, ntle le li-prednisolone, li tlama haholo ho albin (e ka bang 60%), 'me e ka bang 40% e potoloha ka mokhoa oa mahala. 25-35% ea li-glucocorticoids tsa mahala li kentsoe ke lisele tse khubelu tsa mali le lisele tse tšoeu tsa mali.

Ke li-glucocorticoids tse se nang protheine feela tse sebetsang. Ba feta habonolo kahara li-membrane tsa mucous le li-barriers tsa histoological, ho kenyelletsa mali-boko le placental, e tlosoa kapele ho plasma.

Motsoako oa "glucocorticoids" o hlaha haholo-holo ka har'a sebete, ka karolo ea liphio le lisele tse ling. Sebeteng, glucocorticoids e hydroxylated mme e kopantsoe le glucuronide kapa sulfate.Li-cortisone tsa tlhaho le li-prednisone li fumana ts'ebetso ea pharmacological feela ka mor'a ho metabolism ka har'a sebete ho thehoa ha hydrocortisone le prednisone, ka ho latellana.

Metabolization ea li-corticosteroid tsa maiketsetso ka har'a sebete le ho fola li lieha ho bapisoa le li-steroid tsa tlhaho. Ho hlahisoa ha fluorine kapa chlorine halogen ions ka sebopeho sa GCS ho fokotsa metabolism ea lithethefatsi le ho eketsa T1 / 2 ea bona. Ka lebaka lena, phello ea corticosteroids e futhumetseng e nka nako e telele, empa ka nako e ts'oanang ba sitisa ts'ebetso ea adrenal cortex.

Li-glucocorticoids li hlahisoa ke liphio ka ho fafatsa ka mokhoa oa glomerular ka mokhoa oa metabolites o sa sebetseng. Boholo ba li-corticosteroids (85%) li kenngoa ka har'a litubu, 'me ke karolo ea 15% feela e fumanoang' meleng. Ka ho se sebetse hantle ke pheko, ha ho etsoe phetoho ea tekanyetso.

Litemoso

Ho bakuli ba nang le hypothyroidism, cirrhosis, hypoalbuminemia, hammoho le ho bakuli ba tsofetseng, phello ea li-glucocorticoids e ka matlafatsoa.

Glucocorticoids e kenella ka har'a placenta hantle. Lisebelisoa tsa tlholeho le tse sa fetoloang ka mokhoa o sireletsehileng li sireletsehile bakeng sa masea mme ha li lebise ho nts'etsopele ea intrauterine ea Cushing's syndrome le thibelo ea GNSS.

Tsamaiso ea nako e telele ea li-glucocorticoid tse telele li ka baka karabelo e sa batleheng, ho kenyelletsa le bokhopo. Mosali ea belehileng ea neng a ntse a sebelisa li-glucocorticoids lilemong tse 1.5-2 tse fetileng, e le ho thibela ho hloka matla ha kalafo ea methapo, hydrocortisone hemisuccinate 100 mg ka mor'a lihora tse ling le tse ling tse 6 o tlameha ho tsamaisoa ka mokhoa o fapaneng.

Ha ho anyesa, litekanyetso tse tlase tsa glucocorticoids, e lekanang le 5 mg ea prednisone, ha e kotsi ho lesea, hobane li-glucocorticoids li kenella hampe lebeseng la matsoele. Litekanyetso tse phahameng tsa lithethefatsi le tšebeliso ea tsona ea nako e telele li ka baka tsitsipano le thibelo ea HHF.

Molemong oa ho phekola maloetse a 'maloa a' mele ea masculoskeletal, haholo-holo ea tlhaho e sa foleng, lithethefatsi tse kang glucocorticosteroids li fumane ts'ebeliso e atileng. Pele o utloisisa litlamorao tse ka sehloohong tsa kalafo, matšoao le li-contraindication, o hloka ho tseba hore na li-glucocorticosteroids (GCS) ke eng.

Glucocorticosteroids ke lithethefatsi tseo e leng karolo ea sehlopha sa li-hormone tsa steroid ebile li na le li-anti-inflammatory, anti-allergic, anti-shock, immunosuppression le thepa e ngoe.

E sebelisoa neng?

Phekolo ea mafu a manonyeletso le lesapo la mokokotlo, pontšo ea mantlha ea ts'ebeliso ea li-glucocorticosteroids e nkuoa e le ts'ebetso e matla ea ho ruruha, e matla haholo mme e sa arabele kalafo ka lithethefatsi tse seng tsa antiidalidal. Li-pathologies tse kopaneng li ka sebelisoa:

1. Ramatiki (rheumatoid, post-traumatic, gouty, psoriatic, jj).
2. Polyarthritis
3. Osteoarthrosis (ho na le matšoao a ts'ebetso ea ho ruruha).
4. Ankylosing spondylitis.
5. Periarthritis.
6. Tšoaetso ea mokotla oa synovial kapa oa articular.

Ha o fana ka GCS, ngaka e leka ho fumana phello e matla ea kalafo e sebelisang litekanyetso li tlase tsa moriana. Mokhoa oa kalafo ea glucocorticosteroid o itšetlehile haholo ka ho teba ha lefu lena, boemo ba mokuli le karabelo ea hae kalafong, ho fapana le lilemo le boima.

Ho sebetsa hantle ha kliniki

Lithuto tse 'maloa tsa morao-rao tsa saense li bontšitse katleho e phahameng ea li-glucocorticosteroids kalafo ea mefuta e matla ea ho ruruha ho kopaneng. Tšusumetso e potlakileng ea kliniki e ka etsahala le ts'ebeliso e ts'oanang ea GCS ka litekanyetso tse tlase le lithethefatsi tse seng tsa antiidalidal. Ho fumanoe hore bakeng sa boholo ba bakuli ba nang le bokooa ka lebaka la polyarthritis, e ba bonolo haholo maemong a sebetsang ka mor'a matsatsi a 'maloa a kalafo e nang le corticosteroids. Seo ngaka e se balang, ha se beha li-glucocorticosteroids:

• Fokotsa bohlokoa ba bohloko ba manonyeletso a amehang.
• Ntlafatsa maemo a sebetsang a manonyeletso.
• Theola mekhoa e senyang.
• Ho sebetsana le ho ruruha.
• Fokotsa haholo tlhokahalo ea lithethefatsi tse seng khahlanong le ts'oaetso tsa mali.
• Ho eketsa katleho ea tšebeliso ea lithethefatsi tsa mantlha tse thibelang mafu.

Phihlelo ea tleleniki e bontšitse hore bakuli ba bangata ba nang le ramatiki ba ruruhaid hangata ba itšepa ho latela ts'ebetso ea glucocorticosteroid kalafo mme ba qobelloa ho fetohela lithutong tse telele tsa tsamaiso ea bona, eo ntle ho pelaelo e lebisang kholisong ea litla-morao.

U ka etsa kopo joang?

Litsela tse 'maloa tsa tsamaiso ea lithethefatsi tsa GCS lia khonahala. E le molao, kalafo ea ts'oaetso ea methapo ea methapo ea masculoskeletal system, li-glucocorticosteroids li kenngoa kahare. Ka ho sebetsa ka kotloloho molemong oa ho ruruha, phello e phahameng ea kalafo ea atleha.

Re lokela ho hlokomela hore hangata mokelikeli (exudate) o ka ipokella kaharepeng ea manonyeletso a maholo. Maemong a joalo, o tlameha ho tlosa mokelikeli ona pele, 'me ke ho etsa joalo ka taolo ea methapo e kahare ho sefahleho. Ka linako tse ling, molemong oa ho fihlela phello e ntle, tsamaiso ea GCS ho kopaneng e kopantsoe le kalafo ea glucocorticosteroid matlapeng. Mofuta o tšoanang oa kalafo o sebelisoa bakeng sa mefuta e matla ea ts'oaetso e nang le tloaelo e boletsoeng ea ho tsoela pele.

Liente tsa methapo ea methapo ea methapo ea kutlo li etsoa feela ke ngaka e ikhethang tlas'a maemo a hlobaetsang (kamore e hloekileng ea ho apara).

Litokisetso tsa GCS le tsona hangata li fanoa ka molomo ka mokhoa oa litafole kapa tšebetso ea tšebetso ea batsoali (ka mothapo kapa mesifa).

Nako ea thupelo le litekanyetso tsa moriana li itšetlehile ka ho teba le tlhaho ea lefu lena. Bakeng sa bakuli ba bang, thupelo ea kalafo ke ea likhoeli tse 'maloa kapa esita le lilemo. Ka ts'ebetso e phahameng ea ts'ebetso ea methapo ea manonyeletsong, phekolo eo ho thoeng ke ea pulse e sebelisoa. Tabeng ena, sethethefatsi se tsamaisoa ka mokhoa o kenang (ka sekhukhu) ka matsatsi a 3 a latellanang. Maemong a mangata, phekolo ea pulse e nang le glucocorticosteroids eu lumella ho hatella mosebetsi oa ts'oaetso kapele.

Mefuta ea li-glucocorticosteroids

Glucocorticoids, joalo ka cortisol, cortisone le corticosterone, ke cortex ea tlhaho ea adrenal. Tlhahiso ea bona e ka sehloohong e etsoa ho latela morethetho oa letsatsi le letsatsi. Palo e kholo e patiloe ka tlhoko e ntseng e eketseha ea lihormone tsena. Li hlaha ho progesterone ka bongata le mesh ea adrenal cortex. Mali a tsamaisoa ka transcortin. Li-glucocorticoids li sebetsa ka li-receptor tse ka hare. Li ama metabolism ea lik'habohaedreite, liprotheine le mafura. Lihormone tsena li boetse li thibela tšebetso ea ho ruruha, ka hona li bitsoa li-steroid tse thibelang mafu. Li hlokahala ho hlola maemo a sithabetsang 'meleng oa motho.

Boikutlo bo fapaneng

Ho latela tlhahlobo ea bongaka, le ha ho na le litlamorao tse ngata tsa ts'ebeliso ea nako e telele ea GCS lithutong tsa mafu a manonyeletso le lesapo la mokokotlo li nkuoa li le boima haholo, tse ling tsa tsona li hlaha e le taelo ea boholo ha e bapisoa le litlhare tse ling tse thibelang mafu. Litsebi tse ngata li arola litla-morao ka mokhoa o sebelisang nako e telele oa li-glucocorticosteroid ka lihlopha tse peli:

• Ka mokhoa o laoloang (lefu la tsoekere la tsoekere, ho eketseha ho sa feleng ha khatello ea mali, ho khathatsoa ke boroko, glaucoma, ho nyekeloa ke pelo, ho ruruha ha lesapo la mokokotlo, osteoporosis).
• E sa laoloe (phaello ea boima ba 'mele, lefu la mahlo, ho senyeha ha kelello, lekhopho la letlalo, tšoaetso e fapa-fapaneng, osteonecrosis, atherossteosis).

Ka nako e ts'oanang, ho ile ha fumaneha hore ho nka lithethefatsi tse seng tsa steroid tse thibelang mafu hangata ho halefisa nts'etsopele ea lefu la ho senyeha le ho ruruha ha methapo ea kutlo ka mpeng ho feta ts'ebeliso ea lithethefatsi tse tsoang sehlopheng sa GCS.Phekolo ka glucocorticoids e amahanngoa ka nepo le kotsi e eketsehang ea mathata a tšoaetsanoang, empa sena se tloaelehile haholo ho bakuli ba fumanang litekanyetso tse phahameng tsa lithethefatsi. Mekhoa ea kalafo e sa lekaneng ea glucocorticosteroid e lokela ho boleloa:

• Tekanyo e phahameng haholo kapa, ka lehlakoreng le leng, e tlase haholo.
• Nako e telele haholo ea kalafo.
• Khaello ea litlhare tse thibelang mafu.

Ka tsamaiso ea methapo ea methapo ea methapo ea mali ea GCS, e leng e 'ngoe ea mathata a kotsi ka ho fetisisa, empa ho e-na le seo a sa atiseng ho e fumana, ke ts'oaetso e ka mpeng ea mothapo nakong ea ente. Ntle le moo, thepa ea "immunosuppress" ea li-glucocorticoids e thusa ho nts'etsapele ts'ebetso ea ho ruruha ea purulent. Maemong a sa tloaelehang, "post-injection synovitis" e ka bonoa ha, ka mor'a ente, keketseho ea ts'ebetso ea ho ruruha ka har'a membrane ea motsoako o kopaneng, e ka tsoelang pele ho tloha lihora tse 'maloa ho isa ho matsatsi a 2-3.

Ho kenyelletsoa ha lithethefatsi liseleng tsa mesifa ha ho lakatsehe haholo, hobane nts'etsopele ea atrophic kapa necrotic process e khonahala.

Lihormone tsa maiketsetso

Li-glucocorticosteroids tsa maiketsetso - ke eng? Li-glucocorticosteroids tsa maiketsetso (corticosteroids), li-colloquically le tsona tse bitsoang feela li-steroid, li sebelisoa e le baemeli ba tsa kalafo. Li na le phello e matla khahlanong le ho ruruha ho feta metsoako ea tlhaho.

Phekolo ea pharmacological - haholo hangata hangata - li-glucocorticosteroids li sebelisoa e le moriana oa kalafo oa khale kapa oa immunosuppression. Ts'ebeliso ea bona kalafong e atile haholo haeba ho sa na letho le lekaneng la adrenal cortex. Phello ea bona e kholo ke ho thibela ts'oaetso ea ho ruruha, i.e., ho thibela phospholipase A 2, e lebisang ho fokotseheng ha tlhahiso.

Ka molao, kalafong ea lihormone, ho sebelisoa litekanyetso tse tloaelehileng tsa lithethefatsi, tse sa hlahiseng litlamorao tse mpe. Ho molemo ho nka lithethefatsi tsena ka tekanyetso e le 'ngoe le ho ea ka sebopeho sa' mele sa secretion sa cortisol 'meleng, ke hore hoseng. Phekolo ea Glucocorticosteroid e kenyelletsa ho fokotseha butle-butle ho lethal dose ea lihormone tse fanoeng sethaleng sa ho qetela sa kalafo (ho qoba adrenal cortical atrophy).

Li -teroids li ka sebelisoa ka molomo, le maemong a hlobaetsang (moo ho nang le bophelo bo sokelang) - ka mokhoa oa liente kapa infusions ea methapo. Ts'ebeliso ea bona e lokela ho laoloa, ke hore, e sebelisoe ha feela ho na le matšoao a hlakileng a sena, ho nahanela litlamorao tse ka bang teng. Litlhoko li lokela ho khethoa ka bomong bakeng sa mokuli ka mong, li lokela ho fetoloa ho latela botebo ba lefu lena.

Glucocorticosteroids e sebelisoang ho dermatology

Lihormone tsa cortex ea adrenal li na le litlamorao tse khahlanong le ho ruruha, immunosuppressive le antipruritic. Li sebelisoa haholo ho dermatology bakeng sa mafu a letlalo. Li-glucocorticosteroids tsa li-topical - lichelete tse amanang le lithethefatsi tse sebelisoang haholo bakeng sa kalafo ea mafu a dermatological. Li ka sebelisoa, haholoholo kalafo ea:

Mafura a Glucocorticosteroid a sebelisoa kalafo ea psoriasis. Gels, litlolo, litlolo li boetse li sebelisoa ho imolla matšoao a ho ruruha le ho hlohlona ha letlalo. Ho khothalletsoa maro a hormone ea Steroid hore a sebelisoe letlalong. Joalo ka kalafo e tsoelang pele, le maemong a sa tloaelehang, ts'ebeliso ea lithethefatsi tsa steroid, ho molemo ho sebelisa lithethefatsi tse fokolang (ho thibela litla-morao).

Glucocorticosteroid osteoporosis

E 'ngoe ea mathata a bohloko a kalafo ea nako e telele ea glucocorticosteroid ke. Leha ho le joalo, ho ea ka litsebi tse ling, ts'ebetso e phahameng ea ho ruruha ea ramatiki le ho fokotseha ha tšebetso ea 'mele li nkoa e se lintho tsa bohlokoa haholo ponong ea lefu la masapo.ho fapana le kalafo ea nako e telele ea corticosteroids.

Ho fokotsa kotsi ea ho ba le khatello ena, lingaka tse ngata li khothaletsa ho fetola haholo mokhoa oa bona oa bophelo, haholo-holo ho bakuli ba fumanang li-glucocorticosteroids nako e telele. Seo se hlileng se hlokang ho etsoa:

1. Khaotsa ho tsuba le ho noa joala.
2. Ikoetlise kamehla.
3. - Ja lijo tse nang le calcium le vithamine D. e ngata.
4. Hangata ho ba letsatsing.
5. Haeba ho hlokahala, nka meriana e boletsoeng ke ngaka ea hau (, calcitonin, jj.).

Li -teroids kalafong ea tsamaiso ea ho hema

Litlhare tsa Hormonal tse tsoang ho litlhare tsohle tse sebelisitsoeng ho phekola ho ruruha ha bronchi li na le matla a maholohali. Kamora ho hlahisoa ha bona, ho na le phokotseho ea ho ruruha ha mucous membrane le secretion ea mucous, epithelium e tloaelehileng ea bronchial e khutlisoa. Ho kenngoa ha li-steroid 'meleng ho hatella karolo ea morao ea allergies, hammoho le karabelo e eketsehileng ea bronchi. Khetholla:

1. Glucocorticosteroids ka mokhoa oa ho inhaled anesthetics. Ke mofuta oa litlhare tse khethiloeng ka ho fetisisa bakeng sa ho sebelisoa kalafo ea mefuta eohle ea asthma ea bronchial.
2. Glucocorticosteroids, e sebelisoang e le liente tsa systemic maling. Mofuta ona o sebelisoa feela ka mefuta e matla ea asthma ea bronchial, ha mekhoa e meng ea bongaka e sa fane ka litholoana.
3. Li-Steroid bakeng sa tšebeliso ea molomo li ka sebelisoa hape bakeng sa kalafo ea nako e khuts'oane nakong ea ho ata ha lefu lena.

Bokhachane le pelehi

Boithuto bo lebelletsoeng ba kliniki mabapi le polokeho ea tšebeliso ea glucocorticosteroid nakong ea kemolo ha e so etsetsoe. Leha ho le joalo, lingaka li ka fana ka moriana ona ho mosali oa moimana, empa feela haeba phello e lebelletsoeng ea kalafo e feta kotsi e lebelletsoeng ho ngoana. Ho feta moo, bo-'mè ba anyesang ba khothalletsoa ka matla ho emisa ho anyesa nakong ea kalafo ea glucocorticosteroid.

Glucocorticoids ts'ebetsong ea bongaka

Kharkov Setheo sa lithuto tsa bongaka tse tsoetseng pele

Tlas'a maemo a 'mele, lisele tsa adrenal cortex bundle zone li boloka li-glucocorticoids tse peli tse kholo maling a kenang maling - cortisone le cortisol (hydrocortisone). Secretion ea lihormone tsena e laoloa ke corticotropin ea adenohypophysis (eo pele e neng e bitsoa adrenocorticotropic hormone). Keketseho ea boemo ba cortisol maling le ts'ebetso ea ho fana ka maikutlo e thibela secretion ea corticoliberin ho hypothalamus le corticotropin ka har'a gland ea pituitary.

Botebo ba secretion ea li-glucocorticoids maling maling bo fapana haholo. Likahare tse phahameng tsa lihormone maling li bonoa hoseng haholo (lihora tse 6-8), e leng bonyane - ka shoalane le bosiu.

Litlamorao tsa 'mele tsa glucocorticoids haholo li fapane le tse bakoang ke insulin. Lihormone li na le phello ea catabolic ho metabolism ea protheine (i.e., e thusa ho hlakola limolek'hule tse thata tsa protheine ho lintho tse bonolo) le anti-anabolic effect (i.e. Thibela biosynthesis ea limolek'hule tsa protheine). Ka lebaka leo, 'mele o senya protheine mme o eketsa tlhahiso ea lihlahisoa tsa naetrojene. Ho phatloha ha protheine ho etsahala mesifa, mesifa le masapo. Albin ea mali e fokotsehile.

Glucocorticoids e susumetsa triglyceride catabolism le ho thibela synthesis ea mafura ho tsoa ho lik'habohaedreite. Ka nako e ts'oanang, ho fokotseha hoa litekanyetso tsa adipose tsa lipheletso hangata ho kopantsoe le keketseho ea ponaletso ea mafura leboteng la mpa le lipakeng tsa mahetla a mahetla. Hyperglycemia tlas'a tšusumetso ea lihormone e etsahala ka lebaka la sebopeho se ntseng se eketseha sa tsoekere maling se tsoang ho amino acids (gluconeogeneis) le khatello ea ts'ebeliso ea eona ke li-tishu, 'me litaba tsa glycogen tse bokong le tsona lia eketseha. Glucocorticoids e fokotsa kutloisiso ea tiske ho syntulin le syntic acid synthesis.

Lihormone li eketsa kutloisiso ea li-adrenoreceptors ho li-catecholamines, li ntlafatsa litlamorao tsa khatello ea angiotensin II, fokotsa ho eketseha ha capillary, hape li nka karolo ho boloka molumo o tloaelehileng oa arteriole le konteraka ea myocardial. Tlas'a tšusumetso ea li-glucocorticoids, litekanyetso tsa mali tsa li-lymphocyte, li-monocytes, li-eosinophils le basophils li fokotseha, li-neutrophils li tsoa mokokotlong oa masapo mme keketseho ea tsona maling a pherekano e hlohlelletsoa. Lihormone li boloka sodium le metsi 'meleng khahlano le tšilafalo ea tahlehelo ea potasiamo, e thibela ho kenngoa ha calcium ka mpeng, hape e kenya letsoho ho lokollotsoeng ha metsoako ea masapo le ho tsoa ha eona ka har'a moroto. Li-glucocorticoids li eketsa kutloisiso ea maikutlo le thabo ea ts'ebetso ea methapo, ho nka karolo ho kenngeng tšebetsong ha khatello ea maikutlo, ho ama psyche ea motho.

Li-glucocorticoids tsa tlhaho le li-analogu tsa tsona tsa maiketsetso li sebelisoa haholo tleliniking haholo hobane li na le litšobotsi tse 'maloa tsa bohlokoa: li na le litlamorao tse khahlanong le ho ruruha, immunosuppression, anti-allergic le anti-shock. Liphetho tsa ho qetela tsa kalafo li its'etleha ka mabaka a mangata, ho kenyelletsa nako ea kalafo, tekanyetso ea lithethefatsi, mokhoa le mokhoa oa tsamaiso ea bona, litšobotsi tsa immunological le immunogenetic tsa maloetse ka boeona, joalo-joalo. Ho ekelletsa moo, li-glucocorticoids tse fapaneng li na le litekanyetso tse fapaneng tsa boima, immunosuppression le anti-inflammatory. ha ho kamano e tobileng. Kahoo, dexamethasone e na le ts'ebetso e matla ea ho thibela-mafu le e fokolang.

Litšoaneleho tse bapisang tsa glucocorticoids

Ka ts'ebetso ea tleliniki, li-glucocorticoids tsa tlhaho (cortisone le hydrocortisone) le lihlahisoa tsa bona tsa semisynthetic li sebelisoa. Ba morao-rao, ba arotsoe ka bao e seng fluorine (prednisone, prednisolone, methylprednisolone) le fluorinated (triamcinolone, dexamethasone le betamethasone).

Ha e tsamaisoa, li-glucocorticoids li potlaka ebile li batla li kenelletse ka botlalo ho jejunum e kaholimo. Ho ja ha ho ame tekanyo ea ho amoheloa ha lihormone, leha lebelo la ts'ebetso ena le ntse le fokotseha butle.

Ho hlonepha ha tšebeliso ea mefuta e enteloang ho bakoa ke thepa ea glucocorticoid ka boeona le ether e amanang le eona. Mohlala, litlolo, li-hemisuccinate le phosphates li qhibiliha ka metsing, mme ha li fanoa ka mokhoa oa botsoali, li na le phello e potlakileng, empa e le ea nakoana. Ho fapana le moo, li-acetate le acetonides ke li-suspensall tse ntle tsa kristale ebile ha li qhibilihe ka metsing. Ketso ea bona e tsoela pele butle butle ka lihora tse 'maloa, empa e nka nako e telele (libeke). Li-esters tse nang le metsi tse qhibilihang ka metsi li ka sebelisoa kahare;

Ho latela nako ea ts'ebetso ea kalafo, li-glucocorticoids tsohle li arotsoe ka lihlopha tse 3 (tafole 1). Ho tseba litekanyetso tse lekanang tsa corticosteroids ho u fa monyetla oa ho khutlisetsa lithethefatsi tse le ngoe haeba ho hlokahala. Molao-motheo o neng o le teng pele - "pilisi ea pilisi" (ke hore, ha ho hlokahala hore a fetisetse mokuli ho glucocorticoid e 'ngoe, o ne a fuoe matlapa a mangata a moriana o mocha joalokaha a amohetse pele ho phetisetso) - ha joale ha a sebetse. Sena se bakoa ke kenyelletso ea tloaelo ea litekanyetso tsa mefuta ea li-glucocorticoids tse nang le litaba tse fapaneng tsa molao-motheo o sebetsang.

Lihormone tsa Glucocorticoid

Nako ea ketso	Lebitso la lithethefatsi	Tekanyetso e lekanang (mg)
Ketso e khutšoane	Hydrocortisone	20
	Cortisone	25
	Prednisone	5
	Prednisone	5
	Methylprednisolone	4
Triamcinolone	4
Tikoloho ea paramente	2
Ho nka nako e telele	Dexamethasone	0,75
	Betamethasone	0,6

Li-glucocorticoids tsa tlhaho li na le ts'ebetso ea mineralocorticoid, leha e fokola ho feta mineralocorticoids ea 'nete.Li-glucocorticoids tse sa fetoleng fluorocorticoids le tsona li hlahisa litlamorao tsa mineralocorticoid (boholo ba tsona, le bona, bo tlaasana le litlamorao tsa glucocorticoids ea tlhaho). Litokisetsong tse nang le mocheso, mosebetsi oa mineralocorticoid ha o eo (tafoleng ea 2). Ts'ebetso ea glucocorticoid ea lithethefatsi tsa semisynthetic e phahame ho feta ea cortisone le hydrocortisone, e hlalosoang ke ho tlama liprotheine tse tlase ha li bapisoa le li-glucocorticoids tsa tlhaho. Karolo ea lithethefatsi tse nang le mocheso ke tšebeliso ea 'mele butle butle' meleng, e kenyang keketseho ea nako ea ts'ebetso ea lithethefatsi.

Litšobotsi tse bapisang tsa glucocorticoids bakeng sa ts'ebeliso ea kemiso

Nako ea ketso	Lebitso la lithethefatsi	Gluco mosebetsi oa corticoid	Liminerale mosebetsi oa corticoid
Ketso e khutšoane	Hydrocortisone	1	1
	Cortisone	0,8	1
	Prednisone	4	0,8
	Prednisone	4	0,8
	Methylprednisolone	5	0,5
Nako e mahareng	Triamcinolone	5	-
Ho nka nako e telele	Dexamethasone	30	-
	Betamethasone	30	-

Mantsoe a latelang a sebelisoa haholo lingolong tsa bongaka: litekanyetso tse "tlase" tsa "glucocorticoids" "tse phahameng", jj. sethethefatsi leha e le sefe se seng). Lidao tse joalo hangata li fanoa bakeng sa kalafo ea tlhokomelo. Haeba tekanyetso ea letsatsi le letsatsi ea prednisolone ke 20-40 mg (matlapa a 4-8), ba bua ka litekanyetso tsa "mahareng" tsa glucocorticoids, le tse fetang 40 mg / letsatsi - la "phahameng". Melao e haufi le e fanoeng e boetse ea fumanoa ha ho baloa lethal dose ea letsatsi le letsatsi ea corticosteroids ka kilo e le 'ngoe ea boima ba' mele oa mokuli. Moeli o nang le maemo lipakeng tsa tekanyetso ea "mahareng" le "e phahameng" ke 0.5 mg ea prednisone ka kilo e le 'ngoe ea boima ba' mele oa mokuli ka letsatsi.

Lilemong tse 20 tse fetileng, tleliniki e sebelisitse ts'ebetso ea methapo e mengata haholo ea li-glucocorticoids (bonyane 1 g ea methylprednisolone ka letsatsi) matsatsi a 'maloa. Phekolo ena e bitsoa "kalafo ea pulse."

Tekanyo ea li-glucocorticoids tse boletsoeng qalong ea kalafo ea lefu le itseng le itšetlehile haholo ka mofuta oa lefu lena le ho teba ha lefu lena. Lilemo tsa mokuli, ho ba teng kapa ho se be teng ha mafu a tšoanang, tšebeliso ea lithethefatsi tse ling ka nako e tšoanang le lintlha tse ling le tsona li ama tekanyetso.

Likhetho tse ka sehloohong bakeng sa tšebeliso ea bongaka ba li-glucocorticoids li ka hlahisoa ka tsela e latelang:

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bokantle - letlalo, mahlo, litsebe (ka mokhoa oa litlolo, marotholi, litlolo, lilotho, li-aerosols),

inhalation - ka matšoafong kapa ka mpeng.

subshell (lefutso),

Intradermal - ka maqeba,

ho kenella - ka hare ho pleural cavity, intrapericardely, jj.

intraarticular le periarticular,

ts'ebeliso ea sistimi:

ka hare

ka likerese (suppositories),

Pareeral (haholo-holo ka intramuscularly le intravenly).

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Mabapi le ho phehella le ho teba ha kalafo e khahlanong le ho ruruha, hammoho le mamello, prednisolone le methylprednisolone ke tsona tse ntle ka ho fetisisa.

Prednisone e nkoang e le sethethefatsi se tloaelehileng bakeng sa kalafo ea pharmacodynamic. Karolelano ea tšebetso ea glucocorticoid le mineralocorticoid ea prednisolone ke 300: 1.

Methylprednisolone Ha e bapisoa le prednisone, e na le ts'ebetso e phahameng haholo ea glucocorticoid (ka 20%) mme e na le phello e fokolang ea mineralocorticoid. Monyetla oa lithethefatsi ke tšusumetso e leka-lekaneng ea psyche le takatso ea lijo, e lokafatsang ho khethoa ha eona ho bakuli ba nang le psyche e sa tsitsang le e boima.

Prednisone ke hydroxylated ho sebete (moo e fetohang le ho ba prednisone), ka hona ha e khothalletsoe mafu a matla a sebete.Nkoe ho feta prednisone, leha ho le joalo, mokhoeng oa bongaka ha e sebelisoe hangata ho feta ea morao-rao.

Triamcinolone - glucocorticoid e kolobisitsoeng, e se nang mosebetsi oa mineralocorticoid. Kahoo - ha ho bapisoa lithethefatsi tse ling, bokhoni ba ho boloka sodium le metsi. Ha e bapisoa le prednisone, e na le polelo e boletsoeng ho feta (ka 20%) le phello e telele ea glucocorticoid. Ka lehlakoreng le leng, hangata e baka karabelo e sa batleheng ho tsoa ho mesifa ea mesifa ("triamcinolone" myopathy) le letlalo. Ka hona, tšebeliso ea nako e telele ea meriana ena ha e ratehe.

Dexamethasone ts'ebetsong ea glucocorticoid e boholo ba makhetlo a 7 ho feta prednisone. Ke glucocorticoid e kolobisitsoeng mme ha e na phello ea mineralocorticoid. Ha e bapisoa le lithethefatsi tse ling, e hatella ts'ebetso ea adrenal cortex ka tekanyo e kholo. Ts'ebeliso ea nako e telele ha e khothaletsoe ka lebaka la kotsi ea litlamorao tse mpe (haholo-holo, thibelo ea hypothalamic-pituitary-adrenal axis, likhathatso tsa metabolic, litlamorao tse susumetsang tsa psycho).

Betamethasone - e tsoekere glucocorticoid, e haufi haholo ka matla le nako ea ho ba dexamethasone. E feta hanyane ka hanyane mesebetsing ea glucocorticoid (makhetlo a 8-10 e phahame ho feta ea prednisolone) mme ka tekanyo e nyane e ama metabolism ea carbohydrate. Betamethasone phosphate e qhibilihisoa ka metsing mme e ka tsamaisoa ka matla le ka tsela e ikhethileng. Bakeng sa tsamaiso ea methapo, intraarticular le periarticular, ho sebelisoa motsoako oa li-esters tse peli tsa betamethasone - phosphate (e kenang ka potlako) le dipropionate (e kenang butle butle). Motsoako ona ke setlolo se setle sa kristale se ke keng sa tsamaisoa ka matla. Phosphate e fana ka phello e potlakileng (nakong ea metsotso e 30), mme diproprionate e na le phello e telele, ho fihla ho libeke tse 4 kapa ho feta.

Cortisone hajoale ha e sebelisoe ka lebaka la ts'ebetso e tlase le mamello e mpe haholoanyane. Hammoho le hydrocortisone, e na le ts'ebetso e tsebahalang haholo ea mineralocorticoid har'a li-glucocorticoids tsohle. Sebaka se ka sehloohong sa kopo ke phekolo e nkang sebaka sa ho fokola ha adrenal ho bakuli ba nang le ts'ebetso e tloaelehileng ea sebete (kaha cortisone e fetoha hydrocortisone ka har'a sebete, tšebeliso ea lithethefatsi ha e khothalletsoe tšenyo e kholo ho setho sena).

Hydrocortisone Ke eona feela glucocorticoid e ka sebelisetsoang kalafo ea nako e telele ea batsoali, empa e fokola haholo ho lithethefatsi tsa sejoale-joale ka ho mamella. E boreenya ho feta prednisone ts'ebetsong ea glucocorticoid (makhetlo a 4), empa e e feta ka mokhoa o tebileng oa ketso ea mineralocorticoid. Hydrocortisone hangata e sebelisetsoa ho khutlisetsa 'mele le sekoaelo se sithabetsang ho bakuli ba nang le ho se lekane ha hypothalamic-pituitary-adrenal axis. Ho hlobaetsang le ho feteletseng ha adrenal le maemo a mang a tšohanyetso a hydrocortisone, hemisuccinate ke lithethefatsi tsa khetho.

Beclomethasone, flunisolid, budesonide, triamcinolone acetonide le fluticasone e tsamaisoa ke inhalation. Beclomethasone (beclometh, becotide, jj) hangata e laetsoe kalafo ea ho boloka nako e telele bakeng sa asthma ea bronchial. E na le ts'ebetso e nyane ea tsamaiso, leha ho le joalo ka litekanyetso tse kholo (1000-2000 μg / letsatsi) e baka lefu la ho fokola ha masapo le litlamorao tse ling. Ts'ebeliso ea Flunisolid (ingacort) ha e bapisoa le beclomethasone ha e na monyetla oa ho lebisa nts'etsopele ea li-candidiasis tsa molomo oa molomo. Ha inhaled, budesonide (pulmicort) e sebetsa hanyane mme ha e ame ts'ebetso ea liphio ho feta beclomethasone. Fluticasone (flixotide, flixonase) tumellanong ea li-glucocorticoid receptors e phahame ka makhetlo a 30 ho feta prednisone le makhetlo a 2 a phahametseng a budesonide. E na le phello e matla ea anti-inflammatory ea lehae ka makhetlo a 2 ho feta beclomethasone.

Ts'ebeliso ea ts'ebetso ea li-glucocorticoids

Ho fihla joale, lipuisano li ntse li tsoela pele mabapi le khetho ea litekanyetso le litekanyetso tse lekaneng tsa lithethefatsi, mekhoa ea tsamaiso, nako ea kalafo, litla-morao. Ka kakaretso, qeto mabapi le tšebeliso ea li-corticosteroids hangata ha e bake mathata a maholo ho lingaka. Ka hona, nehelanong e latelang, sepheo sa mantlha e tla ba ts'ebetsong ea lihormone e hlophisitsoeng.

Haeba tsamaiso ea li-glucocorticoids e hlophisehileng e hlokahala, ho khethoa ho tsamaisoa ka molomo. Haeba ho sa khonehe ho kenya litlhare tsena kahare, li ka sebelisoa ho li-supplement, lethal dose ho sena le eketseha ka 25-50%. Li-Glucocorticoids tse fumanehang ka mefuta e enteloang li kenngoa 'meleng kapele ka nako ea methapo ea methapo,' me, haholo-holo, tsamaiso ea methapo, ka hona phello ea bona ea nako e khuts'oane mme maemong a mangata ha e na lekaneng kalafo ea nako e telele. Ho fumana se lekanang, ha ho bapisoa le tsamaiso ea molomo, phello ea kalafo, litekanyetso tsa botsoali li tla tlameha ho fanoa ka makhetlo a 2-4 le makhetlo a mararo a sebelisang ente e lokelang ho sebelisoa. Mekhoa ea phekolo ea bongaka e teng ka nako e telele (mohlala, triamcinolone acetonide, kapa kenalog) ha e sebelisoe kalafo e "hatellang", empa haholo joalo ka kalafo e tšehetsang kapa ea lehae (mohlala, intraarticular).

Hoseng, "hypothalamic-pituitary-adrenal axis" e bonolo haholo ho ameha ka litlamorao tsa litlamorao tsa kantle tsa corticosteroids. Ha o arola tekanyetso ea letsatsi le letsatsi ea li-glucocorticoids likarolong tse 3-4 le ho li nka nako le nako, menyetla ea ho hatella li-axoth tsa hypothalamic-pituitary-adrenal ea eketseha. Ka hona, maemong a mangata, lihormone li beoa ka mokhoa oa mofuta o le mong oa litekanyetso tsa hoseng (hangata lithethefatsi tse nkang nako e telele), kapa 2 / 3-3 / 4 ea lethal dose ea letsatsi le letsatsi e nooa hoseng, 'me e setseng e nkuoa har'a motšehare. Morero ona oa kopo o u lumella ho fokotsa menyetla ea ho thibeloa ha leseling la hypothalamic-pituitary-adrenal le ho fokotsa kotsi ea lefu la masapo.

Ho sebetsa hantle ha li-glucocorticoids ho eketseha ka tekanyetso e ntseng e eketseha le khafetsa ea tsamaiso, empa ho teba ha mathata le hona hoa eketseha. Ka tšebeliso ea lihormone (ka matsatsi a mang le a mang), palo ea liphetoho tse nyane ha e na thuso, empa maemong a mangata mokhoa ona oa tsamaiso ha o sebetse ka ho lekaneng (mohlala, ka mafu a mali, (nonspecific) ulcerative colitis, tumello e bohloko, hammoho le maemong a matla a mafu). Phekolo e 'ngoe, joalo ka molao, e sebelisoa kamora khatello ea ts'ebetso ea ho ruruha le ea ente ka ho fokotseha ha tekanyo ea li-glucocorticoids le phetoho ea kalafo ea tlhokomelo. Lenaneong le fapaneng la mefuta, lihomo tsa lihormone tse hlokahalang bakeng sa nako ea lihora tse 48 li fanoa ka letsatsi le leng le le leng la hoseng hoseng ka nako. Mokhoa ona o lumella ho fokotsa phello ea thibelo ea li-glucocorticoids tsa kantle ho ts'ebetso ea adrenal cortex ea mokuli, ka hona, ho thibela ho otla ha eona. Ntle le moo, ts'ebeliso e fapaneng ea li-glucocorticoids, menyetla ea mathata a tšoaetsanoang ea fokotseha, 'me boemo ba morao ba bana ha bo phatlalatsoe joalo ka ho ja lihormone tsa letsatsi le letsatsi.

Ke maemong a sa tloaelehang (ka mohlala, ka lefu la nephrotic ho bana), kalafo e 'ngoe e boletsoeng e tsoa matsatsing a pele a kalafo. Ka tloaelo, mofuta o joalo oa tsamaiso ea li-hormone o boloketsoe bakuli ba atlehileng ho fumana botsitso ba sebelisa li-glucocorticoids tsa letsatsi le letsatsi. Se latelang ke mohlala oa ho fetisetsa mokuli kalafong e 'ngoe, eo ho eona lethal dose ea "prednisolone" e neng e le 50 mg.

Ka kalafo e 'ngoe, ho sebelisoa li-corticosteroids tse mahareng feela (prednisone, prednisolone, methylprednisolone). Kamora ho nka tekanyetso e le 'ngoe ea lithethefatsi tsena, axothalamic-pituitary-adrenal axis e hatelloa ka lihora tse 12-36.Ka ho khethoa ha li-glucocorticoids tse sebetsang nako e telele letsatsi le leng le le leng (triamcinolone, dexamethasone, betamethasone), kotsi ea khatello ea hypothalamic-pituitary-adrenal axis e lula, ka hona ha ho na kelello ho li sebelisa bakeng sa kalafo e 'ngoe. Sebaka sa ts'ebeliso ea li-hormone tsa tlhaho (cortisone le hydrocortisone) hajoale e lekantsoe ke phekolo ea ho nkela sebaka sa ho hlokeha ha adrenal le kalafo e hatellang bakeng sa lefu la adrenogenital.

Ka ho mpefala ha matšoao a lefu lena ka letsatsi la bobeli ("free-hormone"), ho khothalletsoa ho eketsa tekanyetso ea moriana ka letsatsi la pele, kapa ho nka tekanyetso e nyane ka letsatsi la bobeli.

Litekanyetso tse phahameng (mohlala, 0,6-1.0 mg ea prednisolone ka 1kg ea boima ba 'mele ka letsatsi), kapa litekanyetso li arotsoe ka litekanyetso tse' maloa ho pholletsa le letsatsi li bontšoa methating ea pele ea maloetse a bohale haholo. Hoa hlokahala hore u loanele ho fetisetsa mokuli nakong ea libeke tse 1-2 ho ea ho lethal dose la hoseng le le leng la letsatsi le letsatsi. Phokotso e ngoe hape ea tekanyetso e sebetsang ea tokiso (ho fapana le tsamaiso e meng) e khethoa ke maemo a khethehileng a kliniki. Phokotso ea butle-butle e kopantsoe le keketseho ea palo le ho teba ha litlamorao tsa kalafo ea glucocorticoid, 'me kapele haholo - e lebella ho holisa lefu lena.

Bakeng sa ho fokotsa litlamorao, o lokela ho nahana ka monyetla oa "ho boloka li-steroid." Ka rheumatology, mohlala, sena se fihlella ka ts'ebeliso ea lithethefatsi tse seng khahlanong le ts'oaetso tsa motsoako kapa kalafo ea mantlha (li-immunosuppressants, li-antimalarials, jj.). Alternation ke mokhoa o mong oa ho fokotsa mathata a phekolo ea steroid.

Phekolo e nang le litekanyetso tse phahameng tsa glucocorticoids e kanna ea se khotsofatse ka lebaka la ho se sebetse hantle le / kapa ponahalo ea mathata a maholo. Maemong a joalo, o lokela ho nahana ka monyetla oa kalafo ea pulse, i.e., tsamaiso ea methapo ea methapo e kholo haholo ea lihormone ka nako e khuts'oane. Le ha ho ntse ho se na tlhaloso e hlakileng ea kalafo ea pulse, hangata polelo ena e bua ka ts'ebetso e potlakileng ea (nakong ea 30-60 metsotso) tsamaiso e matla ea litekanyetso tse kholo tsa glucocorticoids (bonyane 1 g) hang ka letsatsi bakeng sa matsatsi a 3. Ka mokhoa o akaretsang, kalafo ea "pulse" e ka emeloa e le tsamaiso ea methylprednisolone (setlhare sena hangata se sebelisoa ke ba bang) ka tekanyo ea ho fihlela 1 g / sq. mitha ea 'mele bakeng sa matsatsi a 1-5. Hona joale, kalafo ea pulse e nang le lihormone tsa steroid hangata e sebelisoa qalong ea kalafo bakeng sa maloetse a 'maloa a tsamaeang butle a immunologically. Molemo oa mokhoa ona bakeng sa kalafo ea tlhokomelo ea nako e telele ho bonahala o lekantsoe.

Ka kakaretso, ka ts'ebeliso ea lehae ea li-steroid ha e na litlamorao tse fokolang tse kotsi ho feta ka ts'ebeliso ea kemiso. Palo e kholo ka ho fetisisa ea liketsahalo tse sa thabiseng ka tšebeliso ea li-systemic ea li-hormone e etsahala haeba tekanyetso ea letsatsi le letsatsi e arotsoe ka tekanyetso e 'maloa. Ha tekanyetso ea letsatsi le letsatsi e nkuoa tekong e le 'ngoe, litla-morao tsa eona li fokola,' me mofuta oa tsamaiso e fapaneng ke chefo e fokolang ka ho fetisisa.

Ka ts'ebeliso ea letsatsi le letsatsi, li-analogues tsa glucocorticoid tse entsoeng ka halofo ea bophelo bo bolelele (mohlala, dexamethasone) li baka litlamorao khafetsa ho feta lithethefatsi tse nang le halofo e khutšoanyane le e bohareng ea bophelo. Ho khethoa ha litekanyetso tse phahameng tsa li-steroid ho bolokehile haholo haeba nako ea ts'ebeliso ea eona e sa fete beke e le 'ngoe, ka tekanyetso e telele ea litekanyetso tse joalo, litla-morao tsa bohlokoa le litlamorao tse nang le chefo li ka boleloa esale pele.

Ts'ebeliso ea li-glucocorticoids tsa tlhaho le tse sa fetolehang nakong ea kemolo ka kakaretso e sireletsehile bakeng sa lesea. Ka tšebeliso ea nako e telele ea lithethefatsi tse nang le metsi a futhumetseng, ho nts'etsopele ea litlamorao tse sa rateheng ka popelong, ho kenyeletsoa le ho holofala.Haeba mosali ea sebetsang a ne a ntse a nka li-glucocorticoids lilemong tse 1.5-2 tse fetileng, hydrocortisone hemisuccinate 100 mg ka mor'a lihora tse ling le tse ling tse 6 e romelloa ka mokhoa o ts'oanelang ho thibela ho hloka matla ho matla ha adrenal.

Ha ho anyesa, litekanyetso tse tlase tsa li-hormone tse lekanang le 5 mg ea prednisone ha li kotsi ho lesea. Litekanyetso tse phahameng tsa lithethefatsi li ka baka tsitsipano le thibelo ea "hypothalamic-pituitary-adrenal axis" ka lesea. Ka hona, basali ba nkang tekanyetso e phahameng ea li-glucocorticoids ha ba khothalletsoe ho anyesa.

Bakeng sa thibelo ea khatello ea khatello ea maikutlo ho masea a tlang pele ho nako, ho sebelisoa lithethefatsi tse nkang nako e telele (hangata e le dexamethasone). Tsamaiso ea methapo ea kutlo ea dexamethasone ho mosali ea pepang le eaimana ho isa ho libeke tse 34 e khothaletsoa lihora tse 24-48 pele ho tsoalo e lebelletsoeng. Ts'ebeliso ea litlhare hape e ka etsahala haeba tsoalo pele ho nako e sa etsahetse matsatsing a 7 a tlang.

Morero oa phetisetso ho phekolo e 'ngoe ka ho tlosa butle-butle li-glucocorticoids

Fetisetsa ho mefuta e meng ea kalafo		Phokotso ea litheko tsa Glucocorticoid
Letsatsi	Prednisolone mg	Letsatsi	Prednisolone mg	Letsatsi	Prednisolone mg
1	60	11	90	21	85
2	40	12	5	22	5
3	70	13	90	23	80
4	30	14	5	24	5
5	80	15	90	25	80
6	20	16	5	26	5
7	90	17	85	27	80
8	10	18	5	28	5
9	95	19	85	29	80
10	5	20	5	30	0

Koetliso ea mamello

Mokuli o lokela ho tseba ka litlamorao tsa tliliniki ea ho haella ha axis ea hypothalamus-pituitary-adrenal gland, e ka bang teng ka lebaka la ts'ebeliso ea systemic ea glucocorticoids. Ho lemosa mokuli mabapi le ho se sebetse hantle ha kalafo e felisoa kapa ho fokotseha ha tekanyo ea lihormone ntle le likeletso tsa bongaka tse loketseng. Karabelo ea hypothalamus-pituitary-adrenal axis ho imeloa kelellong e ka fokotseha esita le ka mor'a taolo ea letsatsi le letsatsi ea li-glucocorticoids ka matsatsi a 7. Haeba kalafo ea lihormone tsa molomo e kenella khafetsa ho feta lihora tse 24, mokuli a ka ba le ho putlama ho potoloha ha mali ka lebaka la khatello ea maikutlo, khatello ea maikutlo, ts'oaetso le ts'ebetso ea bongaka e atisang ho hloka taolo ea batsoali ka li-glucocorticoids. Ho ke ke ha khoneha ho bolela esale pele ka tšohanyetso ho hlaha ha ho haella ha hypothalamic-pituitary-adrenal axis kapa ka tekanyetso ea li-hormone, leha e le ka nako ea kalafo, leha e le ka boemo ba cortisol ho plasma e potlakileng (le hoja khaello e sa lekana hangata e hlaha ha tekanyetso e phahameng ea glucocorticoids e laetsoa).

Re lokela ho hlokomela hore kalafo e nang le lihormone e tsosa takatso ea lijo mme e baka boima ba mmele mme e totobatsa bohlokoa ba phepelo ea lijo pele kalafo e qala. Ngaka e lokela ho hlalosa matšoao a lefu la tsoekere, steroid myopathy, neuropsychic, tšoaetso le mathata a mang a kalafo ea glucocorticoid ho mokuli.

Ho sebelisana le meriana e meng

Lithethefatsi tse ling li ka ama ho kenella ha glucocorticoids maling. Kahoo, phenobarbital le rifampicin e matlafatsa metabolism ea lihormone ka har'a sebete 'me ka tsela eo li fokotsa phello ea tsona ea kalafo. Ts'ebeliso e kopaneng ea li-steroid le thiazide diuretics e eketsa haholo kotsi ea hyperglycemia le hypokalemia. Tsamaiso e ts'oanang ea li-glucocorticoids le asiti ea acetylsalicylic e theola boemo ba ho qetela maling hoo khatello ea eona e leng tlase ho feta kalafo.

Qeto

Lihormone tsa Glucocorticoid li lula sebakeng se loketseng ho tsa bongaka. Maemong a mangata, tšebeliso e nepahetseng ea meriana ena ka nako le ka mokhoa o lekaneng e pholosa bophelo ba bakuli, e thusa ho thibela (ho liehisa) ho qala ha ts'oaetso kapa ho fokotsa lipontšo tsa eona. Ka nako e ts'oanang, sechabeng, ho kenyeletsoa tikolohong ea bongaka, ho tšaba "lihormone" ho atile haholo. Senotlolo sa demythologization ea glucocorticoids ke ts'ebeliso ea bona e leka-lekaneng molemong oa ho ikoetlisa.

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2. Bereznyakov I.G.Glucocorticosteroids: ts'ebeliso ea bongaka (tataiso ea lingaka) .- Kharkov, 1995.— 42 p.
3. Lits'oants'o tsa physiology ea motho (tlasa tokiso ea B. I. Tkachenko) .- St. Petersburg: Motheo oa Machaba oa Nalane ea Saense .- T. 1.- S. 178-183.
4. Sigidin Ya. A., Guseva N.G., Ivanova M.M. Ho thatafatsa mafu a lisele tse sebetsanang.— M: Medicine, 1994.— 544 leq.
5. Strachunsky L.S., Kozlov S. H. Glucocorticoid litokisetso. - Smolensk, 1997 .- 64 leq.
6. Buka ea litšupiso ea kalafo ea Univesithi ea Washington (e hlophisitsoe ke M. Woodley, A. Whelan) .- M .: Ho ikoetlisa, 1995.— 832 leq.
7. Boumpas D. T., Chrousos G. P., Wildps R. L., Cupps T. R. Glucocorticoid kalafo bakeng sa mafu a amanang le boits'ireletso: Litlatsetso tsa mantlha le tsa kliniki.Liphatlalatso tsa bongaka ba kahare.

Sebaka sa marang-rang se fana ka tlhaiso-leseling e mabapi le lintlha feela. Ho hlahloba le ho phekola maloetse ho lokela ho etsoa ka tlasa taolo ea setsebi. Lithethefatsi tsohle li na le li-contraindication. Kopo ea setsebi e hlokahala!

Li -teroids kalafong ea mafu a rheumatoid

Lithethefatsi tse sebelisetsoang ho loants'a rheumatism li kenyeletsa glucocorticosteroids. Ke eng, le lithethefatsi tse sebelisoang ho phekola rheumatism, re tla li hlahloba ka botlalo. Lefu la rheumatoid le na le meeli ts'ebetsong ea kalafo. Mekhoa ea litlhare ea Steroid e ka sebelisoa feela ka nako e khuts'oane. Le ha ho le joalo, li sebelisoa hangata ntoeng e khahlano le lipontšo tsa feberu (nakong ea ts'ebetso ea lefu lena). Lithethefatsi tsa sehlopha sena li boetse li sebelisoa kalafong ea ho ruruha manonyeletso a lesapo la mokokotlo. Glucocorticosteroids e sebelisang khafetsa kalafo ea mafu a rheumatoid:

Glucocorticoids le bohlokoa ba tsona ho mafu a hematological

Glucocorticosteroids (cortisone, prednisone, prednisone, dexamethasone) ke e 'ngoe ea lithethefatsi tse sebelisoang haholo ho sebelisa li-immunosuppressive bakeng sa mafu a sistimi ea hematopoietic. Ho pathogenesis ea eona, ts'oaetso ea ho ruruha le liketsahalo tsa autoimmune li khonahala. Prednisone, le maemong a matla, methylprednisone, e sebelisoa kahare ho kalafo ea phokolo ea mali e amanang le thrombocytopenia. Li-Steroid li ka sebelisoa bakeng sa ho tsoa mali, kaha li lebisa hoketseho ea palo ea liplatelete.

Lithethefatsi tsa Steroid bakeng sa khaello ea adrenal

Bakeng sa bokuli, ho sebelisoa li-glucocorticosteroids tse entsoeng. Ke eng, ke matšoao afe a bonahatsoang ho lefu lena? E amana haholo le ho fokotseha ha tlhahiso ea lihormone tsa corticoid. Corticosteroids e sebelisoa kalafo ea ho hlobaela ho matla kapa ho sa feleng ha adrenal. Ho lithethefatsi tse sebelisitsoeng - cortisol (kapa hydrocortisol).

Glucocorticosteroids bakeng sa karabelo ea mmele

Phekolo ea li-glucocorticosteroids tsa allergic le tsona li sebelisoa. Phekolo e joalo e ka etsoa ka matšoao a bobebe a nako le nako ea ho kulisoa ke rhinitis, conjunctivitis, hammoho le maikutlo a ho ruruha kapa ho ruruha ho amanang le ho longoa ke likokonyana. Ho thibela ho pheta-pheta ha anaphylactic reaction, hydrocortisone (200 mg ka methati) kapa prednisolone (20 mg kahare) hangata e sebelisoa. Hape, meriana e tsebahalang haholo e nkiloeng ke sefuba e bakoang ke ho kula ke: flunisolide le fluticasone, tse tlatsetsang ho tloseng ha khatello ea kelello ka potlako.

Phello e khahlanong le ho ruruha

Ke leboha ts'usumetso e matla e khahlanong le ho ruruha eo lihormone li e fumaneng 'me li tšoarelletse niche ea bona ka mokhoa o tiileng. Haholo-holo hangata li sebelisoa ho rheumatology.

Ts'ebetso e phahameng ea li-corticosteroids mabapi le ho ruruha e li lumella ho loana ka katleho le mafu a kang:

1. Ramatiki e sebetsang.
2. SLE, kapa systemic lupus erythematosus.
3. le lits'ebetso tse ling tsa autoimmune.

Glucocorticoids e thibela ts'ebetso ea ho ruruha le ho senya manonyeletsong, ntle le moo ho se na lefu la rheumatological le ka etsang. Lingaka tsa masapo tsa mokokotlo le tsona li li tlamela bakeng sa arthrosis e nang le bohloko bo boholo le e rarahaneng ke ts'ebetso ea ho ruruha.

Li-corticosteroids li na le matla a ho thibela mafu?

Lihormone li etsa ts'ebetso ea bona ea anti-inflammatory ka ho hatella mosebetsi oa enzyme e khethehileng - phospholipase A2. Ka ho otloloha, li ama mesebetsi ea lintho tse ling tse ikarabellang bakeng sa nts'etsopele ea ts'oaetso.

Ntle le moo, li-corticosteroids li fokotsa haholo phallo ea mokelikeli ho tloha betheng ea vascular ka lebaka la ho ts'oaroa ke li-capillaries, ke hore, li felise edema.

Khahlano le semelo sa ts'ebetso ea bona, ts'ebetso ea microcirculation lesion ea matlafatsoa, ​​mme ts'ebetso ea ts'ebetso ea setho se senyehileng e etsahala ka potlako.

Ho ramatiki ea rheumatoid, li-glucocorticoids li sireletsa lefufuru le masapo hore a se ke a senngoa, li u thusa ho boloka sebopeho le tšebetso ea manonyeletso.

Matla a immunomodulatory

Karolo ea glucocorticoids ke thibelo ea ho itšireletsa mafung. E boetse e thibela kholo ea lisele tsa "lymphoid". Sena se hlalosa ho eketsoa habonolo hoa tšoaetso ea vaerase kalafong ea li-corticosteroids.

Leha ho le joalo, ho batho ba nang le boikoetliso bo neng bo le teng pele ho moo, lihormone tsena li ka khutlisa boemo bo hlokahalang ba li-antibodies tsa immunoglobulin.

Kameho ea khatello ea khatello ea ho itšireletsa mafung ke glucocorticoids e sebelisoa haholo ho transplantology ho thibela mokuli ho hana lisele tse fetisitsoeng.

Tšusumetso e mpe

Sistimi ea nts'etsopele ea karabelo efe kapa efe ea allergic e rarahane haholo. Ha ntho e kantle e kena 'meleng, sesole sa' mele se qala ho kopanya li-antibodies tse khethehileng - li-immunoglobulins.

Li ikopanya le meaho e itseng - lisele tsa methapo. Ka lebaka la ts'ebetso ena, ho lokolloa lintho tse 'maloa tse sebetsang ka biology, e' ngoe ea tsona e le histamine. Ke eena ea bakang ho hlaha hoa matšoao a sa thabiseng le a kotsi a tšoaetso ea ho kulisa.

Glucocorticoids e thibela tšebelisano ea 'mele ea li-immunoglobulin ka lisele tsa methapo ebe e thibela tsoelo-pele ea koluoa. GCS e sebelisoa ho loants'a ho thothomela ha anaphylactic, edema ea Quincke, urticaria le mefuta e meng ea allergy.

Litholoana tsa metabolism

Lihormone tsa Steroid li ama mefuta eohle ea metabolism. Leha ho le joalo, ho nka karolo ha bona ho metabolism ea lik'habohaedreite ho kotsi haholo. Li na le litlamorao tse latelang:

1. Ho eketsa litekanyo tsa tsoekere ea mali - ho lebisa kholong ea hyperglycemia.
2. E kenya letsoho ponahalong ea tsoekere ka har'a moriti - glucosuria.
3. Li lebisa ho lefu la tsoekere, leo hape le bitsoang steroid.

Kameho ea li-hormone ho metabolism ea protheine le eona ha e sireletsehe ho bakuli. Ba thibela tlhaho ea bona le ho potlakisa ho bola. Ts'ebetso tsena li boleloa haholo-holo ka har'a mesifa le letlalo.

Liphetho tsa ketso ena ea bo-catabolic ea glucocorticoids ke mesifa ea mesifa, matšoao a ho otlolla, ho theola boima ba 'mele, letlalo le boreleli, pholiso ea maqeba butle.

Ka lebaka la litlamorao tse mpe tsa GCS ho metabolism ea mafura, ho ajoa ha asymmetric ea mafura a kenang 'meleng. Ho bakuli ba joalo, e batla e le sieo ka maoto le matsoho, empa e beoa ka bongata sefahlehong, molaleng le sefubeng.

Lihormone tsa Steroid li boloka metsi le sodium 'meleng, empa ka nako e ts'oanang li khothaletsa tokollo ea calcium le ho tlosoa hoa eona masapong. Hammoho le metabolism e senyehileng ea protheine, hypocalcemia e lebisa ho.

Litlamorao tsamaisong ea pelo le pelo

Matla a glucocorticoids tsamaisong ea pelo le methapo e rarahaneng ke mohato o rarahaneng le o fapaneng. Empa ho mokuli, bokhoni ba bona ba ho tsitsisa methapo ea mali le keketseho ea khatello ea mali bo bohlokoa. Ts'ebetso ena ea khatello e ka sebeletsa molemong oa mokuli, le e kotsi.

Ka ho theoha ho hoholo ha khatello ea mali, vasodilation, ho ts'oaroa, ke tlhahiso ea li-hormone tse bolokang bophelo hangata. Empa ka nako e ts'oanang, ts'ebeliso ea bona e hlophisehileng e kenya letsoho kholisong ea khatello ea mali le likotsi tsa pelo.

Kameho tsamaisong ea endocrine

Tšebeliso ea nako e telele ea lithethefatsi tsa li-hormone bakeng sa mafu a kopaneng kapa a mang a methapo e baka mokhoa oa ho araba. Ka bokong, mofuta oa li-hormone tse susumetsang o thibetsoe, litšoelesa tsa adrenal li khaotsa ho etsa mesebetsi ea tsona.

Ka lebaka la ho se leka-lekane mosebetsing oa litšoelesa tsa endocrine, lits'ebetso tsohle tsa metabolic 'meleng lia khathatseha. Ntle le moo, GCS e thibela tlhahiso ea lihormone tsa thobalano.Sena se ka baka mathata a mangata bophelong ba thobalano le botona. Mefuta e fokotsang ea lihormone tsa thobalano le eona e lebisa ho lefu la masapo.

U ka sebetsana joang le litlamorao tse sa batleheng tsa corticosteroids?

Liphello tse mpe

Leha ho na le lethathamo le khahlisang la litlamorao tse kotsi, lihormone li ntse li tsoela pele ho ba kalafo e tsebahalang bakeng sa maloetse a mangata - manonyeletso, letlalo le sesole sa 'mele.

Ka linako tse ling GCS ke lithethefatsi tsa khetho. Hangata sena se hlokomeloa ho mafu a autoimmune, ha lithethefatsi tse ling li hloleha.

Ho fokotsa sekhahla le ho teba ha litlamorao ho u thusa ho khetha lethathamo la mofuta le mofuta oa phekolo ka hloko. Ho na le kalafo ho li-dose tse kholo, empa tsa nako e khuts'oanyane - kalafo ea pulse. Ka lehlakoreng le leng, lithethefatsi tsa lihormone li ka nooa bophelo bohle, empa litekanyetso li fokotsehile.

Ho bohlokoa hore kalafo e etsoe tlasa taolo ea ngaka e tla hlahloba maemo a pelo le mesifa kamehla, tsoekere ea mali le calcium, le ponahalo ea mokuli.

Ha e le molao, ka tekanyetso e khethiloeng ea moriana, kalafo ea glucocorticoid ha e utloise mokuli bohloko, empa e ntlafatsa bophelo ba hae bo botle le boemo ba bophelo bo botle.

Mmele oa motho ke sistimi e rarahaneng, e sebetsang e tsoelang pele e khonang ho hlahisa lintho tse sebetsang bakeng sa ho felisoa ka mokhoa o ikemetseng oa matšoao a mafu le tšireletso khahlanong le lintlha tse mpe tsa tikoloho e kantle le e ka hare. Lintho tsena tse mafolofolo li bitsoa lihormone, 'me hape, ts'ebetsong ea ts'ireletso li boetse li thusa ho tsamaisa lits'ebetso tse ngata' meleng.

Li-glucocorticosteroids ke eng

Glucocorticosteroids (glucocorticoids) ke lihormone tsa corticosteroid tse hlahisoang ke adrenal cortex. Setho sa pituitary, se hlahisang ntho e ikhethang maling, corticotropin, ke sona se ikarabellang bakeng sa tokollo ea lihormone tsena tsa steroid. E hlohlelletsa cortex ea adrenal hore e pate bongata bo boholo ba li-glucocorticoids.

Litsebi li lumela hore ka hare ho lisele tsa motho ho na le babuelli ba khethehileng ba ikarabellang bakeng sa karabelo ea sele ho lik'hemik'hale tse sebetsang ho eona. Ke kamoo ba hlalosang mokhoa oa ts'ebetso oa li-hormone leha e le life.

Li-glucocorticosteroids li na le phello e pharalletseng ho 'mele:

• ho ba le anti-khatello ea maikutlo le li-anti-shock athari,
• ho akofisa tšebetso ea tloaelo ea ho ikamahanya le maemo a batho,
• tsosa tlhahiso ea lisele tsa mali mokopeng oa masapo,
• eketsa kutloisiso ea myocardium le methapo ea mali, tsosa kholo ea khatello ea mali,
• eketsa 'me u be le phello e ntle ho gluconeogenesis e hlahang ka har'a sebete. 'Mele o ka emisa ho hlaseloa ke tlhaselo ea hypoglycemia, e leng se hlahisang ho lokolloa ha lihormone tsa steroid maling,
• eketsa li-anabolism, ho potlakisa phapanyetsano ea li-electrolyte tse molemo 'meleng,
• ba le phello e matla ea thibelo ea mafu a amanang le thobalano,
• fokotsa ho lokolloa ha babuelli, ho fana ka phello ea antihistamine,
• ho ba le phello e matla ea khahlanong le ho ruruha, ho fokotsa mosebetsi oa li-enzyme tse bakang lits'ebetso tse senyang liseleng le liseleng. Khatello ea babuelli ba marang-rang e baka ho fokotseha ha phapanyetsano ea maro lipakeng tsa lisele tse phetseng hantle le tse amehang, ka lebaka leo ts'oaetso e sa holang ebile e sa tsoelepele. Ntle le moo, GCS ha e lumelle lipocortins tse tsoang ho arachidonic acid ho hlahisoa - li-catalysts tsa ts'ebetso ea ho ruruha,

Bokhoni bona bohle ba lihormone tsa steroid ea adrenal cortex li fumanoe ke bo-rasaense ka laboratoring, ka lebaka leo ho bileng le ts'ebetso e atlehileng ea li-glucocorticosteroids lefapheng la meriana. Hamorao ho ile ha bonoa phello ea li-antipruritic ea li-hormone ka tšebeliso ea kantle.

Keketso ea maiketsetso ea li-glucocorticoids 'meleng oa motho, ebang ke kahare kapa kantle, e thusa' mele ho sebetsana le mathata a mangata kapele.

Leha ho na le katleho e kholo le melemo ea lihormone tsena, liindasteri tsa mehleng ea kajeno tsa meriana li sebelisa li-analogu tsa tsona tsa maiketsetso, hobane lihormone tsa ticantosteroid tse sebelisitsoeng ka sebopeho sa bona se hloekileng li ka baka palo e kholo ea litlamorao tse mpe.

Matšoao a ho nka li-glucocorticosteroids

Glucocorticosteroids e beoa ke lingaka maemong ao 'mele o hlokang phekolo e tšehetsang e eketsehileng. Lithethefatsi tsena ha li hlalosoe hangata e le monotherapy, li kenyelletsoa haholo kalafong e rarahaneng ea lefu le itseng.

Hangata, matšoao a ts'ebeliso ea lihormone tsa maiketsetso tsa glucocorticoids a kenyelletsa maemo a latelang:

• mmele, ho kenyelletsa vasomotor rhinitis,
• le maemo a pele ho asthmatic ,,
• ho ruruha ha letlalo la li-etiologies tse fapaneng. Glucocorticosteroids e sebelisoa le ha ho tsoa maqeba a letlalo a tšoaetsanoang, hammoho le lithethefatsi tse ka emang le microorganism e ileng ea qholotsa lefu lena,
• oa tšimoloho efe kapa efe, ho kenyelletsa le tlokotsi e bakiloeng ke tahlehelo ea mali,
• , le lipontšo tse ling tsa methapo ea methapo e amehang,
• ho fokotseha ho hoholo ka lebaka la li-pathologies tsa ka hare,
• Pholoso e telele kamora ho fetisoa hoa litho le lisele, tšelo ea mali. Lihormone tsa mofuta ona li thusa 'mele hore o ikamahanye le' mele le lisele tse tsoang kantle ho naha, ho mamella mamello haholo.
• glucocorticosteroids e kenyellelitsoe molemong oa ho hlaphoheloa ka morao le kalafo ea radiation ea oncology,
• bokhoni bo fokotsehileng ba cortex ea bona ea ho qholotsa tekano ea lihormone le mafu a mang a endocrine maemong a hlobaetsang le a sa foleng.
• mafu a mang a lefu la ka mpeng: ,,
• lefu la sebete sa autoimmune,
• edema
• mafu a mahlo: keratitis, cornea iritis.

U hloka ho nka li-glucocorticosteroids feela kamora ho khethoa ke ngaka, hobane haeba u e nka ka nepo 'me lethalamo le sa sebetsoa ka nepo, meriana ena e ka baka litlamorao tse kotsi kapele.

Lihormone tsa Synthetic tsa steroid li ka baka matšoao a ho tlohela - ho senyeha ha bophelo bo botle ba mokuli kamora ho emisa meriana, ho fihlela ho haelloa ke glucocorticoid. Ho thibela sena ho etsahala, ngaka ha e bale feela tekanyetso ea kalafo ea lithethefatsi ka li-glucocorticoids. O boetse o hloka ho theha mofuta oa kalafo ka keketseho ea butle-butle ea bongata ba lithethefatsi bakeng sa ho phomola sethaleng sa lefu la methapo, le ho theola tekanyo ho ea bonyane kamora ho fetoloa hoa tlhalo ea lefu lena.

Tlhotlhomiso ea li-glucocorticoids

Nako ea ketso ea li-glucocorticosteroids e lekantsoe ke litsebi ka boqhetseke, ka bokhoni ba tekanyetso e le 'ngoe ea lithethefatsi tse ling ho thibela hormone ea adrenocorticotropic, e sebetsang hoo e batlang e le maemong ohle a kaholimo ho metabolism. Sehlopha sena se arola lihormone tsa steroid tsa mofuta ona ho mefuta e latelang:

1. Likarolo tse khutšoane - ho thibela ts'ebetso ea ACTH ka nako e fetang e fetang letsatsi (Cortisol, Hydrocortisone, Cortisone, Prednisolone, Metipred),
2. Nako e mahareng - nako ea nnete ea matsatsi a ka bang a mabeli (Traimcinolone, Polcortolone),
3. Ho nka lithethefatsi nako e telele - phello e nka nako e telele ho feta lihora tse 48 (Batmethasone, Dexamethasone).

Ntle le moo, ho na le sehlopha sa lithethefatsi tse khetholloang ka mokhoa oo li hlahisang 'mele oa mokuli ka ona.

1. Oral (matlapeng le likhabaneng),
2. nosetso ea manonyeletso le makhapetla
3. mefuta ea inhaled ea lithethefatsi (hangata e sebelisoang ke asthmatics),
4. litlolo le litlolo bakeng sa ts'ebeliso ea kantle.

Ho latela boemo ba 'mele le mofuta oa pathology, ka bobeli mefuta e 1 ea lithethefatsi tse nang le li-glucocorticosteroids e ka khethoa.

Lethathamo la lithethefatsi tse tsebahalang tsa glucocorticosteroid

Har'a lithethefatsi tse ngata tse nang le glucocorticosteroids, lingaka le litsebi tsa meriana li khetholla lithethefatsi tse 'maloa tsa lihlopha tse fapaneng tse sebetsang hantle mme li na le kotsi e tlase ea ho baka litlamorao.

Ho latela boemo ba mokuli le karolo ea ho hola ea lefu lena, ho khethoa sebopeho sa moriana, tekanyetso le nako ea tšebeliso. Ts'ebeliso ea li-glucocorticosteroids e hlile e etsahala tlasa taolo ea kamehla ea ngaka ho beha leihlo liphetoho tse teng maemong a mokuli.

Li-Corticosteroids tsa tlhaho

Corticosteroids e etsa mesebetsi e mengata ea bohlokoa 'meleng.

Glucocorticoids amanang le li-steroid ho ba le phello e khahlanong le ho ruruha, ba nka karolo taolong ea metabolism ea lik'habohaedreite, mafura le liprotheine, taolo ea bokhachane, ts'ebetso ea liphio, karabelo ea 'mele ho khatello ea maikutlo, e kenya letsoho molemong oa kemolo. Li-corticosteroid tse ka har'a sebete li se ke tsa kenella le ho pepesetsoa ka har'a moroto.

Aldosterone e laola phapanyetsano ea sodium le potasiamo. Ho susumetsoa ke hona mineralocorticoids Na + e bolokoa 'meleng' me masapo a K + ions a tsoang 'meleng aa eketseha.

Syorthetic corticosteroids

Corticosteroids e baka tsitsipano le khatello ea maikutlo 'meleng,' me sena se lebisa ho fokotseheng ha boits'ireletso, hobane boits'ireletso bo fanoa ka tekanyo e lekaneng feela maemong a phomolo. Ha ho fanoa ka se boletsoeng ka holimo, ho ka boleloa hore ts'ebeliso ea corticosteroids e kenya letsoho molemong oa lefu lena, e thibela ts'ebetso ea ho nchafala.

Ntle le moo, li-corticosteroids tsa maiketsetso li thibela tšebetso ea lihormone tsa tlhaho tsa corticosteroids, e lebisang tšebetsong ea adrenal ka kakaretso. Corticosteroids e ama ts'ebetso ea litšoelesa tse ling tsa endocrine, botsitso ba lihormone ba mmele boa senyeha.

Lithethefatsi tsa Corticosteroid, ho tlosa ho ruruha, le tsona li na le phello ea analgesic. Li-corticosteroids tsa synthetiki li kenyelletsa Dexamethasone, Prednisolone, Sinalar, Triamcinolone le ba bang. Lithethefatsi tsena li na le ts'ebetso e phahameng mme li baka litla-morao tse fokolang ho feta tsa tlhaho.

Litokisetso bakeng sa tšebeliso ea lehae (tsa sehlooho)

• Prednisone (mafura),
• Hydrocortisone (mafura),
• Lokoid (mafura),
• Cortade (mafura),
• Afloderm (tranelate),
• Laticort (tranelate),
• Dermoveit (tranelate),
• Fluorocort (setlolo),
• Loriana (setlolo, setlolo se matla)
• Sinaflan (mafura),
• Flucinar (mafura, gel),
• Clobetasol (mafura), jj.

Li-corticosteroids tsa topical li arotsoe ka ho sebetsa ho feta kapa ka tlase.
Bofokoli bo bolela: Prednisone, Hydrocortisone, Cortade, Lokoid,
E sebetsang hantle Afloderm, Laticort, Dermoveit, Fluorocort, Lorinden,
E sebetsang haholo Akriderm, Advantan, Kuterid, Apulein, Kutiveyt, Sinaflan, Sinalar, Sinoderm, Flucinar.
E sebetsa haholo: Clobetasol.

U ka sebelisa corticosteroids joang?

Ngoliso ea litekanyetso li beoa ke ngaka. Ho hlophisoa ha letlapa ho lokela ho nkuoa ka hora ea 6 hoseng (tekanyetso ea pele) eseng kamora lihora tse 14 hamorao. Maemo a joalo a ho amoheloa a hlokahala hore a lekanyetse ho kenella ha 'mele oa glucocorticoids maling nakong ea tlhahiso ea ona ke adrenal cortex.

Maemong a mang, tekanyetso e phahameng le ho latela mofuta oa lefu lena, litekanyetso li fetisoa ke ngaka bakeng sa kamohelo e tšoanang motšehare bakeng sa litekanyetso tse tharo.

Matlapa a lokela ho nooa le lijo kapa hang ka mor'a lijo ka metsi a manyane.

Phekolo ea corticosteroid

Ho fokotsa kalafo e sebelisoa bakeng sa lits'ebetso tse telele, tse sa foleng - mefuta ea litafole hangata e sebelisoa likhoeli tse 'maloa kapa lilemo.

Ho fokotsa phello e thibelang tšebetsong ea litšoelesa tsa endocrine, ho sebelisoa mekhoa e meng ea nakoana ea lithethefatsi:

• mofuta o mong oa phekolo - glucocorticoids e nang le nako e khuts'oane le e bohareng (Prednisolone, Methylprednisolone) e sebelisoa hang ho tloha ka 6 ho isa ho 8 hoseng ka mor'a lihora tse ling le tse ling tse 48,
• phekolo ea nakoana - lithuto tse khuts'oanyane tsa matsatsi a 3-4 tsa ho sebelisa moriana ka matsatsi a 4 a phomolo lipakeng tsa bona,
• phekolo ea pelo - tsamaiso ea methapo e potlakileng ea lethal dose le leholo (bonyane 1 g) ea lithethefatsi bakeng sa tlhokomelo ea tšohanyetso. Lithethefatsi tsa khetho bakeng sa kalafo ena ke Methylprednisolone (e fumaneha habonolo bakeng sa tsamaiso libakeng tse amehang mme e fana ka litlamorao tse fokolang).

Litekanyetso tsa letsatsi le letsatsi tsa lithethefatsi (ho ea ka polelo ea prednisone):

• E tlase - ka tlase ho 7.5 mg
• Bohareng - 7.5-30 mg,
• Phahameng - 30-100 mg
• E phahameng haholo - kaholimo ho 100 mg,
• Pulse kalafo e kaholimo ho 250 mg.

Phekolo e nang le corticosteroids e lokela ho tsamaisana le ho khethoa ha litlhare tsa calcium, vithamine D bakeng sa thibelo ea lefu la masapo. Lijo tsa mokuli li lokela ho ba le liprotheine tse ngata, calcium le ho kenyelletsa lik'habohaedreite tse ngata le sodium chloride (ho fihlela ho 5 g ka letsatsi), metsi (ho fihlela ho 1.5 l ka letsatsi).

Bakeng sa prophylaxis litlamorao tse sa rateheng tsa corticosteroids ka sethaleng sa ka mpeng pele ho lipilisi, ho ka khothalletsoa tšebeliso ea Almagel le jelly. Ho khothalletsoa ho khetholla ho tsuba, tšebeliso e mpe ea joala, boikoetliso bo itekanetseng.

Corticosteroids bakeng sa bana

Bana ba nang le ts'oaetso ea li-hormone (bakeng sa lefu la bronchial asma, mohlala) kamora ho kenella kahare ho moriana oa meriana o fetisetsoa ho lethal dose ea prednisolone. Ka khafetsa khafetsa ea asthma, Beklamethasone dipropionate e sebelisoa ka mokhoa oa ho inhalation - lethal dose le khethoa ka bonngoe. Kamora ho fumana phello, lethalinyana le fokotseha butle-butle hore e be tekanyetso ea tlhokomelo (motho ka mong o khethoa).

Li-Glucocorticoids tsa li-topical . Sena se bakoa ke taba ea hore ho bana karolelano ea sebaka sa 'mele ho boima ba' mele e kholo ho feta ho batho ba baholo.

Ka lebaka lena, li-glucocorticoids tsa topical ho bana li lokela ho sebelisoa feela libakeng tse lekanyelitsoeng le ka nako e khutšoane. Sena ke nnete haholo bakeng sa masea a sa tsoa tsoaloa. Bakeng sa bana ba selemo sa pele sa bophelo, ke litlolo feela tse se nang 1% hydrocortisone kapa sethethefatsi sa moloko oa bone - Prednicarbat (Dermatol) li ka sebelisoa, 'me li ka fihla ho lilemo tse 5 - Hydrocortisone 17-butyrate kapa litlolo tse nang le lithethefatsi tse mahareng.

Bakeng sa kalafo ea bana ba ka holimo ho lilemo tse 2, Mometasone e ka sebelisoa joalo ka ha ho laetsoe ke ngaka (setlolo, se na le tšusumetso e telele, e sebelisoa 1 r. Ka letsatsi).

Ho na le lithethefatsi tse ling bakeng sa kalafo ea dermatitis ea atopic ho bana ba nang le mokhoa o fokolang oa ho bitsoa oa kemiso, mohlala, Advantan. E ka sebelisoa ho fihlela libeke tse 4, empa ts'ebeliso ea eona e lekantsoe ka lebaka la monyetla oa ho etsa lintho tse mpe tsa sebakeng seo (ho oma le ho fifala ha letlalo). Leha ho le joalo, khetho ea moriana oa ho phekola ngoana e lula le ngaka.

Corticosteroids nakong ea bokhachane le lactation

Tšusumetso ena e mpe ea li-glucocorticoids e eketsoa ka lebaka la lithethefatsi tsa sejoale-joale tse sebetsang ka nako e telele (Metipred, Dexamethasone) ha li sa etsoa ke li-enzyme tsa placenta mme li na le phello ea nako e telele ho lesea. Glucocorticoids, e hatellang tsamaiso ea 'mele ea ho itšireletsa mafung, e thusa ho fokotsa ho hanyetsa ha mosali oa moimana ho tšoaetso ea baktheria le vaerase, e ka amang lesea le sa emeng hantle.

Lithethefatsi tsa Glucocorticoid li ka fuoa mosali oa moimana ha feela phello ea ts'ebeliso ea tsona e feta kotsi ea litlamorao tse mpe tse ka bang teng ho lesea.

Matšoao a joalo e ka ba:
1. Tšokelo ea tsoalo pele ho nako (thupelo e khutšoane ea lihormone e ntlafatsa bokhachane ba pelehi ba pelehi), ts'ebeliso ea surfantant bakeng sa lesea kamora tsoalo e entse hore ho fokotsoe tšebeliso ea li-hormone polelong ena.
2. Rheumatism le mafu a autoimmune karolong e sebetsang.
3. Herkenia (intrauterine) hyperplasia ka popelong ea karolo ea cortical ea tšoelesa ea adrenal e thata ho tseba lefu.

Pele ho moo, ho ne ho e-na le tloaelo ea ho khetha li-glucocorticoids ho boloka bokhachane. Empa lintlha tse kholisang mabapi le katleho ea mokhoa o joalo ha li e-so fumanoe, ka hona, ha e sa sebelisoa hona joale.

Tloaelo ea bakhachane Metipred, Prednisone le Dexamethasone li sebelisoa hangata. Li kenella ka har'a placenta ka litsela tse fapaneng: Prednisolone e senngoa ke li-enzyme ka placenta ho ea holimo, 'me Dexamethasone le Metipred feela ke 50%. Ka hona, haeba litokisetso tsa li-hormone li sebelisoa ho phekola mosali oa moimana, ho molemo ho fana ka taelo ea "prednisolone", 'me haeba bakeng sa kalafo ea "fetus" - Dexamethasone kapa Metipred. Ntlheng ena, li-prednisolone le karabelo e mpe ka popelong ha e sa tloaeleha.

Li-glucocorticoids tse kulang haholo li ngolisitsoe ka bobeli li-systemic (liente kapa matlapa), le tsa lehae (litlolo, li-gels, marotholi, inhalations). Li na le phello e matla ea ho fokola. Lithethefatsi tse latelang li sebelisoa haholoholo: Hydrocortisone, Prednisolone, Dexamethasone, Betamethasone, Beclomethasone.

Ho li-glucocorticoids tsa topical (bakeng sa kalafo ea lehae), maemong a mangata, ho sebelisoa li-aerosols tsa intranasal: ka hay fever, allergic rhinitis, tšubuhlellano ea nasal (ho thothomela). Hangata li ba le phello e ntle. Fluticasone, dipropionate, propionate le ba bang ba fumane ts'ebeliso e atileng.

Ho allergic conjunctivitis, li-glucocorticoids ha li sebelisoe hangata ka lebaka la kotsi e kholo ea litla-morao. Leha ho le joalo, ka lipontšo tsa lintho tse kulang, ho ke ke ha khoneha ho sebelisa lithethefatsi tsa lihormone ka bo tsona ho qoba litlamorao tse sa rateheng.

Corticosteroids bakeng sa Psoriasis

Li-glucocorticoids bakeng sa tšebeliso ea li-topical (litlolo, litlolo) hangata li sebelisoa 2 p. ka letsatsi: litlolo motšehare li sa apara, 'me bosiu ka terata ea mashala kapa anthralin li sebelisa mokhoa o tloahelehileng oa ho roala. Ka liso tse pharaletseng, hoo e ka bang 30 g ea moriana o sebelisetsoa ho phekola mmele kaofela.

Khetho ea tokiso ea glucocorticoid ho latela tekanyo ea ts'ebetso bakeng sa ts'ebeliso ea li-topical ho latela botebo ba thupelo ea psoriasis le ho ata ha eona. Ha kelello ea Psoriasis e fokotseha nakong ea kalafo, moriana o lokela ho fetoloa hore o se sebetse (kapa o sebelisoe haholo) ho fokotsa ho hlaha hoa litla-morao. Ha phello e fumaneha kamora libeke tse 3, ho molemo ho khutlisetsa moriana oa lihormone ka moemeli oa ho nolofatsa libeke tse 1-2.

Ho sebelisoa ha li-glucocorticoids libakeng tse kholo ka nako e telele ho ka mpefatsa ts'ebetso. Ho khutla hape ha psoriasis ka mor'a ho khaotsa lithethefatsi ho etsahala pejana ho feta nakong ea kalafo ntle le li-glucocorticoids.
, Coaxil, Imipramine le ba bang) hammoho le glucocorticoids li ka baka keketseho ea khatello ea methapo.

Glucocorticoids (e nang le tšebeliso ea nako e telele) e ntlafatsa ts'ebetso ea li-agrenists tsa adrenergic (Adrenaline, Dopamine, Norepinephrine).

Theophylline hammoho le glucocorticoids e khothalletsa ponahalo ea phello ea pelo, e ntlafatsa phello e khahlanong le ho ruruha ea glucocorticoids.

Amphotericin le diuretics hammoho le corticosteroids li eketsa kotsi ea hypokalemia (ho fokotseha hoa boemo ba potasiamo maling) le keketseho ea phello ea diuretic (mme ka linako tse ling ho bolokoa ha sodium).

Ts'ebeliso e kopaneng ea mineralocorticoids le glucocorticoids e ntlafatsa hypokalemia le hypernatremia. Ka hypokalemia, litla-morao tsa lefu la pelo li ka hlaha. Laxatives e ka eketsa hypokalemia.

Li-anticoagulants tse sa tobang, Butadion, Ethacrynic acid, Ibuprofen hammoho le li-glucocorticoids li ka baka lipontšo tsa hemorrhagic (ho tsoa mali), mme salicylates le Indomethacin li ka baka liso kahare ho litho tsa ka mpeng tsa lijo.

Glucocorticoids e eketsa phello e chefo ho sebete sa paracetamol.

Litokisetso tsa retinol li fokotsa phello e khahlanong le ho ruruha ea li-glucocorticoids le ho ntlafatsa pholiso ea leqeba.

Ts'ebeliso ea lihormone hammoho le Azathioprine, Methandrostenolone le Hingamine e eketsa kotsi ea ho ba le likoluoa ​​le maikutlo a mang a mabe.

Glucocorticoids e fokotsa phello ea cyclophosphamide, phello ea antiviral ea idoxuridine, ts'ebetso ea lithethefatsi tse fokotsang tsoekere.

Estrogens e ntlafatsa phello ea li-glucocorticoids, tse ka fokotsang litekanyetso tsa bona.

Androgens (lihormone tsa banna tsa botona le botšehali) le litokisetso tsa tšepe li ntlafatsa erythropoiesis (sebopeho sa lisele tse khubelu tsa mali) ha e kopantsoe le glucocorticoids, e fokotsa ts'ebetso ea tlhahiso ea li-hormone, 'me e baka litlamorao (ho eketseha ha mali, ho bolokoa ha sodium, ho se sebetse ha matsatsi a ho ea khoeling).

Mokhahlelong oa pele oa ho robatsa litho ka tšebeliso ea li-glucocorticoids bolelele le nako ea ho opa lijalo e fokotsehile, litekanyetso tsa Fentanyl li fokotsehile.

Melao ea ho khaola Corticosteroid

Haeba nako ea thupelo ea glucocorticoid e ka ba ho isa likhoeli tse 'maloa, joale tekanyetso ea prednisolone e ka fokotsoa ke 2,5 mg (litafole tse 0.5) ka matsatsi a mang le a mang a 3-5. Ha e le nako e telele haholo, lethalinyana le fokotseha butle - ka 2,5 mg ka beke tse ling le tse ling tse tharo. Ka tlhokomelo e kholo, tekanyo e fokotsoa ka tlase ho 10 mg - litafole tsa 0,25 ka matsatsi ohle a 3-5-7.

Haeba tekanyetso ea pele ea prednisolone e ne e phahame, qalong ho fokotseha ho tebile haholoanyane: ka 5-10 mg letsatsi le leng le le leng la 3. Ha a fihla ka tekanyetso ea letsatsi le letsatsi e lekanang le 1/3 ea lethal dose la mantlha o fokotsoa ke 1.25 mg (matlapa a 1/4) ka mor'a libeke tse ling le tse ling tse tharo. Ka lebaka la ho fokotseha ho joalo, mokuli o fumana tekanyetso ea tlhokomelo bakeng sa selemo kapa ho feta.

Ngaka e beha mofuta oa moriana oa phokotso ea lithethefatsi, 'me ho tlola melao ena ho ka lebisa ho ruruha ha lefu lena - kalafo e tla tlameha ho qala hape ka tekanyetso e kholo.

Litheko tsa corticosteroid

Ka har'a 'mele oa motho, ts'ebetso ea lik'hemik'hale le ea biochemical e lula e etsahala, ka lebaka leo lintho tse ling li hlahisoa. Li ama ts'ebetso ea litho le litsamaiso, lits'ebetso tsohle tse etsahalang seleng ea sele. Boithuto ba likarolo tse joalo - lihormone, ha bo lumelle feela ho utloisisa ts'ebetso ea bona le mekhoa ea ts'ebetso, empa hape e sebelisetsoa merero ea kalafo. Phekolo ea phetisetso ea Hormone ho bakuli ba bangata ke eona feela tsela ea ho tsoa ho mafu a sa arabeng kalafo ka lithethefatsi tse ling. Glucocorticosteroids e sebelisoa mokhoeng oa meno, bongaka, urological, dermatological le mekhoa e meng. Joale li-glucocorticosteroids, ke eng?

Ts'ebetso ea pharmacological ea corticosteroids

Glucocorticosteroids (lebitso le leng - glucocorticoids) ke li-hormone tsa steroid tseo e leng karolo ea subclass ea corticosteroids e hlahisoang 'meleng ke adrenal cortex. Ena ke cortisol (e na le ts'ebetso e phahameng ka ho fetisisa ea tlhaho), corticosterone, jj.

Ho bohlokoa ho tseba: li-glucocorticoids li na le phello e matla ea ho thibela khatello ea maikutlo, anti-shock effect. Ho tsitsipana ha bona maling ho eketseha haholo khahlanong le semelo sa boemo bo sithabetsang, bo sithabetsang bo tsamaeang le tahlehelo ea mali. Keketseho ea boemo ba lihormone litšoantšong tse joalo e amahanngoa le ho ikamahanya le 'mele bakeng sa tahlehelo e matla ea mali, ho ts'oha, litlamorao tsa ho sithabela ha maikutlo le litlamorao tse ling tse mpe.

Kameho ea lihormone tsa "glucose" ea mmele oa motho ke e latelang:

• Tlatsetsa keketseho ea khatello ea systolic le diastolic,
• Eketsa ts'ebetso ea masapo a sele ea mesifa ea pelo ho litlamorao tsa catecholamines,
• Ba thibela tahlehelo ea receptor susceptibility e nang le litaba tse phahameng tsa catecholamines,
• Ho susumetsa tlhahiso ea lisele tse tšoeu tsa mali 'meleng,
• Eketsa tsoekere ea tsoekere ka har'a sebete,
• Eketsa khatello ea tsoekere
• Inhibit ho kenella ha tsoekere ho linama tse kenang,
• Ho potlakisa tlhahiso ea glycogen
• Ho thibela tšebetso ea tlhahiso ea liprotheine, ho phatloha ha tsona,
• Glucocorticosteroids e tlosa calcium le potasiamo, e fana ka pokello ea metsi, chlorine le sodium 'meleng,
• Fokotsa nts'etsopele ea methapo ea kutlo.

Lihormone tsa "Glucocorticoid" li "laola" tšebeliso ea lipids liseleng tsa linama tse kenellang, li ama ho senyeha hoa lisele tse bonolo ho litlamorao tsa li-hormone tse itseng. Ntle le moo, lintho tsena li ama ts'ebetso ea sesole sa 'mele - li thibela ts'ebetso ea li-antibodies tse ling, empa li potlakisa ho etsoa ha lisele tse ling, jj. Lethathamo la thepa ea lihormone le ntse le tsoela pele. Ho ka etsahala hore ba kenelle ka mafolofolo lits'ebetsong tse ling, tse seng li tsejoe.

Joale li-glucocorticosteroids, ke eng? Tsena ke lihormone tse hlahisoang 'meleng oa motho e mong le e mong. Li na le thepa e ngata. Empa ketso e 'ngoe ea bohlokoahali e bakang ts'ebeliso ea GCS ke phello e khahlanong le ho hlasimoloha. GCS e thibela ts'ebetso ea likarolo tse itseng tsa enzyme 'meleng, e lebisang phomolong e potlakileng ea ts'ebetso ea ho ruruha.

Lihormone li thibela ho etsoa ha edema molemong oa ho ruruha, kaha li fana ka phokotso ea boteng ba tumello ea methapo ea methapo. Li boetse li baka tlhahiso ea lintho tse ling tse bonts'itsoeng ke thepa e khahlanong le ho ruruha.

Bohlokoa: glucocorticosteroids ke lithethefatsi tse nang le litlamorao tse ngata, ts'ebeliso ea eona e lumelletsoe feela ka mabaka a thata a bongaka. Ts'ebeliso e ikemetseng e tletse mathata a mangata.

Matšoao a ho sebelisoa

Li-glucocorticosteroids li laeloa kalafo ea adrenal gland pathologies. Ho bohlokoa ho li nka khahlanong le semelo sa mofuta o thata kapa o sa foleng oa ho sebetsoa ke masapo, ka hyperplasia ea mokokotlo oa cortical ea tlhaho ea tlhaho. Ka maloetse ana, tlhahiso ea tlhaho ea lihormone e ferekanngoa, ka hona, ts'ebeliso ea lithethefatsi ho khutlisa botsitso ba lihormone e ea hlokahala.

1. Phekolo ea mafu a mofuta oa autoimmune (mohlala, ka rheumatism, sarcidosis). Morero oa bona o ipapisitse le bokhoni ba ho potlakisa kapa ho hatella mekhoa e meng ea boits'ireletso ea mmele. GCS e laetsoe kalafo ea ramatiki.
2. Therapy ea methapo ea methapo ea methapo ea kutlo, ho kenyelletsa tlhaho ea ho ruruha (tumellano ea ts'ebetso e bakoa ke thepa e khahlanong le ho ruruha).
3. GCS ka karohano ea ho kulisa e sebelisoa e le lithethefatsi tse amang tlhahiso ea likarolo tse sebetsang tse ntlafatsang ho se mamellane ha 'mele ho hlekefetsang - allergener.
4. Pheko ea Hormone e khutlisetsoang bakeng sa maloetse a tsamaiso ea phefumoloho (khahlano le semolao sa bronchial asthma, allergic rhinitis, pneumonia). Hlokomela hore lithethefatsi tsa lihormone li fapana mochineng le lebelong la ho pepeseha. Lithethefatsi tse ling li sebetsa kapele, ha tse ling li sebetsa butle butle. Lithethefatsi tse sebetsang butle li ke ke tsa sebelisoa ho imolla tleliniki e bohloko.
5. Mesebetsing ea meno, corticosteroids e laetsoa pulpitis, periodontitis le mafu a mang.
6. Pheko ea mafu a dermatological. Ha e le molao, tranelate kapa setlolo se thehiloeng ho lihormone li fanoe. Ba thusa ho imolla lits'oaetso tsa ts'oaetso ka hara dermis, ho imoloha ho tsoa tleliniking e mpe - ho soetseha, ho sesa letlalo, leqeba la ho ruruha, jj.
7. Phekolo ea li-pathologies tsa gastrointestinal (lefu la Crohn).
8. GCS e laetsoe bakeng sa likotsi, tse ipapisitseng le liketso tsa anti-inflammatory le anti-shock.
9. Ka kalafo e rarahaneng khahlanong le semelo sa 'mele oa "cerebral" edema.

Ho ipapisitsoe le metsoako ea sehlopha sa li-glucocorticosteroid li-hormone, ho entsoe meriana e mengata. Li tla ka mefuta e fapaneng ea litekanyetso - li-lotion, balms, litlolo, litlolo, likhalase, likhalase, matlapa a ts'ebeliso ea kahare.

Mabitso a lithethefatsi tsa glucocorticosteroid: Cortisone, Triamcinolone, Hydrocortisone, Prednisolone, Beclomethasone, Dexamethasone, joalo-joalo kalafo ea phetisetso ea Hormone e na le litšoaneleho tsa eona, ke ngaka feela e fanang ka litlhare tse nang le li-hormone.

Litlamorao tse ka etsahalang tsa glucocorticosteroids

Lithethefatsi tsa Glucocorticosteroid li sebelisoa ka lebaka la katleho ea tsona kalafong ea maloetse a mangata. Li thusa ho khutlisa botsitso ba lihormone 'meleng, bo felisang li-pathologies tse' maloa. Empa kalafo ea li-hormone ha e bolokehe kamehla, kaha hangata e lebisa ho hlaha hoa liketsahalo tse mpe. Ke ka lebaka leo lithethefatsi li nang le matšoao a hlakileng.

Lintho tse mpe tse atileng haholo li kenyeletsa:

• Ho senyeha ha letlalo, moriri, ponahalo ea matšoao a otlolohileng, makhopho, makhopho,
• Kholo e matla ea moriri ho basali libakeng tsa 'mele (mohlala, sefubeng, sefahlehong, jj.),
• Ho senyeha ha boemo ba methapo ea mali (matla, elasticity le ho fokotseha ha moea),
• Litla-morao tse bohloko tsamaisong ea methapo ea kutlo. E bonahatsoa ke ho khathatseha boroko, ho sithabela maikutlong, ho se ts'oenyehe ho sa hlokahaleng, neurosis, ho hloka thahasello, khatello ea maikutlo le maemo a mang a pathological
• Ho sitisoa ha pono.

Tlhahisoleseling: glucocorticosteroids e ka baka nts'etsopele ea lefu la tsoekere (lefu le sa foleng la tsoekere ea mali), leqeba la peptic, khatello ea mali ea methapo (khatello e phahameng ea mali), ho se sireletsehe ha mmele, botenya, jj.

Ts'ebetsong ea bongaka, linyeoe li fumanoe ha GCS e lebisa ts'ebetsong ea sefefo se matla 'meleng. Sena se bakoa ke taba ea hore khahlano le boteng ba likokoana-hloko tsa pathogenic, lithethefatsi li lebisa ho fokotseheng hoa boits'ireletso, ka lebaka leo, libaktheria li qala ho ata ka bongata, hobane sesole sa 'mele ha se khone ho sebetsana le tsona.

Liketsahalo tse sa thabiseng ha li tsoelle feela ka tšebeliso ea nako e telele kapa ka lebaka la tšebeliso e ngata ea meriana, empa hape le maemong ao mokuli a noang moriana ho latela litaelo. Hape, kholo ea bona e etsahala khahlanong le semelo sa ho tlosoa hoa lithethefatsi (syndrome ea ho ntša), hobane ha lihormone li amoheloa ka ntle, litšoelesa tsa adrenal ha li li hlahise ka botsona.

Qetellong ea kalafo ea li-hormone, matšoao a latelang a bonoa hangata:

1. Ho opa ha mesifa.
2. Ho fokotse takatso ea lijo.
3. Lethargy, ho hloka thahasello.
4. Keketseho ea mocheso oa 'mele.
5. Ho eketseha ha maloetse a sa foleng historing.

Phello e kotsi ka ho fetisisa ea ts'ebeliso ea glucocorticosteroid ke ho ba teng ha khaello ea phetoho ea adrenal. E tšoauoa ka ho fokotseha ho hoholo ha khatello ea mali, tlolo ea ts'ilo ea lijo, bohloko ba ka mpeng, boemo ba ho bolaoa le ho tsitsipana.

Li-glucocorticosteroids li na le matšoao a bang teng, kahoo ho emisa tšebeliso ea tsona ka boyona ha ho kotsi ho feta ho ikoetlisa. Phetha kalafo tlasa tataiso ea ngaka. Tekanyetso e fokotseha butle-butle, e fokotsang ho teba ha litla-morao.