风湿病患者想要正确使用糖皮质激素,看着一篇就够了!

2022-06-06 高丽丽 问问风湿APP

就通过这一篇文章,解答关于糖皮质激素的诸多疑问。

糖皮质激素(简称激素)是治疗风湿病的主要药物与基础治疗药物,其基本结构为类固醇,有广泛的抗炎和免疫抑制作用,在风湿性疾病的治疗中广泛应用。常见的激素包括内源性的可的松、氢化可的松,及外源性的泼尼松(强的松)、泼尼松龙 (强的松龙)、甲泼尼龙(甲基强的松龙)、地塞米松、倍他米松等。

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但很多患者朋友在运用糖皮质激素时都会有很多的顾虑,“用了之后是不是会变胖?”“用了之后是不是会有依赖性?”“激素是不是对脏器的损伤特别大?”,今天我们就通过这一篇文章,解答关于糖皮质激素的诸多疑问。

一、糖皮质激素的选用

常用激素可分为短效、中效与长效药物。

其中短效制剂(作用时间8-12h)如氢化可的松、可的松,中效制剂(作用时间12-36h)如泼尼松、甲泼尼龙、泼尼松龙、曲安西龙,长效制剂(作用时间36-54h)如地塞米松、倍他米松等。

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可的松、氢化可的松为短效制剂,其与人体内源性皮质激素功能相同,抗炎效力弱,作用时间短,有糖和盐皮质激素活性,对下丘脑-垂体-肾上腺(HPA)轴的抑制作用较轻,水钠潴留不良反应明显,故适于生理性替代治疗。可的松需在肝内转化为氢化可的松才有生物活性,故氢化可的松较可的松更适于肝功能障碍者。

外源性的泼尼松(强的松)等为中效制剂,其加强了抗炎作用,作用时间延长,并降低了水钠潴留,是治疗自身免疫性疾病的主要药物。泼尼松需在肝内转化为泼尼松龙才有生物活性,故泼尼松龙(强的松龙)较泼尼松更适于肝功能障碍者。

外源性的地塞米松、倍他米松为长效制剂,其更加强化抗炎作用,使作用时间更长,并进一步降低了水钠潴留,但对HPA轴抑制作用长而强,故不宜长期使用,只适于短期使用。儿童避免使用对HPA轴影响较大的长效激素。

二、糖皮质激素的不良反应

激素的不良反应与药物种类、剂型、剂量、疗程、用法等明显相关。如营养物质代谢紊乱、水盐代谢紊乱、水钠潴留、低血钾、诱发和加重溃疡、骨质疏松与骨折、股骨头坏死、诱发和加重感染、血压异常、精神神经症状(失眠、精神错乱、诱发癫痫发作)、出血倾向、医源性肾上腺皮质功能亢进、撤药反应、糖尿病、高脂血症、体重增加等。

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氢化可的松琥珀酸钠溶媒为水,氢化可的松注射液溶媒为酒精,与有甲硫四氮唑侧链结构的药物如头孢哌酮、有甲硫三嗪侧链结构的药物如头孢曲松等抑制乙醛脱氢酶活性的药物联用,会引起双硫仑样反应,避免联用。

三、糖皮质激素漏服后的处理

根据病情需要,激素可选择晨起顿服、 隔日给药或每日分次给药。

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每日服用1次药物,若当日错过了服药的时间应立即补服,若次日发现漏服时不必补服,继续按照正常服药方法顺延即可;

隔日服用1次药物,若当日忘记服药或在次日发现漏服药物时,应立即补服,以后的服药时间按照补服的时间顺延;

每日服用2次或3次药物,发现漏服时应立即按量补服,若在此次服药时发现了前一次的药漏服,此次的服药量应加倍,以后仍应按原规定的时间和剂量服药[7]

四、糖皮质激素的撤药措施

糖皮质激素使用短疗程者可快速减药,长疗程者需缓慢减药,需遵循“先快后慢”原则。

 

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糖皮质激素疗程在7d内者可直接停药,而超过7d者需先减药后撤药;泼尼松30mg/d×2周者,可每3-5d减少5mg/d的剂量;泼尼松50mg/d×4-8周者,需每1-2周减少5mg/d的剂量,至20mg左右后每2-4周减5mg。若在减药过程中病情反复,可酌情增加剂量[2]

参考文献:

[1]风湿性疾病患者围妊娠期药物使用规范[J].中华内科杂志,2021,60(11):946-950

[2]糖皮质激素急诊应用专家共识[J].中华急诊医学杂志,2020,19(6):765-769

[3]糖皮质激素在系统性红斑狼疮患者合理应用的专家共识[J].中华内科杂志,2014,53(6):502-504

[4]糖皮质激素在儿童风湿病中应用专家共识(上)[J].中华儿科杂志,2018,53(6):166-171

[5]糖皮质激素类药物临床应用指导原则[J].中华内分泌代谢杂志,2012,28:增录2a-1-32

[6]国家药监局关于修订氢化可的松注射液、注射用氢化可的松琥珀酸钠说明书的公告(2020年第35号)

[7]新型冠状病毒肺炎及常见合并症药物治疗与药学监护指引[J].2020

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    2022-06-07 ayqdf

    感谢分享。

    0

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    2022-06-07 ms6000000960504356

    不错的文章

    0

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    2022-06-07 1881ea519em

    受益

    0

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    2022-06-07 ms5000000518166734

    学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习

    0

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    2022-06-06 医鸣惊人

    认真学习了

    0

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    2022-06-06 何以笙箫

    可的松需在肝内转化为氢化可的松才有生物活性,故氢化可的松较可的松更适于肝功能障碍者。

    0

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