糖皮质激素的副作用

糖皮质激素的副作用 糖皮质激素(Glucocorticoid)，又名“肾上腺皮质激素”，是由肾上腺皮质分泌的一类甾体激素，也可由化学方法人工合成。由于可用于一般的抗生素或消炎药所不及的病症，如SARS、败血症等，具有调节糖、脂肪、和蛋白质的生物合成和代谢的作用，还具有抗炎作用，称其为“糖皮质激素”是因为其调节糖类代谢的活性最早为人们所认识。 糖皮质激素的基本结构特征包括肾上腺皮质激素所具有的C3的羰基、Δ4和17β酮醇侧链以及糖皮质激素独有的17α-OH和11β-OH。 目前糖皮质激素这个概念不仅包括具有上述特征和活性的内源性物质，还包括很多经过结构优化的具有类似结构和活性的人工合成药物，目前糖皮质激素类药物是临床应用较多的一类药物。 糖皮质激素的副作用主要包括以下几点: 1. 诱发或加重感染 糖皮质激素可抑制机体的免疫功能，且无抗菌作用，故长期应用常可诱发感染或加 重感染，可使体内潜伏的感染灶扩散或静止感染灶复燃，格外是原有反抗力下降者， 如肾病综合征、肺结核、再生障碍性贫血病人等。由于用糖皮质激素时病人往往自 我感觉良好，掩饰感染进展的症状，故在决定采纳长程治疗之前应先检察身体，排 除潜伏的感染，应用过程中也宜进步警惕，必要时需与有效抗菌药适用，格外注意 对潜伏结核病灶的防治。 2. 物质代谢和水盐代谢紊乱 steel bolts, screws and studs GB/T3098.6-2000 scope of this project are: 1, 2, 3 aluminium sheet curtain wall of glass curtain wall and the Aluminum plastic Board curtain wall 4, and stone curtain wall 5, and curtain wall buried pieces 6, and light steel points type glass rain canopy, and aluminum Board rain canopy 7, and aluminum Venetian 8, and outdoor advertising (containing roofing and the State surface advertising) 9 to spring glass door 10, and concrete structure and curtain wall between of layer between, and around fire seal blocking 11, and anti-mine 12, and daughter wall top processing 13, and pan light ming, engineering of tie construction 14, and buildings of deformation sewing (settlement sewing, and expansion joints,) 15, and After the detailed design drawings issued a wall embedded part is inconsistent with the tenderer needs to increase fixed curtain wall structure 16, decorative surfaces and decorative surface and joints between parts of other buildings facing sealing process, required to support the outer decoration of a hole, hole, plugging holes and so on. This works more decorative items, in order to ensure that the decoration construction progress and quality, trying to avoid construction does not ... Processing. After installation is complete if you have damaged galvanized parts should 长期大量应用糖皮质激素可引起物质代谢和水盐代谢紊乱，出现类肾上腺皮质功能 亢进综合征，如浮肿、低血钾、高血压、糖尿、皮肤变薄、满月脸、水牛背、向心 性肥胖、多毛、痤疮、肌无力和肌萎缩等症状，一般不需格外治疗，停药后可自行 消退。但肌无力恢复慢且不完全。低盐、低糖、高蛋白饮食及加用氯化钾等措施可 减轻这些症状。此外，糖皮质激素由于抑制蛋白质的合成，可延缓创伤病人的伤口 愈合。在儿童可因抑制生长激素的分泌而造成负氮平衡，使生长发育受到影响。 3. 心血管系统并发症 长期应用糖皮质激素，由于可导致钠、水潴留和血脂升高，可诱发高血压和动脉粥 样硬化。 4. 消化系统并发症 Gucocorticoid能刺激胃酸、胃蛋白酶的分泌并抑制胃粘液分泌，降低胃粘膜的反抗 力，故可诱发或加剧消化性溃疡，糖皮质激素也能掩饰溃疡的初期症状，以致出现 突发出血和穿孔等严重并发症，应加以注意。长期使用时可使胃或十二指肠溃疡加 重。在适用其他有胃刺激作用的药物(如aspirin、indometacin、butazolidin)时更 易发生此副作用。对少数患者可诱发胰腺炎或脂肪肝。 5. 白内障和青光眼 糖皮质激素能诱发白内障，全身或局部给药均可发生。白内障的产生可能与糖皮质 激素抑制晶状体上皮Na+-K+泵功能，导致晶体纤维积水和蛋白质凝集有关。糖皮 质激素还能使眼内压升高，诱发青光眼或使青光眼恶化，全身或局部给药均可发生， 眼内压升高的原因可能是由于糖皮质激素使眼前房角小梁网结构的胶原束肿胀，阻 碍房水流通所致。 6. 骨质疏松及椎骨压迫性骨折 骨质疏松及椎骨压迫性骨折是各种年龄患者应用糖皮质激素治疗中严重的合并症。 肋骨与及脊椎骨具有高度的梁柱结构，通常受影响最严重。这可能与糖皮质激素抑 制成骨细胞活性，增加钙磷排泄，抑制肠内钙的吸取以及增加骨细胞对甲状旁腺素 的敏感性等因素有关。如发生骨质疏松症则必需停药。为防治骨质疏松宜补充维生 素D(vitamin D)，钙盐和蛋白同化激素等。 7. 神经精神异常 糖皮质激素可引起多种形式的行为异常。如欣快现象常可掩饰某些疾病的症状而贻 误诊断。又如神经过敏、激动、失眠、情感改变或甚至出现明显的精神病症状。某 steel bolts, screws and studs GB/T3098.6-2000 scope of this project are: 1, 2, 3 aluminium sheet curtain wall of glass curtain wall and the Aluminum plastic Board curtain wall 4, and stone curtain wall 5, and curtain wall buried pieces 6, and light steel points type glass rain canopy, and aluminum Board rain canopy 7, and aluminum Venetian 8, and outdoor advertising (containing roofing and the State surface advertising) 9 to spring glass door 10, and concrete structure and curtain wall between of layer between, and around fire seal blocking 11, and anti-mine 12, and daughter wall top processing 13, and pan light ming, engineering of tie construction 14, and buildings of deformation sewing (settlement sewing, and expansion joints,) 15, and After the detailed design drawings issued a wall embedded part is inconsistent with the tenderer needs to increase fixed curtain wall structure 16, decorative surfaces and decorative surface and joints between parts of other buildings facing sealing process, required to support the outer decoration of a hole, hole, plugging holes and so on. This works more decorative items, in order to ensure that the decoration construction progress and quality, trying to avoid construction does not ... Processing. After installation is complete if you have damaged galvanized parts should 些病人还有自杀倾向。此外，糖皮质激素也可能诱发癫痫发作。 注意事项 , 无论大剂量的应用糖皮质激素可起到抗炎、抗过敏、抗中毒、抗休克的作用，但考 虑其巨大的副作用患者用药时还需慎重。另外糖皮质激素对待肾病的治疗只能起到 抗炎的作用，解决不了肾脏缺血缺氧及血流通畅的问题，更不能对已经硬化的肾小 球进行降解。所以若想治疗肾脏疾病还应寻求针对正在纤维化的肾脏的扩血管、抗 炎、抗凝、降解的综合规范治疗方法。 临床上治疗系统性红斑狼疮等自身免疫病时，常使用糖皮质激素(老百姓简称激素)治疗。 激素可带来一些副作用，主要反映在: 1、长期大剂量使用，可引起水、盐、糖、蛋白质及脂肪代谢紊乱，表现为向心型肥胖、满月面容、多毛、无力、低血钾、水肿、高血压和糖尿病等，临床上称之为库欣综合征。这些症状可不特殊治疗，停药后一般会自行逐渐消退，数月或较长时间后可恢复正常。必要时可配用降压、降糖药，并给予低压、低糖、高蛋白饮食及补钾等对症治疗。因此，有高血压、动脉硬化、肾功能不全及糖尿病的病人，应该适当补充维生素 D 及钙剂，并在医生的 指导下慎用皮质激素。 2、诱发或加重感染:皮质激素有抗炎作用，但不具有抗菌作用，且能降低机体抗感染能力，使机体抗病能力下降，利于细菌生长、繁殖和扩散。因此，长期用皮质激素可诱发感染或使机体内潜在的感染灶扩大或扩散，还可使原来静止的结核灶扩散。在用药过程中应 注意病情的变化及是否有诱发感染现象，同时给予抗感染治疗。 3、诱发或加重消化性溃疡:糖皮质激素除妨碍组织修复、延缓组织愈合外，还可使胃酸及胃蛋白酶分泌增多，又能减少胃粘液分泌，降低胃粘膜的抵抗力，可诱发或加重胃、 十二指肠溃疡出血，甚至造成消化道穿孔。 4、神经症状:可发生激动、失眠，个别病人可诱发精神病，癫痫病人可诱发癫痫发 作。故有精神病倾向病人、精神病人及癫痫者应禁用。 5、肾上腺皮质萎缩或功能不全:较长期应用该药，由于体内糖皮质激素水平长期高于正常，可引起负反馈作用，而影响下丘脑及垂体前叶分泌促肾上腺皮质激素，使内源性糖皮质激素分泌减少或导致肾上腺皮质激素功能不全。一旦遇到应激时，如出血、感染，则可 出现头晕、恶心、呕吐、低血压、低血糖或发生低血糖昏迷。 6、反跳现象及停药症状:长期应用激素，症状基本控制时，若减量太大或突然停药，原来症状可很快出现或加重，此种现象称为反跳现象。这是因病人对激素产生依赖作用或症 状尚未完全被控制所致。处理措施为恢复激素用量，待症状控制后再缓慢减量。 steel bolts, screws and studs GB/T3098.6-2000 scope of this project are: 1, 2, 3 aluminium sheet curtain wall of glass curtain wall and the Aluminum plastic Board curtain wall 4, and stone curtain wall 5, and curtain wall buried pieces 6, and light steel points type glass rain canopy, and aluminum Board rain canopy 7, and aluminum Venetian 8, and outdoor advertising (containing roofing and the State surface advertising) 9 to spring glass door 10, and concrete structure and curtain wall between of layer between, and around fire seal blocking 11, and anti-mine 12, and daughter wall top processing 13, and pan light ming, engineering of tie construction 14, and buildings of deformation sewing (settlement sewing, and expansion joints,) 15, and After the detailed design drawings issued a wall embedded part is inconsistent with the tenderer needs to increase fixed curtain wall structure 16, decorative surfaces and decorative surface and joints between parts of other buildings facing sealing process, required to support the outer decoration of a hole, hole, plugging holes and so on. This works more decorative items, in order to ensure that the decoration construction progress and quality, trying to avoid construction does not ... Processing. After installation is complete if you have damaged galvanized parts should 如何对待这些副作用,首先评估激素的风险，是带来的益处多还是坏处多，如果益处远多于坏处，就应该使用，哪怕创造条件也要使用。其次，要想方设法减少一些副作用，同 时可配合使用其他药物使激素剂量能尽可能在短期内降低剂量。 短期内不会出现肥胖. 糖皮质激素长期大量应用引起的不良反应 物质代谢和水盐代谢紊乱 长期大量应用糖皮质激素可引起物质代谢和水盐代谢紊乱，出现类肾上腺皮质功能亢进综合征，如浮肿、低血钾、高血压、糖尿、皮肤变薄、满月脸、水牛背、向心性肥胖、多毛、痤疮、肌无力和肌萎缩等症状，一般不需特殊治疗，停药后可自行消退。但肌无力恢复慢且不完全。低盐、低糖、高蛋白饮食及加用氯化钾等措施可减轻这些症状。此外，糖皮质激素由于抑制蛋白质的合成，可延缓创伤病人的伤口愈合。在儿童可因抑制生长激素的分泌而造成负氮平衡，使生长发育受到影响。 诱发或加重感染 糖皮质激素可抑制机体的免疫功能，且无抗菌作用，故长期应用常可诱发感染或加重感染，可使体内潜在的感染灶扩散或静止感染灶复燃，特别是原有抵抗力下降者，如肾病综合征、肺结核、再生障碍性贫血病人等。由于用糖皮质激素时病人往往自我感觉良好，掩盖感染发展的症状，故在决定采用长程治疗之前应先检查身体，排除潜在的感染，应用过程中也宜提高警惕，必要时需与有效抗菌药合用，特别注意对潜在结核病灶的防治。 消化系统并发症 Gucocorticoid能刺激胃酸、胃蛋白酶的分泌并抑制胃粘液分泌，降低胃粘膜的抵抗力，故可诱发或加剧消化性溃疡，糖皮质激素也能掩盖溃疡的初期症状，以致出现突发出血和穿孔等严重并发症，应加以注意。长期使用时可使胃或十二指肠溃疡加重。在合用其他有胃刺激作用的药物(如aspirin、indometacin、butazolidin)时更易发生此副作用。对少数患者可诱发胰腺炎或脂肪肝。 心血管系统并发症 长期应用糖皮质激素，由于可导致钠、水潴留和血脂升高，可诱发高血压和动脉粥样硬化。 骨质疏松及椎骨压迫性骨折 骨质疏松及椎骨压迫性骨折是各种年龄患者应用糖皮质激素治疗中严重的合并症。肋骨与及脊椎骨具有高度的梁柱结构，通常受影响最严重。这可能与糖皮质激素抑制成骨细胞活性，增加钙磷排泄，抑制肠内钙的吸收以及增加骨细胞对甲状旁腺素的敏感性等因素有关。如发生骨质疏松症则必须停药。为防治骨质疏松宜补充维生素D(vitamin D)，钙盐和蛋白同化激素等。 steel bolts, screws and studs GB/T3098.6-2000 scope of this project are: 1, 2, 3 aluminium sheet curtain wall of glass curtain wall and the Aluminum plastic Board curtain wall 4, and stone curtain wall 5, and curtain wall buried pieces 6, and light steel points type glass rain canopy, and aluminum Board rain canopy 7, and aluminum Venetian 8, and outdoor advertising (containing roofing and the State surface advertising) 9 to spring glass door 10, and concrete structure and curtain wall between of layer between, and around fire seal blocking 11, and anti-mine 12, and daughter wall top processing 13, and pan light ming, engineering of tie construction 14, and buildings of deformation sewing (settlement sewing, and expansion joints,) 15, and After the detailed design drawings issued a wall embedded part is inconsistent with the tenderer needs to increase fixed curtain wall structure 16, decorative surfaces and decorative surface and joints between parts of other buildings facing sealing process, required to support the outer decoration of a hole, hole, plugging holes and so on. This works more decorative items, in order to ensure that the decoration construction progress and quality, trying to avoid construction does not ... Processing. After installation is complete if you have damaged galvanized parts should 神经精神异常 糖皮质激素可引起多种形式的行为异常。如欣快现象常可掩盖某些疾病的症状而贻误诊断。又如神经过敏、激动、失眠、情感改变或甚至出现明显的精神病症状。某些病人还有自杀倾向。此外，糖皮质激素也可能诱发癫痫发作。 白内障和青光眼 糖皮质激素能诱发白内障，全身或局部给药均可发生。白内障的产生可能与糖皮质激素抑制晶状体上皮Na+-K+泵功能，导致晶体纤维积水和蛋白质凝集有关。糖皮质激素还能使眼内压升高，诱发青光眼或使青光眼恶化，全身或局部给药均可发生，眼内压升高的原因可能是由于糖皮质激素使眼前房角小梁网结构的胶原束肿胀，阻碍房水流通所致。 steel bolts, screws and studs GB/T3098.6-2000 scope of this project are: 1, 2, 3 aluminium sheet curtain wall of glass curtain wall and the Aluminum plastic Board curtain wall 4, and stone curtain wall 5, and curtain wall buried pieces 6, and light steel points type glass rain canopy, and aluminum Board rain canopy 7, and aluminum Venetian 8, and outdoor advertising (containing roofing and the State surface advertising) 9 to spring glass door 10, and concrete structure and curtain wall between of layer between, and around fire seal blocking 11, and anti-mine 12, and daughter wall top processing 13, and pan light ming, engineering of tie construction 14, and buildings of deformation sewing (settlement sewing, and expansion joints,) 15, and After the detailed design drawings issued a wall embedded part is inconsistent with the tenderer needs to increase fixed curtain wall structure 16, decorative surfaces and decorative surface and joints between parts of other buildings facing sealing process, required to support the outer decoration of a hole, hole, plugging holes and so on. This works more decorative items, in order to ensure that the decoration construction progress and quality, trying to avoid construction does not ... Processing. After installation is complete if you have damaged galvanized parts should