糖皮质激素与高血糖

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1、类固醇性糖尿病Steroiddiabetes管庆波山东省立医院内分泌代谢科山东省内分泌代谢病临床医学中心山东省临床医学研究院内分泌代谢病研究所概述流行病学机制诊断治疗History1855–Addison'sdisease1856–Adrenalglandsessentialforlife1930–Cortex>medulla1932–Cushing’ssyndrome1949–Henchetal(Steroidsinrheumatoidarthritis)1952–AldosteronePromotenormalintermediarymetabolism:Glucone

2、ogenesisStimulateproteincatabolismStimulatelipolysisIncreaseresistancetostressby:RaisingbloodglucoselevelModestriseinBPAlterbloodcelllevelsinplasma:Decreaseineosinophils,basophils,monocytesandlymphocytesbyredistributionfromcirculationtolymphoidtissueIncreaseinthenumberofRBC,platelets,neutr

3、ophilsActionsofGlucocorticoidsAntiinflammatoryaction:(Complexmechanism)SuppressionofimmunityIndirectinhibitionofphospholipaseA2Alterotherendocrinesystems:DecreaseinACTHandTSHIncreaseinGHEffectsonothersystems:Increasedproductionofgastricacid,pepsinEffectsonCNSBonelossMyopathyActions…Cont.常用

4、糖皮质激素剂量换算、作用、半衰期及效能—————————————————————————————————————药物等效剂量 糖皮质激素作用   抗炎效价钠潴留作用     生物学半衰                                                             期（小时）—————————————————————————————————————低效可的松25mg      0.8          2     8～12         8～36氢化可的松20mg  1         1.0      >2           

5、8～12中效强的松5mg    4         3.5      1        12～26强的松龙5mg     4          4.0      1         12～36甲基强的松龙4mg 5         5.0       0          12～36去炎松4mg        5         5.0       0          12～36高效倍他米松0.6mg     25        30.0      0              36～54地塞米松0.75mg    25        30.0      0       

6、    36～54—————————————————————————————————————AdverseeffectsPsychiatricSleepdisturbance/activationMooddisturbancePsychosisSkin/softtissueCushingoidappearanceAbdominalstriaeAcneHirsutismOedemaNeurologicNeuropathyPseudomotorcerebriCardiovascularHypertensionOccurwithprolongeduseofhighdosesCus

7、hing’sdiseaseMSKOsteoporosisAscepticnecrosisofboneMyopathyEndocrineDiabetesmellitusAdrenalcortexsuppressionImmunologicLymphocytopeniaImmunosuppressionFalse-negativeskintestOpthalmicCataractNarrow-angleglaucomaDevelopmentalGrowthretardation糖皮质激素因其多种生物学作用被广泛用于临床