糖皮质激素与高血糖课件.ppt

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–Addisonsdisease1856–Adrenalglandsessentialforlife1930–Cortexmedulla1932–Cushing’ssyndrome1949–Henchetal(Steroidsinrheumatoidarthritis)1952–Aldosterone

Promotenormalintermediarymetabolism: Gluconeogenesis Stimulateproteincatabolism StimulatelipolysisIncreaseresistancetostressby: Raisingbloodglucoselevel ModestriseinBPAlterbloodcelllevelsinplasma: Decreaseineosinophils,basophils,monocytesandlymphocytesbyredistributionfromcirculationtolymphoidtissue IncreaseinthenumberofRBC,platelets,neutrophilsActionsofGlucocorticoids

Antiinflammatoryaction:(Complexmechanism) Suppressionofimmunity IndirectinhibitionofphospholipaseA2Alterotherendocrinesystems: DecreaseinACTHandTSH IncreaseinGHEffectsonothersystems: Increasedproductionofgastricacid,pepsin EffectsonCNS Boneloss MyopathyActions…Cont.

常用糖皮质激素剂量换算、作用、半衰期及效能

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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〕

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低效

可的松25mg??????0.8??????????2?????8～12?????????8～36

氢化可的松20mg??1?????????1.0??????2???????????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????????