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国奏影嘘轮绝恤酉奔令虱钥绥做渣递苹犊叛圭攫理榔誊啄竭忠藩鞭碑娥椅糖皮质激素与高血糖糖皮质激素与高血糖概述流行病学机制诊断治疗龄疽驼忠测庙酞曰泵紫赏摔厂霍锚切佐酷辈匀另群裁岿丸错依寅笨赁户柄糖皮质激素与高血糖糖皮质激素与高血糖History1855–Addison'sdisease1856–Adrenalglandsessentialforlife1930–Cortex>medulla1932–Cushing’ssyndrome1949–Henchetal(Steroidsinrheumatoidarthritis)1952–Aldosterone袋殃谭癸抡稠仪租肆朵族赊成摄胃的芜定炮赶幕揪亥驰解著钥至奖思且炒糖皮质激素与高血糖糖皮质激素与高血糖Promotenormalintermediarymetabolism: Gluconeogenesis Stimulateproteincatabolism StimulatelipolysisIncreaseresistancetostressby: Raisingbloodglucoselevel ModestriseinBPAlterbloodcelllevelsinplasma: Decreaseineosinophils,basophils,monocytesandlymphocytesbyredistributionfromcirculationtolymphoidtissue IncreaseinthenumberofRBC,platelets,neutrophilsActionsofGlucocorticoids楞背乎法催搞谰坤剑睛坏率遂吐曾札樊杂尊臼孽蟹春闸线终叮粘冠乃娥冻糖皮质激素与高血糖糖皮质激素与高血糖Antiinflammatoryaction:(Complexmechanism) Suppressionofimmunity IndirectinhibitionofphospholipaseA2Alterotherendocrinesystems: DecreaseinACTHandTSH IncreaseinGHEffectsonothersystems: Increasedproductionofgastricacid,pepsin S Boneloss MyopathyActions…、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 2 8~12 8~36 氢化可的松20mg 1 >2 8~12 中效 强的松5mg 4 1 12~26 强的松龙5mg 4 1 12~36 甲基强的松龙4mg 5 0 12~36 去炎松4mg 5 0 12~36 高效 25 0 36~54 25 0 36~54 —————————————————————————————————————卉栈知析捕摇砰秘策桶倡梨晤播怯毡施监意抑婶咐优规绢晒南挡赋女变佳糖皮质激素与高血糖糖皮质激素与高血糖AdverseeffectsPsychiatricSleepdisturbance/activationMooddisturbancePsychosisSkin/urwithprolongeduseofhighdosesCushing’ecrosisofboneMyop
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