Yuav Siv Li Cas Feem Ntau Siv Hormones hauv Nephrology?
Nov 29, 2022
Cov tshuaj hormones peb feem ntau xa mus rau feem ntau yog xa mus rau adrenal cortex cov tshuaj hormones. Adrenal corticosteroids yog synthesized thiab secreted los ntawm adrenal cortex thiab yuav muab faib ua peb pawg: mineralocorticoids, glucocorticoids, thiab kev sib deev hormones. Glucocorticoids feem ntau tswj glycoprotein thiab rog metabolism, thiab muaj cov tshuaj pharmacological xws li tshuaj tiv thaiv kab mob thiab kev tiv thaiv kab mob; mineralocorticoids feem ntau cuam tshuam rau dej thiab ntsev metabolism; cov tshuaj hormones kev sib deev feem ntau
Nyem rau cistanche tubulosa hmoov rau mob raum
Tuam Tshoj yog ib cheeb tsam uas muaj mob raum mob. Raws li kev soj ntsuam kab mob thiab kev txheeb cais ntawm cov kab mob raum ntev (CKD) thiab lub raum tsis ua haujlwm, muaj ntau dua 130 lab tus neeg mob CKD hauv kuv lub tebchaws [1]. Hauv kev siv tshuaj nephrology, cov tshuaj hormones yog ib feem tseem ceeb. Mineralocorticoids thiab glucocorticoids feem ntau yog siv. Muaj li ntawm 14 cov tshuaj uas nquag siv, xws li hydrocortisone, cortisone acetate, thiab prednisolone. Songlong et al.
Clinically, cov tshuaj hormones yuav tsum raug xaiv raws li tus neeg mob tus mob thiab hom kab mob. Cia peb saib seb cov tshuaj hormones twg tuaj yeem siv rau hauv nephrology, siv cov tshuaj hormones li cas, thiab kawm txog kev ceev faj txog kev siv cov tshuaj hormones no.
Raws li hom kab mob, kev siv cov tshuaj hormones rational
nephrotic syndrome
Qhov pom tseeb tshaj plaws ntawm nephrotic syndrome yog proteinuria, thiab nws yog qhov ntau ntawm cov proteinuria (Ntau dua lossis sib npaug ntawm 3.5g / d lossis 3.5g / 1.73m2 / 24h), vim tias poob ntawm cov protein ntau, ob qho tib si hypoalbuminemia (tsawg dua. tshaj los yog sib npaug rau 30g / L) thiab edema. Nyob ntawm seb hom pathological ntawm nephrotic syndrome, daim ntawv thov ntawm glucocorticoids kuj txawv, uas tuaj yeem muab faib ua pawg hauv qab no:
tsawg kawg tus kab mob hloov
Cov neeg mob menyuam yaus: Nws raug nquahu kom noj cov tshuaj prednisone (Dragon) 60mg / m2 / d ntawm qhov ncauj (tsis ntau tshaj 80 mg / d). Tom qab cov zis protein hloov tsis zoo, hloov mus rau prednisone (Drone) 40mg / m2 txhua hnub, feem ntau yog 8 lub lis piam. Cov neeg laus: Cov koob tshuaj thawj zaug yog prednisone (Drone) 1mg / kg / d (qhov siab tshaj plaws koob tshuaj tsis tshaj 80mg / d), thiab tom qab ua tiav kev tshem tawm, pib txo cov kev kho mob, txo 5 feem pua ~ 10 ntawm thawj koob tshuaj txhua 2. lub lis piam feem pua , thiab muab 5-10mg txhua hnub lossis txhua hnub, lossis siv methylprednisolone 4-8mg los tswj kev kho mob rau lub sijhawm ntev ua ntej nres cov tshuaj.
focal segmental glomerulosclerosis
Focal segmental glomerulosclerosis yuav tsum tau siv ntau npaum li cas ntawm glucocorticoid (1 mg / kg / d lossis 60 mg / d) rau 3 mus rau 4 lub hlis. Yog tias tsis muaj kev txhim kho pom tseeb tom qab thov rau ntau tshaj 6 lub hlis, muaj cov tshuaj glucocorticoid Hormone tsis kam.
Membranous nephropathy:
Qhov koob tshuaj ntawm glucocorticoids rau cov neeg mob membranous nephropathy yog prednisone (Lone) 0 5-1 mg/kg/d. Yog tias ua tiav lossis ib nrab kev tso tawm tom qab kev kho mob, koob tshuaj glucocorticoids yuav tsum raug txo thiab tswj raws li qhov tsim nyog, thiab tag nrho cov kev kho mob yuav tsum yog tsawg kawg yog 6-12 lub hlis.
IgA nephropathy:
Rau cov neeg mob uas muaj IgA nephropathy uas cov zis muaj protein ntau tsawg dua 1. Cov neeg mob uas muaj cov zis protein ntau ntawm 1.0-3.5g/24h tuaj yeem kho nrog glucocorticoid lossis ua ke nrog cov tshuaj tiv thaiv kab mob, kev siv yog prednisone (Drone) 0.5 ~ 1.0mg / k / d, maj mam txo cov koob tshuaj tom qab 6 ~ 8 lub lis piam, thiab txo mus rau 5 ~ 10mg txhua hnub lossis txhua hnub kom tswj tau, tag nrho cov kev kho mob yog 6 lub hlis lossis ntau dua [2].
crescentic nephritis
Crescentic nephritis yog hom mob hnyav tshaj plaws ntawm glomerulonephritis, kev kho mob tshwm sim raws li oliguric lossis anuric raum tsis ua haujlwm. Rau cov neeg mob uas muaj cellular crescentic nephritis, methylprednisolone ({0}} mg / d, txuas ntxiv rau 3-5 hnub) tau muab rau lub sijhawm induction, ua raws li prednisone (Drone) 1 mg / kg / d rau 4 hnub. Maj mam txo cov koob tshuaj tom qab ~ 8 lub lis piam; feem ntau nkag mus rau lub sijhawm txij nkawm tom qab 6 lub hlis, thiab txo cov koob tshuaj rau prednisone (Drone) 5 ~ 15 mg ib hnub lossis txhua hnub rau kev kho mob. Rau cov neeg mob hnyav, methylprednisolone poob siab (500 mg / d, txuas ntxiv thov rau 3 mus rau 5 hnub) tuaj yeem muab.
mob lupus nephritis
Lupus nephritis yog hais txog kev puas tsuaj rau lub raum nyuaj los ntawm cov kab mob lupus erythematosus, thiab nws cov kab mob tau muab faib ua hom mob me (hom Ⅰ), mesangial hyperplasia type (type Ⅱ), focal hyperplasia type (type Ⅲ), diffuse hyperplasia type (type Ⅳ) , Membrane type (V type), sclerosis type (Ⅵ type), feem ntau yog kho nrog qhov ncauj glucocorticoids. Rau cov neeg mob uas muaj hom I thiab hom II proteinuria, cov koob tshuaj ntawm glucocorticoids tuaj yeem muab tau. Rau cov neeg mob hom III thiab hom IV, prednisone (Lone) 1mg / kg / d tuaj yeem muab. Yog tias hom III teb tau zoo, cov koob tshuaj tuaj yeem txo qis rau txhua hnub lossis txhua hnub prednisone (Lone) 5 ~ 10mg rau kev kho mob. Hom VI Combined immunosuppressive therapy.
interstitial nephritis
Xws li idiopathic interstitial nephritis, Sjogren's syndrome, e thiab interstitial nephritis tshwm sim los ntawm cov tshuaj. Idiopathic mob interstitial nephritis: Prednisone (Drone) 1 mg / kg / d tuaj yeem muab tau, maj mam txo thiab tswj kev kho mob tom qab 2 mus rau 4 lub lis piam thaum tus mob txhim kho; Interstitial nephritis tshwm sim los ntawm cov tshuaj thiab lwm yam: Nws yog ib qho tsim nyog yuav tsum tsis txhob siv cov tshuaj uas yuav ua rau lub raum puas ua ntej. Yog tias lub raum ua haujlwm tsis zoo, prednisone (Drone) 0.5 ~ 1.0mg/kg/d tuaj yeem siv rau kev kho mob. Tom qab tus mob zoo lawm, nws tuaj yeem txo qis.
Intermediate-acting hormones feem ntau siv hauv nephrology
Tom qab nyeem txog cov kab mob thiab cov tshuaj saum toj no, peb tuaj yeem nkag siab tias cov tshuaj hormones nruab nrab xws li prednisone thiab methylprednisolone yog siv los kho cov kab mob autoimmune raum. Prednisone thiab prednisolone yog ntau hom tshuaj tib yam, thiab prednisone yog metabolized hauv lub cev los tsim prednisolone.
Dab tsi yog cov kev mob tshwm sim ntawm kev siv steroid mus sij hawm ntev?
Kev siv cov tshuaj hormones ntev ntev tuaj yeem ua rau muaj kev cuam tshuam tsis zoo, thiab qib ntawm cov tshuaj tiv thaiv tsis zoo yog ncaj qha proportional rau qhov ntau npaum thiab lub sijhawm ntawm cov tshuaj. Cov kev tsis zoo tshwm sim feem ntau suav nrog cov hauv qab no:
1. Iatrogenic Cushing's syndrome: xws li kev rog hauv nruab nrab, lub ntsej muag puv hli, daim tawv nqaij ntshav ecchymosis, steroid-induced diabetes (los yog exacerbated los ntawm cov ntshav qab zib uas twb muaj lawm), osteoporosis, spontaneous fracture los yog txawm osteonecrosis (xws li femoral taub hau tsis muaj kab mob necrosis), poj niam hirsutism , menstrual disorders los yog amenorrhea infertility, txiv neej impotence, los ntshav nyiam, thiab lwm yam.
2. Induce los yog aggravate ntau yam kab mob xws li kab mob, kab mob, thiab fungi.
3. Induce los yog aggravate gastroduodenal rwj, thiab txawm ua rau loj los ntshav los yog perforation ntawm lub plab zom mov.
4. Ntshav siab, congestive plawv tsis ua hauj lwm, atherosclerosis, thiab thrombosis.
5. Hyperlipidemia, tshwj xeeb tshaj yog hypertriglyceridemia.
6. Cov leeg tsis muaj zog, cov leeg nqaij atrophy, qeeb qhov txhab kho.
7. Steroid-induced glaucoma thiab steroid-induced cataract.
8. Cov tsos mob ntawm lub hlwb xws li kev ntxhov siab, kev zoo siab, kev zoo siab lossis kev nyuaj siab, insomnia, thiab kev hloov ntawm tus cwj pwm tuaj yeem ua rau muaj kev puas siab puas ntsws thiab qaug dab peg thaum mob hnyav.
9. Kev siv mus sij hawm ntev ntawm cov menyuam yaus cuam tshuam rau kev loj hlob thiab kev loj hlob.
10. Kev siv cov glucocorticoids sab nraud mus ntev yuav ua rau cov tawv nqaij atrophy hauv zos thiab khoom, telangiectasia, pigmentation, kab mob thib ob, n thiab lwm yam kev phiv; Kev siv sab nraud ntev ntawm lub ntsej muag tuaj yeem ua rau perioral dermatitis, rosacea zoo li daim tawv nqaij, thiab lwm yam.
11. Cov tsos mob tsis zoo ntawm qhov nqus tau cov glucocorticoids muaj xws li hawb pob, caj pas tsis xis nyob, candida colonization, thiab kis kab mob. Cov kev tsis zoo tshwm sim kuj tseem tuaj yeem tshwm sim nyob rau hauv kev siv ntev ntev ntawm cov koob tshuaj ntau dua ntawm nqus tau glucocorticoids.
