糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件

糖皮質(zhì)激素在風(fēng)濕病中的應(yīng)用遼寧醫(yī)學(xué)院附屬第一醫(yī)院高薇糖皮質(zhì)激素在風(fēng)濕病中的應(yīng)用1風(fēng)濕性疾病的菊物治療非甾體類抗炎藥>糖皮質(zhì)激素改善病情的抗風(fēng)濕藥風(fēng)濕性疾病的菊物治療2歷史的回顧1942年化學(xué)家從腎上腺皮質(zhì)中提取純化28種甾體類化合物其中包括可的松、氫化可的松1949年Hench首次報道應(yīng)用可的松治療RA,1950年獲諾貝爾醫(yī)學(xué)獎近50年風(fēng)濕病治療實踐證明:糖皮質(zhì)激素是最強大的抗炎藥物,同時也是把雙刃劍歷史的回顧3糖皮質(zhì)激素的結(jié)構(gòu)特點糖皮質(zhì)激素的結(jié)構(gòu)特點421CHOOH甲基氫化強的松龍強的可的松CH3CHOHCHOH強的松地塞米去炎松松21CHO5糖皮質(zhì)激素的合成與分泌合成部位:腎上腺皮質(zhì)束狀帶小正常分泌量:皮質(zhì)醇10~20mg/日冷分泌方式:呈脈沖式分泌☆分泌規(guī)律:具有晝夜節(jié)律性糖皮質(zhì)激素的合成與分泌6人體血漿皮質(zhì)醇分泌的正常節(jié)律24Hour24Hour20periodnightnight85050BAM4PM12Mid8AM4PM12Mid人體血漿皮質(zhì)醇分泌的正常節(jié)律7糖皮質(zhì)激素的分泌調(diào)斧一HPA軸HPA軸調(diào)節(jié)Gc在基礎(chǔ)和應(yīng)激時的釋放應(yīng)激包括:寒冷、運動、感染垂體及手術(shù)等。ACTHHPA軸對負(fù)反饋敏感,長期負(fù)反饋可引起腎上腺皮質(zhì)萎縮,腎上腺鈍化下丘腦一垂體一腎上腺反應(yīng),在給予AcTH或在應(yīng)激情GC況下,不能分泌足夠的Gc。糖皮質(zhì)激素的分泌調(diào)斧一HPA軸8糖坡質(zhì)激素的藥代動力學(xué)特點糖坡質(zhì)激素的藥代動力學(xué)特點9糖皮質(zhì)激素類藥物的吸收與轉(zhuǎn)運口吸收:口服、注射和局部給藥吸收都很好口轉(zhuǎn)運:GC,結(jié)合蛋自(80%)白蛋白(10%)靶器官游離(10%)糖皮質(zhì)激素類藥物的吸收與轉(zhuǎn)運10糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件11糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件12糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件13糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件14糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件15糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件16糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件17糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件18糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件19糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件20糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件21糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件22糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件23糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件24糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件25糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件26糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件27糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件28糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件29糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件30糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件31糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件32糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件33糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件34糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件35糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件36糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件37糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件38糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件39糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件40糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件41糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件42糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件43糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件44糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件45糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件46糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件47糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件48糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件49糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件50糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件51糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件52糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件53糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件54糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件55糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件56糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件57糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件58糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件59糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件60糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件61糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件62糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件63糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件64糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件65糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件66糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件67糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件68糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件69糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件70糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件71糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件72糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件73糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件74糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件75糖皮質(zhì)激素在風(fēng)濕病中的應(yīng)用遼寧醫(yī)學(xué)院附屬第一醫(yī)院高薇糖皮質(zhì)激素在風(fēng)濕病中的應(yīng)用76風(fēng)濕性疾病的菊物治療非甾體類抗炎藥>糖皮質(zhì)激素改善病情的抗風(fēng)濕藥風(fēng)濕性疾病的菊物治療77歷史的回顧1942年化學(xué)家從腎上腺皮質(zhì)中提取純化28種甾體類化合物其中包括可的松、氫化可的松1949年Hench首次報道應(yīng)用可的松治療RA,1950年獲諾貝爾醫(yī)學(xué)獎近50年風(fēng)濕病治療實踐證明:糖皮質(zhì)激素是最強大的抗炎藥物,同時也是把雙刃劍歷史的回顧78糖皮質(zhì)激素的結(jié)構(gòu)特點糖皮質(zhì)激素的結(jié)構(gòu)特點7921CHOOH甲基氫化強的松龍強的可的松CH3CHOHCHOH強的松地塞米去炎松松21CHO80糖皮質(zhì)激素的合成與分泌合成部位:腎上腺皮質(zhì)束狀帶小正常分泌量:皮質(zhì)醇10~20mg/日冷分泌方式:呈脈沖式分泌☆分泌規(guī)律:具有晝夜節(jié)律性糖皮質(zhì)激素的合成與分泌81人體血漿皮質(zhì)醇分泌的正常節(jié)律24Hour24Hour20periodnightnight85050BAM4PM12Mid8AM4PM12Mid人體血漿皮質(zhì)醇分泌的正常節(jié)律82糖皮質(zhì)激素的分泌調(diào)斧一HPA軸HPA軸調(diào)節(jié)Gc在基礎(chǔ)和應(yīng)激時的釋放應(yīng)激包括:寒冷、運動、感染垂體及手術(shù)等。ACTHHPA軸對負(fù)反饋敏感,長期負(fù)反饋可引起腎上腺皮質(zhì)萎縮,腎上腺鈍化下丘腦一垂體一腎上腺反應(yīng),在給予AcTH或在應(yīng)激情GC況下,不能分泌足夠的Gc。糖皮質(zhì)激素的分泌調(diào)斧一HPA軸83糖坡質(zhì)激素的藥代動力學(xué)特點糖坡質(zhì)激素的藥代動力學(xué)特點84糖皮質(zhì)激素類藥物的吸收與轉(zhuǎn)運口吸收:口服、注射和局部給藥吸收都很好口轉(zhuǎn)運:GC,結(jié)合蛋自(80%)白蛋白(10%)靶器官游離(10%)糖皮質(zhì)激素類藥物的吸收與轉(zhuǎn)運85糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件86糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件87糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件88糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件89糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件90糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件91糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件92糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件93糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件94糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件95糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件96糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件97糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件98糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件99糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件100糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件101糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件102糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件103糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件104糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件105糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件106糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件107糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件108糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件109糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件110糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課件111糖皮質(zhì)激素在風(fēng)濕的應(yīng)用課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