葡萄糖皮质类药物治疗对儿科脏综合征中下丘脑-垂体-上腺轴功能的影响:叙述性综述
Subhankar Sarkar1, Asiri Samantha Abeyagunawardena2, Rajiv Sinha3
1Department of Pediatrics, All India Institute of Medical Sciences, Kalyani, Kolkata 700019, West Bengal, India.
World journal of clinical pediatrics
|November 19, 2025
概括
像普德尼索隆这样的葡萄皮质类药物 (GC) 可以抑制下丘脑-垂体-上腺 (HPA) 轴,导致二次上腺功能不充分 (AI). 谨慎的GC管理至关重要,特别是在儿科性综合征中,以防止上腺危机.
科学领域:
- 内分泌学 在内分泌学.
- 儿科 儿科 儿科
- 药理学 药理学是指药理学的学科.
背景情况:
- 葡萄糖皮质类药物 (GCs) 是肝脏病综合征,喘和自身免疫性疾病的重要疗法.
- 长时间或高剂量GC的使用可能会导致下丘脑-垂体-上腺 (HPA) 轴的抑制.
- 抑制HPA轴导致二次上腺功能不充分 (AI),损害对新陈代谢和应激反应至关重要的皮质醇生产.
研究的目的:
- 为了研究葡萄糖皮质类药物对HPA轴的影响.
- 要突出使用GC的患者中二次上腺功能不全的风险,特别是上腺素在性综合征中的风险.
- 强调在GC治疗期间监测和管理HPA轴功能的重要性.
主要方法:
- 对HPA轴抑制和AI的诊断标准的审查.
- 分析影响HPA轴抑制的因素,包括GC剂量,持续时间和时间.
- 讨论HPA轴抑制的诊断测试,如早晨皮质醇水平和动态测试 (胰岛素耐受性,ACTH刺激, metyrapone测试).
主要成果:
- 早晨皮质醇水平>18 ng/mL表明HPA轴的正常功能;水平<3 ng/mL表明AI.
- 中间皮质醇值需要进一步的动态测试来准确诊断.
- 在性综合征中使用普雷迪尼索隆是HPA轴抑制的重要危险因素.
结论:
- 虽然GC是有效的,但存在HPA轴抑制和二次AI的风险.
- 精心管理GC治疗是减轻风险的关键,同时确保疾病控制.
- 早期检测和干预HPA轴抑制至关重要,特别是在儿科患者中,以预防上腺危机.
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