GCS - hais tias qhov no tshuaj? Qhov kev txiav txim thiab los ntawm cov tshuaj glucocorticosteroids

Muaj tseeb koj twb puas tau hnov txog steroid cov tshuaj hormones. Peb lub cev yeej muaj ua lawv tswj lub neej muaj dab. Nyob rau hauv no tsab xov xwm, peb yuav xav txog glucocorticoids - steroid cov tshuaj hormones, uas yog nyob rau hauv lub adrenal cortex. Thaum uas feem ntau ntawm peb xav nyob rau hauv lawv cov hluavtaws analogues - GCS. Yuav ua li cas yog cov tshuaj? Rau cov uas lawv yog siv thiab zoo li cas ntawm kev puas tsuaj nws ua rau? Cia peb kawm saib.

General ntaub ntawv hais txog GCS. Yuav ua li cas yog cov tshuaj?

Peb kab synthesises steroid cov tshuaj hormones xws li glucocorticoids. Lawv yog ua los ntawm cov adrenal cortex, thiab lawv cov kev siv yog tsuas yog hais txog cov kev kho mob ntawm adrenal insufficiency. Niaj hnub no, siv tsis tau tsuas yog tej yam ntuj tso glucocorticoids, tab sis kuj lawv hluavtaws analogues - GCS. Yuav ua li cas yog cov tshuaj? Rau tib neeg, cov analogs txhais li cas ib tug ntau, raws li muaj nyob rau hauv lub cev anti-inflammatory, immunosuppressive, antishock, anti-kev tsis haum cov nyhuv.

Glucocorticoids tau ua siv raws li cov tshuaj (xa mus rau hauv tsab xov xwm - PM) nyob rau hauv lub 40-ies ntawm XX caug xyoo. Los ntawm kawg ntawm tus 30s ntawm lub thib nees nkaum xyoo pua, zaum tau pom steroid lawm tebchaw nyob rau hauv tib neeg adrenal cortex, thiab nyob rau hauv 1937 nws tau xaiv mineralocorticoid deoxycorticosterone. Nyob rau hauv thaum ntxov 40-ies tau muab glucocorticoid hydrocortisone thiab cortisone. Pharmacological los ntawm cortisone thiab hydrocortisone thiaj li muaj ntau haiv neeg, hais tias nws tau txiav txim siab siv lawv li tshuaj. Tom qab ib co sij hawm, zaum tau nqa tawm lawv synthesis.

Qhov tseem active glucocorticoid nyob rau hauv tus tib neeg lub kab yog - cortisol (analogue - hydrocortisone, uas nws nqi - 100-150 rubles), thiab nws yog ib tug loj. Nws yog tseem tau mus rau faib tsawg active: corticosterone, cortisone, 11-deoxycortisol, 11-dehydrocorticosterone.

Ntawm tag nrho cov natural glucocorticoids li siv yeeb tshuaj pom xwb hydrocortisone thiab cortisone. Txawm li cas los, lub tom kawg ua sab teebmeem ntau heev tshaj lwm yam lawm, uas yog vim li cas tam sim no lub sij hawm nws siv nyob rau hauv cov tshuaj no xwb. Rau hnub tim, tsuas yog siv glucocorticoid hydrocortisone los yog nws cov esters (hydrocortisone hemisuccinate thiab hydrocortisone acetate).

Hais txog glucocorticosteroids (hluavtaws glucocorticoids), tam sim no peb tsim ib tug xov tooj ntawm tej kab mob, cov uas lub fluorinated (flumethasone, triamcinolone, betamethasone, dexamethasone, etc.) Thiab tsis yog-fluorinated (methylprednisolone, prednisolone, prednisone) glucocorticoids.

Tej cov tshuaj mas siv active dua lawv tej yam ntuj tso counterparts, thiab yuav tsum rau cov kev kho mob ntawm me me koob tshuaj.

Lub mechanism ntawm qhov kev txiav txim ntawm corticosteroids

Qhov kev txiav txim ntawm glucocorticoids molecular theem yog tsis qoos taub. Zaum ntseeg hais tias cov tshuaj ua rau hlwb nyob rau theem ntawm kev cai ntawm noob transcription.

Corticosteroids nrog intracellular glucocorticoid receptors yog tam sim no nyob rau hauv txhua lub cell ntawm tib neeg lub cev. Nyob rau hauv lub qhaj ntawv ntawm hormone receptors (uas yog cytosolic cov nqaijrog) tsuas deactivated. Nyob rau hauv lub tsaug zog lub xeev, lawv yog ib feem ntawm lub heterocomplexes, uas muaj xws li kuj immunophilin, Thaum tshav kub kub poob siab cov nqaijrog thiab li ntawd.

Thaum steroids txeem lub hlwb (los ntawm daim nyias nyias), lawv khi rau receptors thiab qhib txoj "glucocorticoid + receptor", tom qab uas nws nkag mus rau hauv cell nucleus thiab ua num ua ke nrog lub DNA cheeb tsam uas nyob rau hauv lub promoter fragment steroid coj noob (lawv kuj hu ua glucocorticoid 'teb hais tias cov ntsiab). Complex "+ glucocorticoid receptor" yog tau tswj (inhibit los yog, conversely, qhib) tus txheej txheem ntawm transcription ntawm tej noob. Qhov no yog qhov ua rau cov hluav los yog stimulation ntawm mRNA, raws li zoo raws li ib tug kev hloov nyob rau hauv lub synthesis ntawm ntau yam enzymes thiab ntxawg proteins uas kho cellular los.

Ntau yam kev tshawb fawb qhia tau tias cov complex "glucocorticoid + receptor" yog reacted uas muaj ntau yam transcription yam, e.g., xws li nuclear tau kappa B (NF-kB), los yog cov activator ntawm transcription protein (AP-1) uas tswj cov noob muab kev koom tes nyob rau hauv lub cev lo lus teb, thiab o (adhesion molecules, cytokine noob, protease thiab thiaj li nyob.).

Lub ntsiab los ntawm GCS

glucocorticoids los rau tib neeg lub cev yog heev heev. Cov tshuaj hormones muaj antitoxic, antishock, imunnodepressivnoe, antiallergic, antiinflammatory thiab antiinflammatory kev txiav txim. Cia wb mus ze zog saib yuav ua li cas cov kev ntawm cov corticosteroids.

• Anti-inflammatory los ntawm corticosteroids. Ua cov hluav ntawm cov kev ua ntawm phospholipase A _2. Thaum inhibition ntawm no enzyme nyob rau hauv tib neeg lub cev yog suppressed liberatiou (tso) cov inhibition ntawm arachidonic acid thiab tsim los ntawm ib co inflammatory kev sib kho (xws li prostaglandins, leukotrienes, thiab troboksan t. D.). Ntxiv mus, lub txais tos glucocorticosteroids thiaj li kua exudation, vasoconstriction (narrowing) cov hlab ntsha, kev txhim kho ntawm microcirculation nyob rau hauv lub o.
• Anti-tsis haum cov nyhuv ntawm GCS. Nws tshwm sim raws li ib tug tshwm sim ntawm tej pa thiab synthesis ntawm kev sib kho ntawm kev tsis haum tshuaj, txo circulating basophils, inhibition ntawm histamine tso tawm los ntawm basophils thiab mast hlwb sensitized, txo tus naj npawb ntawm B thiab T lymphocytes, txo rhiab heev ntawm hlwb mus rau lub kev sib kho ntawm kev tsis haum tshuaj, lub cev tsis teb hloov, raws li zoo raws li tsuj ntawm antibody ntau lawm.
• Immunosuppressive kev ua ntawm GCS. Yuav ua li cas yog cov tshuaj? Qhov no txhais tau tias cov tshuaj inhibit immunogenez, suppress zus tau tej cov tshuaj. Corticosteroids inhibit tsiv teb tsaws ntawm pob txha tsim muaj cov qe ntshav, inhibit qhov kev ua si ntawm B thiab T lymphocytes inhibit qhov kev tso tawm ntawm cytokines los ntawm macrophages thiab leukocytes.
• Anti-tshuaj lom thiab antishock nyhuv ntawm corticosteroids. Cov nyhuv ntawm cov tshuaj hormones tshwm sim los ntawm cov ntshav siab nyob rau hauv tib neeg, raws li tau zoo raws li qhov ua kom siab enzymes muab kev koom tes nyob rau hauv lub metabolism ntawm xenon thiab endobiotikov.
• Mineralocorticoid kev ua si. Glucocorticosteroids muaj lub peev xwm mus retard sodium thiab dej nyob rau hauv lub cev, tsim kho lub feem ntawm poov tshuaj. Qhov no synthetic hloov yog tsis li zoo li tej yam ntuj tso tshuaj hormones, tab sis nws yog cov nyhuv rau lub cev uas lawv muaj.

tshuaj

Rau lub caij ntawm kev txiav txim ntawm mauj steroids yuav tau muab faib mus rau hauv:

1. Glucocorticosteroids luv luv txiav txim (e.g., hydrocortisone, tus nqi ntawm uas nws txawv ntawm 100 rau 150 rubles).
2. Glucocorticosteroids nrog ib tug nruab nrab ntev ntawm kev txiav txim (prednisolone (tswv yim uas yog tsis zoo heev), methylprednisolone).
3. Glucocorticosteroids nrog heev kev txiav txim (triamcinolone acetonide, dexamethasone, betamethasone).

Tab sis tsis tsuas yog rau cov qhov ntev ntawm glucocorticosteroids tej zaum yuav txiav txim tau. Ib suam ntawm lawv tej zaum yuav kuj yuav lub hom ntawm koom haum saib xyuas:

• qhov ncauj;
• intranasal;
• Nqus tau cov pa glucocorticosteroids.

Qhov no faib tawm, li cas los xij, tsuas yog siv rau system glucocorticosteroids.

Muaj ib co tshuaj nyob rau hauv daim ntawv ntawm cov tshuaj pleev thiab cream (lub zos corticosteroids). Piv txwv li, "Afloderm". Xyuas los ntawm tej formulations yog zoo.

Cia saib hom ntawm muaj quag corticosteroids nyob ib leeg.

Ncauj steroids txig absorbed nyob rau hauv cov hnyuv tsis tas yuav ua teeb meem. Rau siab khi rau cov nqaijrog nyob rau hauv cov ntshav (transcortin, albumin). Qhov siab tshaj plaws concentration ntawm qhov ncauj corticosteroids nyob rau hauv cov ntshav yog mus txog tom qab 1.5 teev tom qab thawj coj. Lawv yauv mus biotransformation nyob rau hauv lub siab, mob raum (cov) thiab lwm yam ntaub so ntswg los conjugation rau glucuronide los yog sulfate.

Kwv yees li 70% ntawm cov conjugated GCS tas nyob hauv cov zis, lwm 20% nyob rau hauv cov quav yuav qhia tom qab, thiab tus so - nrog rau lwm cov lom kua (e.g., tom qab ntawd). Lub ib nrab - los ntawm 2 mus rau 4 teev.

Koj muaj peev xwm tsim ib tug me me rooj nrog tus pharmacokinetic tsis hais lus ntawm ncauj corticosteroids.

Glucocorticosteroids. Tshuaj (npe)	Lub ib nrab-lub neej ntawm cov ntaub so ntswg	Ntshav ib nrab-lub neej
hydrocortisone	8-12 teev	0.5-1.5 teev
cortisone	8-12 teev	0.7-2 teev
Prednisolone (xyuas yog tsis zoo heev)	18-36 teev	2-4 teev
methylprednisolone	18-36 teev	2-4 teev
fludrocortisone	18-36 teev	3.5 teev
dexamethasone	36-54 teev	5:00

Nqus tau cov pa tshuaj steriods kho nyob rau hauv niaj hnub soj ntsuam xyaum hais triamcinolone acetonide, fluticasone propionate, mometasone furoate, budesonide thiab beclomethasone dipropionate.

Pharmacokinetic tsis muaj peev xwm kuj yuav hais nyob rau hauv ib lub rooj:

Glucocorticosteroids. Tshuaj (npe)	Lub zos anti-inflammatory kev ua si	ntim ntawm muab faib rau	Ntshav ib nrab-lub neej	Efficiency ntawm zaj ntawm lub siab
beclomethasone dipropionate	0,64 units.	-	0.5 teev	70%
budesonide	1 unit.	4.3 l / kg	1,7-3,4 teev	90%
triamcinolone acetonide	0,27 units.	1.2 l / kg	1.4-2 teev	80-90%
fluticasone propionate	1 unit.	3.7 l / kg	3.1 teev	99%
flunisolide	0,34 units.	1.8 l / kg	1.6 teev	-

Qhov ntswg steroids nyob rau hauv cov tshuaj hnub no hais fluticasone propionate, flunisolide, triamcinolone acetonide, mometasone furoate, budesonide thiab beclomethasone dipropionate. Ib txhia ntawm lawv yog hu ua cov tib txoj kev raws li nqus tau cov pa corticosteroids.

Tom qab daim ntawv thov ntawm cov tshuaj intranasal corticosteroids absorbed nyob rau hauv cov hnyuv thiab lwm feem los ntawm caj pas mucosa ncaj qha mus rau hauv cov hlab ntsha.

Glucocorticosteroids, daig nyob rau hauv cov hnyuv, yog absorbed rau txog 1-8 feem pua, thiab cov thawj pass los ntawm lub siab biotransformed yuav luag tag rau tsaug zog metabolites.

Glucocorticosteroids uas tau txais mus rau hauv cov ntshav, hydrolyze rau tsaug zog tshuaj. Ntawm no yog ib lub rooj rau lawv pharmacokinetic tsis:

Glucocorticosteroids. npaj	Bioavailability thaum nkag mus kawm rau cov ntshav, raws li ib feem pua	Bioavailability thaum absorbed los ntawm tus mob huam, nyob rau hauv feem pua
budesonide	34	11
beclomethasone dipropionate	44	20-25
mometasone furoate	<0.1	<1
triamcinolone acetonide	Tsis ntaub ntawv	10,6-23
fluticasone propionate	0.5-2
flunisolide	40-50	21

Cov tshuaj xws li "Afloderm" (tswv yim uas yuav popping nyob rau hauv net), mus rau piav qhia txog nyias ua rau tsis muaj kev txiav txim zoo. Txhua tus ntawm lawv yog lub ntsiab active khoom sib ua zaub mov, uas yog yuav tau twb tau hais saum toj no. Cov tshuaj - lub zos corticosteroids, thiab lawv yog sawv cev feem ntau nyob rau hauv daim ntawv ntawm cov tshuaj pleev los yog cream.

Muab glucocorticosteroid txoj kev kho (indications kev siv rau)

Rau txhua hom ntawm glucocorticosteroids nws indications rau siv. Yog li, qhov ncauj corticosteroids yog siv los kho:

• Crohn tus kab mob;
• ulcerative mob plab;
• interstitial ntsws mob;
• mob ua pa nyuaj siab syndrome;
• mob loj heev mob ntsws;
• mob obstructive koj muaj teebmeem kev kab mob nyob rau hauv mob theem;
• bronchial hawb pob;
• subacute thyroiditis;
• congenital adrenal hyperplasia (nyob rau hauv cov ntaub ntawv no, ib tug neeg tsis tsim corticoids nws tus kheej thiab yog yuam kom coj lawv hluavtaws analogues);
• mob adrenal insufficiency.

Tsis tas li ntawd steroids yog siv nyob rau hauv kev hloov kho ntawm thawj thiab napochechnikovoy tsis ua hauj lwm.

Intranasal corticosteroids yog siv rau:

• idiopathic txhaws ntswg (vasomotor);
• uas tsis yog-kev tsis haum txhaws ntswg nrog eosinophilia;
• pilipoze qhov ntswg;
• perennial tsis haum txhaws ntswg (pheej);
• raws caij nyoog tsis haum txhaws ntswg (sib quas ntus).

Nqus tau cov pa corticosteroids yog siv los kho mob obstructive koj muaj teebmeem kev kab mob, bronchial hawb pob.

Contraindications

Ceev faj yuav tsum kho GCS nyob rau hauv cov kev soj ntsuam no:

• lactation;
• glaucoma;
• Ib txhia cov kab mob ntawm lub cornea, uas yog nrog rau kev txawv txav ntawm lub epithelium;
• fungal los yog kab mob ntawm lub qhov muag;
• purulent kab mob;
• txhaj tshuaj tiv thaiv lub sij hawm;
• syphilis;
• active hauv daim ntawv ntawm tuberculosis;
• herpes kab mob;
• mauj fungal kab mob;
• ib co kev puas hlwb nrog tsim cov tsos mob;
• mob loj heev degree ntawm lub raum tsis ua hauj lwm;
• tawg;
• thromboembolism;
• duodenal rwj los yog mob plab;
• mob ntshav qab zib;
• Cushing tus kab mob.

Nruj me ntsis txhob intranasal corticosteroids nyob rau hauv xws li mob:

• nquag nosebleeds nyob rau hauv keeb kwm;
• hemorrhagic diathesis;
• npau taws me ntsis.

Glucocorticosteroids: phiv

Tshwm sim los ntawm corticosteroids yuav tau muab faib mus rau hauv lub zos thiab mauj.

Local phiv

Faib mus rau hauv cov teebmeem ntawm nqus tau cov pa thiab intranasal corticosteroids.

1. Lub zos phiv los ntawm nqus tau cov pa glucocorticosteroids:

• hnoos;
• dysphonia;
• Candidiasis ntawm lub qhov ncauj kab noj hniav thiab lub caj pas.

2. Lub zos tshwm sim los ntawm intranasal corticosteroids:

• perforation ntawm lub qhov ntswg septum;
• nosebleeds;
• hlawv thiab qhuav txheej nyias nyias ntawm lub qhov ntswg thiab caj pas;
• txham;
• khaus khaus qhov ntswg.

Mauj kev phiv

Muab faib raws li mus rau qhov chaw ntawm lub cev, uas ua hauj lwm.

1. Ib feem ntawm lub hauv paus poob siab system:

• psychoses;
• kev nyuaj siab;
• zoo siab;
• insomnia;
• txob taus.

2. Vim cov hlab plawv system:

• thromboembolism;
• sib sib zog nqus cov hlab ntsha thrombosis;
• ntshav siab;
• myocardiodystrophy.

3. Los ntawm cov me nyuam system:

• hirsutism;
• ncua kev sib deev kev loj hlob;
• kev sib deev kawg;
• tsis ruaj tsis khov cev ntas.

4. Los ntawm cov digestive system:

• fatty siab;
• pancreatitis;
• los ntshav los ntawm tus mob huam;
• steroid ulcers ntawm lub plab thiab cov hnyuv.

5. Los ntawm cov endocrine system:

• mob ntshav qab zib;
• Cushing tus syndrome;
• rog;
• Atrophy ntawm lub adrenal cortex vim inhibition ntawm nws txoj kev ua.

6. Los ntawm cov sab ntawm view:

• glaucoma;
• posterior subcapsular cataracts.

7. Los ntawm cov licas:

• nqaij wasting;
• myopathy;
• stunted kev loj hlob nyob rau hauv cov me nyuam;
• avascular necrosis thiab pob txha lov;
• txha.

8. ntawm daim tawv nqaij:

• alopecia;
• striae;
• thinning ntawm daim tawv nqaij.

9. Lwm yam kev phiv:

• mob kis thiab mob ntaub ntawv ntawm inflammatory dab;
• o;
• sodium thiab dej tuav nyob rau hauv lub cev.

precautionary ntsuas

Nyob rau hauv tej rooj plaub, corticosteroids yuav tsum tau siv nrog ceev faj.

Piv txwv li, cov neeg mob uas mob npuas paug, hypothyroidism, hypoalbuminemia, thiab ua tem toob cov neeg mob los yog neeg laus muaj peev xwm yuav kho kom zoo kev txiav txim ntawm corticosteroids.

Nyob rau hauv daim ntawv thov ntawm corticosteroids thaum lub sij hawm cev xeeb tub yuav tsum coj mus rau hauv tus account lub tsim nyhuv ntawm cov kev kho mob rau cov niam thiab cov kev pheej hmoo ntawm ib tug tsis zoo zoo ntawm cov tshuaj nyob rau hauv lub fetus, raws li corticosteroids peev xwm cuam tshuam txoj kev loj hlob ntawm me nyuam hauv plab kev loj hlob thiab txawm tsis xws luag xws li cleft palate thiab thiaj li nyob.

Yog hais tias thaum lub sij hawm siv GCS neeg mob suffers kab mob (chicken pox, qhua pias, thiab hais txog. D.), Nws tej zaum yuav tshwm sim heev tiag.

Nyob rau hauv cov kev kho mob ntawm cov neeg mob nrog corticosteroids los yog autoimmune inflammatory kab mob (rheumatoid mob caj dab, plob tsis so tswj kab mob, mauj lupus erythematosus thiab cov zoo li. D.) sightings steroid kuj yuav tsum tau cai.

Cov neeg mob uas tau txais qhov ncauj steroids rau ib ntev lub sij hawm, nws yog tsim nyog tseg coj quav Occult ntshav thiab dhau fibroezofagogastroduodenoskopiyu li steroid rwj thaum lub sij hawm kev kho mob nrog corticosteroids tej zaum yuav tsis raug ntxhov.

Nyob rau hauv 30-50% ntawm cov neeg mob kho nrog corticosteroids rau ib ntev lub sij hawm, tsim kab mob. Raws li ib tug txoj cai, nws muaj feem xyuam rau cov ko taw, tes, lub plab mog, tav, tus txha nqaj.

Sis nrog lwm yam tshuaj

Tag nrho glucocorticosteroids (kev faib tsis nyob ntawm no) thaum nyob rau hauv kev sib cuag nrog lwm yam tshuaj muab ib tug tej yam nyhuv, thiab qhov no nyhuv yog tsis ib txwm zoo rau peb lub cev. Ntawm no yog dab tsi koj yuav tsum paub ua ntej koj thov corticosteroids nyob rau hauv nrog lwm yam tshuaj:

1. GCS thiab antacids - glucocorticosteroids haum lawm.
2. GCS thiab barbiturates, phenytoin, hexamidine, diphenhydramine, carbamazepine, rifampicin - glucocorticosteroids biotransformation nyob rau hauv lub siab yog muaj zog.
3. GCS thiab Isoniazid, erythromycin - glucocorticosteroids biotransformation nyob rau hauv lub siab lawm.
4. SCS thiab salicylates, phenylbutazone, barbiturates, digitoxin, penicillin, chloramphenicol - tag nrho ntawm cov tshuaj yog kho kom zoo tshem tawm.
5. GCS thiab Isoniazid - ib tug ua txhaum ntawm tus tib neeg psyche.
6. Corticosteroids thiab reserpine - lub rov tshwm sim ntawm depressive lub xeev.
7. GCS thiab tricyclic antidepressants - nce intraocular siab.
8. GCS thiab agonists - qhov kev txiav txim ntawm cov tshuaj yog nce.
9. Corticosteroids thiab theophylline - anti-inflammatory kev txiav txim ntawm glucocorticoids nce, tsim cardiotoxic los.
10. SCS thiab diuretics, amphotericin B, mineralocorticoid - tsub kom kev pheej hmoo ntawm hypokalemia.
11. GCS thiab indirect anticoagulants, fibrinolytics, butadiene, ibuprofen, ethacrynic acid - tej zaum yuav tsum tau ua raws los ntawm hemorrhagic teeb meem.
12. SCS thiab indomethacin, salicylates - no thaum lawv tseem muaj peev xwm ua rau ulcerative txhab ntawm tus mob huam.
13. Corticosteroids thiab paracetamol - lub toxicity ntawm cov tshuaj yog nce.
14. Corticosteroids thiab azathioprine - tsub kom kev pheej hmoo ntawm cataracts, myopathy.
15. GCS thiab mercaptopurine - thaum lawv tseem yuav ua tau kom muaj zog concentration ntawm uric acid nyob rau hauv cov ntshav.
16. GCS thiab hingamin - amplified pliaj los ntawm cov tshuaj no (corneal opacity, myopathy, dermatitis).
17. GCS thiab methandrostenolone - ua kom nrov loj phiv los ntawm glucocorticoids.
18. Corticosteroids thiab hlau npaj, androgens - nce synthesis ntawm erythropoietin, thiab tawm tsam no tom qab, thiab muaj zog erythropoiesis.
19. GCS thiab hypoglycemic tshuaj - yuav luag tiav yuav txo tau ntawm cov hauj lwm zoo.

xaus

Yuam - tshuaj, tsis muaj uas niaj hnub tshuaj yog tsis zoo li mus raug nqi. Lawv yog siv rau cov kev kho mob ntawm heev heev theem ntawm tus kab mob, los yog tsuas yog yuav txhim khu lub kev txiav txim ntawm ib tug yeeb tshuaj. Txawm li cas los, raws li nrog tag nrho cov tshuaj, glucocorticosteroids mob tshwm sim thiab muaj contraindications thiab. Tsis txhob hnov qab txog nws. Saum toj no peb tau sau tseg tag nrho cov neeg mob qhov twg nws yog tsis tsim nyog los siv steroids thiab muaj kuj muab ib daim ntawv teev txog tus sis ntawm corticosteroids nrog lwm yam tshuaj. lub mechanism ntawm qhov kev txiav txim ntawm corticosteroids thiab tag nrho cov ntawm lawv cov teebmeem tau kuj tau piav nyob rau hauv kom meej no. Tam sim no txhua yam koj yuav tsum paub txog GCS, yog nyob rau hauv ib qhov chaw - qhov no tsab xov xwm. Txawm li cas los, nyob rau hauv txhua rooj plaub, tsis txhob pib kev kho mob tsuas yog tom qab nyeem ntawv cov lus qhia dav dav txog GCS. Cov tshuaj, ntawm chav kawm, yuav tsum tau muas tsis muaj ib tug tshuaj, tab sis yog vim li cas koj xav tau nws? Ua ntej siv cov tshuaj yuav tsum xub sab laj ib tug tshwj xeeb. Noj qab nyob zoo thiab tsis self-medicate!