1、类固醇性糖尿病Steroid diabetes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 概述 流行病学 机制 诊断 治疗History1855 Addisons disease1856 Adrenal glands essential for life1930 Cortex medulla1932 Cushings syndrome1949 Hench et al (Steroids in rheumatoid arthritis)1952 Aldosterone Promote normal intermediary metaboli
2、sm:GluconeogenesisStimulate protein catabolismStimulate lipolysis Increase resistance to stress by:Raising blood glucose levelModest rise in BP Alter blood cell levels in plasma:Decrease in eosinophils, basophils, monocytes and lymphocytes by redistribution from circulation to lymphoid tissueIncreas
3、e in the number of RBC, platelets, neutrophilsActions of Glucocorticoids Anti inflammatory action: (Complex mechanism)Suppression of immunityIndirect inhibition of phospholipase A2 Alter other endocrine systems:Decrease in ACTH and TSHIncrease in GH Effects on other systems:Increased production of g
4、astric acid, pepsinEffects on CNSBone lossMyopathyActionsCont.常用糖皮质激素剂量换算、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 0.8 2 812 836氢化可的松 20mg 1 1.0 2 812中效强的松 5mg 4 3.5 1 1226强的松龙 5mg 4 4.0 1 1236甲基强的松龙 4mg 5 5.0 0 1236去炎松 4mg 5 5.0 0 1236高效倍他米松 0.6mg 25 30.0 0 3654地塞米松 0.75mg 25 30.0
5、0 3654Adverse effectsPsychiatricSleep disturbance/activationMood disturbancePsychosisSkin/soft tissueCushingoid appearanceAbdominal striaeAcneHirsutismOedemaNeurologicNeuropathyPseudomotor cerebriCardiovascularHypertension Occur with prolonged use of high doses Cushings disease MSKOsteoporosisAscept
6、ic necrosis of boneMyopathyEndocrineDiabetes mellitusAdrenal cortex suppressionImmunologicLymphocytopeniaImmunosuppressionFalse-negative skin testOpthalmicCataractNarrow-angle glaucomaDevelopmentalGrowth retardation 糖皮质激素因其多种生物学作用被广泛用于临床多种疾病的短期或长期治疗 “双刃剑”：发挥治疗作用的同时，也不可避免的引起一些副作用，血糖异常便是其中常见的情况之一 了解其发病规律、临床特性及治疗策略对于在临床上合理、安全运用皮质激素，避免或者有效控制高血糖 有 性糖 病(Steroid diabetes) 性 上 皮质 多，或 用糖皮质激素 的 发性糖 病 一种特 的糖 合
