Глюкокортикоидный синдром Кушинга в практике ревматолога (обзор литературы)
Аннотация
Глюкокортикоиды (ГК) используют для лечения различных воспалительных и аутоиммунных заболеваний благодаря их противовоспалительным и иммунорегуляторным свойствам. Однако ГК могут приводить к развитию многих нежелательных реакций (НР): артериальная гипертония, сахарный диабет, нарушения липидного обмена, апноэ сна, остеопороз, миопатия и нарушения коагуляции и фибринолиза, которые являются компонентами синдрома Иценко – Кушинга (СК). Известно, что НР, индуцированные ГК, зависят от их состава, способа введения, дозы и продолжительности лечения. Однако основные патогенетические механизмы НР четко не определены. Имеются доказательства, указывающие на роль дисбаланса между вазоконстрикцией и вазодилатацией, а также возможную связь с оксидом азота, простаноидами (простагландины, простациклин и тромбоксан), ангиотензином II, вазопрессином, аргинином, эндотелинами, катехоламинами, нейропептидами Y и предсердным натрийуретическим пептидом. Также свой вклад вносят усиление окислительного стресса, активизация системы ренин – ангиотензин, эскалация прессорного ответа, метаболический синдром и апноэ сна. Идеальным могло бы стать прерывание лечения ГК, но чаще всего это невозможно из-за последующего обострения заболевания. Кроме того, необходимо тщательно планировать выбор дозы, времени и способа введения ГК и оценивать каждую НР. Центральное место в исследованиях должна занимать разработка ГК с выраженным противовоспалительным действием и незначительными метаболическими эффектами.
Об авторе
А. М. Сатыбалдыев
ФГБУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой» РАМН, Москва
Россия
Россия
Литература
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Для цитирования:
Сатыбалдыев А.М. Глюкокортикоидный синдром Кушинга в практике ревматолога (обзор литературы). Современная ревматология. 2013;7(4):78-84. https://doi.org/10.14412/1996-7012-2013-2443
For citation:
Satybaldyev A.M. Cushing’s glucocorticoid syndrome in the practice of a rheumatologist (A review of literature). Modern Rheumatology Journal. 2013;7(4):78-84. (In Russ.) https://doi.org/10.14412/1996-7012-2013-2443
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